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

Michele Gnech; Lisette ’t Hoen; Christian Radmayr; Berk Burgu; Guy Bogaert; Fardod O'Kelly; Marco Castagnetti; Josine Quaedackers; Mesrur Selcuk Silay; Uchenna Kennedy; Allon van Uitert; Martin Skott; Niklas Pakkasjärvi; Anna Bujons; Yuhong Yuan; Yazan F. Rawashdeh

doi:10.1016/j.euf.2025.01.012

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

Michele Gnech^*, Lisette ’t Hoen, Christian Radmayr, Berk Burgu, Guy Bogaert, Fardod O'Kelly, Marco Castagnetti, Josine Quaedackers, Mesrur Selcuk Silay, Uchenna Kennedy, Allon van Uitert, Martin Skott, Niklas Pakkasjärvi, Anna Bujons, Yuhong Yuan, Yazan F. Rawashdeh

^*Corresponding author for this work

Department of Clinical Medicine - Department of Urology

Research output: Contribution to journal/Conference contribution in journal/Contribution to newspaper › Journal article › Research › peer-review

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.

Original language	English
Journal	European Urology Focus
ISSN	2405-4569
DOIs	https://doi.org/10.1016/j.euf.2025.01.012
Publication status	E-pub / Early view - Feb 2025

Keywords

Congenital lower urinary tract obstruction
Hydronephrosis
Hydroureteronephrosis
Megacystis
Posterior urethral valves
Urinary tract dilation

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10.1016/j.euf.2025.01.012

Cite this

Gnech, M., ’t Hoen, L., Radmayr, C., Burgu, B., Bogaert, G., O'Kelly, F., Castagnetti, M., Quaedackers, J., Silay, M. S., Kennedy, U., van Uitert, A., Skott, M., Pakkasjärvi, N., Bujons, A., Yuan, Y., & Rawashdeh, Y. F. (2025). Congenital Lower Urinary Tract Obstruction: Update and Summary of the European Association of Urology and European Society for Paediatric Urology Guidelines. European Urology Focus. Advance online publication. https://doi.org/10.1016/j.euf.2025.01.012

@article{4736907b723b4d44ba4a8234f2ebf7bf,

title = "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",

author = "Michele Gnech and {{\textquoteright}t Hoen}, Lisette and Christian Radmayr and Berk Burgu and Guy Bogaert and Fardod O'Kelly and Marco Castagnetti and Josine Quaedackers and Silay, {Mesrur Selcuk} and Uchenna Kennedy and {van Uitert}, Allon and Martin Skott and Niklas Pakkasj{\"a}rvi and Anna Bujons and Yuhong Yuan and Rawashdeh, {Yazan F.}",

note = "Publisher Copyright: {\textcopyright} 2025 European Association of Urology",

year = "2025",

month = feb,

doi = "10.1016/j.euf.2025.01.012",

language = "English",

journal = "European Urology Focus",

issn = "2405-4569",

publisher = "Elsevier B.V.",

}

Gnech, M, ’t Hoen, L, Radmayr, C, Burgu, B, Bogaert, G, O'Kelly, F, Castagnetti, M, Quaedackers, J, Silay, MS, Kennedy, U, van Uitert, A, Skott, M, Pakkasjärvi, N, Bujons, A, Yuan, Y & Rawashdeh, YF 2025, 'Congenital Lower Urinary Tract Obstruction: Update and Summary of the European Association of Urology and European Society for Paediatric Urology Guidelines', European Urology Focus. https://doi.org/10.1016/j.euf.2025.01.012

Congenital Lower Urinary Tract Obstruction: Update and Summary of the European Association of Urology and European Society for Paediatric Urology Guidelines. / Gnech, Michele; ’t Hoen, Lisette; Radmayr, Christian et al.
In: European Urology Focus, 02.2025.

Research output: Contribution to journal/Conference contribution in journal/Contribution to newspaper › Journal article › Research › peer-review

TY - JOUR

T1 - Congenital Lower Urinary Tract Obstruction

T2 - Update and Summary of the European Association of Urology and European Society for Paediatric Urology Guidelines

AU - Gnech, Michele

AU - ’t Hoen, Lisette

AU - Radmayr, Christian

AU - Burgu, Berk

AU - Bogaert, Guy

AU - O'Kelly, Fardod

AU - Castagnetti, Marco

AU - Quaedackers, Josine

AU - Silay, Mesrur Selcuk

AU - Kennedy, Uchenna

AU - van Uitert, Allon

AU - Skott, Martin

AU - Pakkasjärvi, Niklas

AU - Bujons, Anna

AU - Yuan, Yuhong

AU - Rawashdeh, Yazan F.

PY - 2025/2

Y1 - 2025/2

N2 - 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.

AB - 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.

KW - Congenital lower urinary tract obstruction

KW - Hydronephrosis

KW - Hydroureteronephrosis

KW - Megacystis

KW - Posterior urethral valves

KW - Urinary tract dilation

UR - http://www.scopus.com/inward/record.url?scp=85216945466&partnerID=8YFLogxK

U2 - 10.1016/j.euf.2025.01.012

DO - 10.1016/j.euf.2025.01.012

M3 - Journal article

C2 - 39909817

AN - SCOPUS:85216945466

SN - 2405-4569

JO - European Urology Focus

JF - European Urology Focus

ER -

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

Abstract

Keywords

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