Congenital Lower Urinary Tract Obstruction: Update and Summary of the European Association of Urology and European Society for Paediatric Urology Guidelines

Abstract

Background and objective: The literature on congenital lower urinary tract obstruction (CLUTO) is still limited, resulting in a generally low level of evidence. These guidelines aim to provide a practical approach based on a consensus from the European Association of Urology (EAU)/European Society for Paediatric Urology (ESPU) Paediatric Urology Guidelines Panel. The primary aim of this update was to revise and expand the 2024 EAU/ESPU paediatric urology guidelines, focusing on the comprehensive management of CLUTO.

Methods: A structured literature review was performed for all relevant publications published from the last update until March 21, 2023.

Key findings and limitations: Antenatal management should be considered based on ultrasound findings, foetal urine biochemistry, amniotic fluid levels, and chromosomal status. In newborns with a suspected diagnosis of infravesical obstruction, bladder drainage should be performed and antibiotic prophylaxis initiated. Voiding cystography should be conducted as soon as possible in cases where posterior urethral valves (PUVs) are suspected. A serum creatinine nadir of above 0.85 mg/dl is associated with a poor prognosis. Despite optimal treatment, 20% of patients will progress to end-stage renal disease. Lifelong monitoring and management of both bladder and renal function are essential. Neonatal circumcision, as an adjunct to antibiotic prophylaxis in PUV patients, significantly reduces the risk of febrile urinary tract infections during the first 2 yr of life.

Conclusions: This paper is a summary of the updated 2024 EAU/ESPU guidelines, and it provides practical considerations for patients with CLUTO.

Patient summary: In this summary and update of the European Association of Urology/European Society for Paediatric Urology guidelines, we provide practical considerations for the management of children with congenital lower urinary tract obstruction.

Keywords: Congenital lower urinary tract obstruction; Hydronephrosis; Hydroureteronephrosis; Megacystis; Posterior urethral valves; Urinary tract dilation.