Routh et al. describe a prospective trial which aims to determine the optimal urological management for children with spina bifida. The primary aim of neuropathic bladder management is to provide the patient with the best long-term quality of life with preservation of normal renal function. It is well known that the care of children with spina bifida has greatly advanced over the last 50 years; however, the optimal childhood management of these patients remains unknown. Existing guidelines e.g. NICE 2012 and EAU 2011 on the management of the neuropathic bladder are not specific to children. The Centres for Disease Control and Prevention convened a working group in 2012 to develop a protocol to optimise the urological care of children from birth through to five years of age. An iterative quality improvement protocol has been selected and will be modified (if required) during the time of the study. Primary outcomes will include urinary tract infections, renal scarring, renal function and bladder characteristics. Nine spina bifida centres around the United States are involved in this collaborative project and patient accrual began in 2015.
The publication nicely outlines the recruitment and follow-up protocol and provides information on catheterisation / clean intermittent catheterisation, anti-muscarinic medications and prophylactic antibiotics. The authors also summarise planned investigations (and their timings) such as urodynamics, ultrasound and determination of GFR / renal scarring. Although there is no control group, I shall look forward to the results in due course and already plan to utilise some of the study schema in adapting the management guideline at our institution.