Manchester Metropolitan University, Manchester, United Kingdom.
University of Bristol, Bristol, United Kingdom.
Neurourol Urodyn. 2018 Sep;37(7):2273-2280. doi: 10.1002/nau.23581. Epub 2018 Apr 17.
Healthcare guidelines are an important vehicle in establishing up-to-date evidence based medicine (EBM) in clinical practice. Due to varying development processes, clinical guidelines created by different institutions can often contain contrasting recommendations. This can have implications for optimal and standardized patient care across management settings.
The similarities and differences of treatment recommendations made in the National Institute for Health and Care Excellence (NICE), The European Association of Urology (EAU), and the International Consultation on Continence (ICI) guidelines for neurogenic lower urinary tract dysfunction (NLUTD) were assessed.
The guidelines generally agree on their approach to conservative management, including behavioral therapies, and catheterization techniques. There was discrepancy on the benefit of using an alpha blocker in NLUTD and bladder outlet obstruction (BOO) and administering Botulinum toxin A (Onabotulinum-A) in NLUTD. The highest degree of divergence was seen in recommendations for surgical treatments, where the EAU made gender-specific recommendations, and gave continent urinary diversion higher preference than given in the NICE and ICI guidelines.
In the absence of high-quality clinical evidence, many of the recommendations made across all three guidelines are based on expert opinion. NICE, the EAU and ICI have similarities but they place differing emphasis on costs and expert opinion, which translated in notably different recommendations. It is evident that increased research efforts, possibly in the form of prospective registries, pragmatic trials, and resource utilization studies are necessary to improve the underlying evidence base for NLUTD, and subsequently the strength and concordance of recommendations across guidelines.
医疗保健指南是在临床实践中建立最新循证医学（EBM）的重要手段。由于开发过程的不同，不同机构制定的临床指南常常包含相互矛盾的建议。这可能会对管理环境下的最佳和标准化患者护理产生影响。
评估了国家卫生与保健卓越研究所（NICE）、欧洲泌尿外科学会（EAU）和国际尿控协会（ICI）神经原性下尿路功能障碍（NLUTD）指南中治疗建议的相似之处和差异。
这些指南在保守治疗方法上基本一致，包括行为疗法和导尿技术。在 NLUTD 和膀胱出口梗阻（BOO）中使用α受体阻滞剂的益处以及在 NLUTD 中使用肉毒毒素 A（Onabotulinum-A）的问题上存在分歧。在手术治疗建议方面存在最大程度的分歧，EAU 提出了性别特异性建议，并比 NICE 和 ICI 指南更倾向于使用 continent urinary diversion。
在缺乏高质量临床证据的情况下，这三个指南中的许多建议都是基于专家意见。NICE、EAU 和 ICI 有相似之处，但它们对成本和专家意见的重视程度不同，这导致了明显不同的建议。显然，需要加大研究力度，可能采取前瞻性登记、实用试验和资源利用研究的形式，以改善 NLUTD 的基础证据，并随后提高指南中建议的强度和一致性。
