We present an overview of the 2024 updates for the European Association of Urology (EAU)/European Society for Paediatric Urology (ESPU) guidelines on paediatric urology to offer evidence-based standards for perioperative management, minimally invasive surgery (MIS), hydrocele, congenital lower urinary tract obstruction (CLUTO), trauma/emergencies, and fertility preservation.
A broad literature search was performed for each condition. Recommendations were developed and rated as strong or weak on the basis of the quality of the evidence, the benefit/harm ratio, and potential patient preferences.
Recommendations for perioperative management include points related to fasting, premedication, antibiotic prophylaxis, pain control, and thromboprophylaxis in patients requiring general anaesthesia. MIS use is increasing in paediatric urology, with no major differences observed among different MIS approaches. For hydrocele, observation is the initial approach recommended. For persistent cases, treatment varies according to the type of hydrocele. CLUTO cases should be managed in tertiary centres with multidisciplinary expertise in prenatal and postnatal management. Neonatal valve ablation remains the mainstay of treatment, but associated bladder dysfunction requires continuous treatment. Among urological traumas and emergencies, renal trauma is still an important cause of morbidity and mortality. Conservative management has become the standard approach in haemodynamically stable children. Ischaemic priapism is a medical emergency and requires stepwise management. Initial management of nonischaemic priapism is conservative. Fertility preservation in prepubertal children and adolescents has become an increasingly relevant issue owing to the ever-increasing number of cancer survivors receiving gonadotoxic therapies. A major limitation is the scarcity of relevant literature.
This summary of the 2024 EAU/ESPU guidelines provides updated guidance for evidence-based management of some paediatric urological conditions.
We provide a summary of the updated European Association of Urology/European Society for Paediatric Urology guidelines on paediatric urology. There are recommendations on steps to take before and immediately after surgery, management of hydrocele, congenital lower urinary tract obstruction, and urological trauma/emergencies, as well as preservation of fertility. Recommendations are based on a comprehensive review of recent studies.
European urology. 2024 Apr 15 [Epub ahead of print]
Michele Gnech, Allon van Uitert, Uchenna Kennedy, Martin Skott, Alexandra Zachou, Berk Burgu, Marco Castagnetti, Lisette't Hoen, Fardod O'Kelly, Josine Quaedackers, Yazan F Rawashdeh, Mesrur Selcuk Silay, Guy Bogaert, Christian Radmayr
Department of Paediatric Urology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy., Department of Urology, Radboud University Medical Centre, Nijmegen, The Netherlands., Department of Pediatric Urology, University Children's Hospital Zurich, Zurich, Switzerland., Department of Urology, Section of Pediatric Urology, Aarhus University Hospital, Aarhus, Denmark., Department of HIV and Sexual Health, Chelsea & Westminster Hospital, London, UK., Department of Pediatric Urology, Ankara University School of Medicine, Ankara, Turkey., Department of Surgical, Oncological and Gastroenterological Sciences, University of Padova, Padua, Italy; Pediatric Urology Unit, Bambino Gesù Children's Hospital, Rome, Italy. Electronic address: ., Department of Pediatric Urology, Erasmus Medical Center, Rotterdam, The Netherlands., Division of Paediatric Urology, Beacon Hospital and University College Dublin, Dublin, Ireland., Department of Urology and Pediatric Urology, University Medical Center Groningen, Groningen, The Netherlands., Division of Pediatric Urology, Department of Urology, Birurni University, Istanbul, Turkey., Department of Urology, University of Leuven, Leuven, Belgium., Pediatric Urology, Medical University of Innsbruck, Innsbruck, Austria.