LAUSR

OBJECTIVE This appraisal aimed to examine and critique current international clinical practice guidelines (CPGs) on management of pediatric neurogenic lower urinary tract dysfunction (NLUTD) and assess the applicability of these guidelines to clinical practice. MATERIALS AND METHODS We conducted a systematic review of all CPGs on NLUTD published in English from year 2010 to 2022. Six reviewers independently used the AGREE II (Appraisal of Guidelines and Research Evaluation) instrument to appraise all eligible CPGs. This instrument is comprised of 23 items organized into 6 quality domains. The scores for each item and domain were tabulated for each reviewer and interrater reliability was assessed for each domain using intraclass correlation coefficient (ICC). RESULTS Six CPGs were appraised and these included National Institute for Health and Care Excellence (NICE), European Society for Pediatric Urology, International Children's Continence Society, Irish, Spina Bifida Association (SBA) and International Brazilian Journal of Urology guidelines. They had high mean standardized scores in the domain on "scope and purpose" and "clarity of presentation" but had low scores in the domain of "applicability". The top 3 CPGs based on overall score were NICE, Irish and SBA guidelines and the reviewers had high degree of interrater reliability (ICC = 0.912, p < 0.001). The mean scores in various domains for top 3 guidelines were 95.8 (scope and purpose), 87.5 (stakeholder involvement), 69.1 (rigour of development), 94.0 (clarity of presentation), 68.4 (applicability) and 59.7 (editorial independence). The diagnostic and treatment recommendations of the top 3 guidelines were presented. CONCLUSION The existing CPGs on pediatric NLUTD provide high quality evidence based recommendations. NICE, Irish and SBA guidelines were the top 3 CPGs identified. They scored high on most domains except applicability and editorial independence. These domains need to be considered for future updates to improve the utility.