Clinical Guideline for the management of Neurogenic Bladder in population under 18 years of age. Part 1: Diagnosis and Follow-up

Abstract

Neurogenic bladder is a condition with risk of renal damage. Its diagnosis and timely management improve the renal prognosis of pediatric patients. As an initiative of the Colombian Association of Pediatric Nephrology (ACONEPE), and in collaboration with specialists in pediatric urology, pediatric surgery, pediatric nephrology, and pelvic floor physiotherapists in Latin America, we designed a clinical practice guideline for the diagnosis, treatment, and follow-up of patients under 18 years of age with neurogenic bladder.

Objective: To create guidelines to unify the clinical practice of professionals for the care of patients with neurogenic bladder, in order to reduce the associated complications and progression to chronic kidney disease

Material and Method: The guidelines available in the literature with a score higher than 60% in the domains of methodological rigor and editorial independence according to the AGREE II (Appraisal of Guidelines for Research and Evaluation II) tool were analyzed. For questions that merited additional information, supplementary searches were performed. The recommendations were graded using the GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) system. For the recommendations extracted from other guidelines, the grading of the original developer group was maintained. An expert consensus was reached, with a threshold of 80% agreement which was used to define the final recommendations.

Results: The initial search yielded 75 documents, of which 8 clinical practice guidelines published between 2012 and 2020 were included in the initial analysis. Two documents did not meet the domain of methodological rigor, and one did not meet the editorial independence criteria. In the end, 5 guidelines were included.

Conclusion: Recommendations were generated to unify the clinical practice of healthcare professionals involved in the care of patients with neurogenic bladder. These recommendations are applicable in all Latin American countries. This first part presents the diagnostic and follow-up recommendations.