The summary of this paper states that a “consensus statement is not a guideline nor a method with which to establish what is best practice. It is a way of surveying practice and providing a benchmark for others to compare their own practice and be reassured where there is a paucity of clinical evidence.” It is with this statement in mind that the British Association of Paediatric Urologists (BAPU) has over recent years undergone a series of consensus debates at its annual meeting in September, and come up with a number of consensus statements as a result. This is one of them. The article is a good summary of the dilemmas and some of the questions raised when treating children with a neuropathic bladder. The summary is as follows:

  1. Urodynamics tend to be reserved for children with a clinical indication. Yearly ultrasound scan (USS) should be performed on all.
  2. Clean intermittent catheterisation (CIC) is used either in all patients or only when there was evidence of poor bladder emptying, split 50:50 between practitioners.
  3. Prophylactic antibiotics when using CIC is not usual.
  4. Anticholinergics are not used routinely but when used, oxybutynin is the first-line treatment.
  5. Botulinum toxin A is used by many despite the paucity of paediatric literature evidence. The dose is weight related and often more than six treatments have been given.
  6. Ileocystoplasty is the most commonly offered surgical solution and is likely to remain so for the foreseeable future.
  7. Post augmentation cystoscopy surveillance begins about 10 years post surgery.
  8. DMSA scans are only performed if there is a clinical or radiological indication. 
British Association of Paediatric Urologists consensus statement on the management of the neuropathic bladder.
Lee B, Featherstone N, Nagappan P, et al.
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Henrik Steinbrecher

Southampton University Hospital NHS Trust

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