Why do so many urologists disagree or conflict on how to treat uti in patients with spina bifida. i've seen studies who support preventative antibiotics and other studies that goes against preventative antibiotics?

The issue isn't only spina bifida, but any neurological condition that interferes with normal bladder function and often needs chronic catheterization. There isn't really that much disagreement among urologists, or among infectious diseases specialists. Seeming disagreements mostly are the result of the wide differences in the best approach in various patients. Every case is different.

You are correct, prophylactic abx therapy for recurrent lower urinary tract infection is still a controversy matter. I am among the ones who argue against this therapy because the resistant organisms will happen sooner or later. If you have an indwelling catheter or you are doing self-catheterization, episodic antibiotic irrigation may be considered. An ID specialist's input should be considered.

There is no set rigid way to treat any condition. It depends on the pt., kind of infection etc. So the circumstances are different hence the treatment will differ. The studies you have seen are attempts to find general guidelines and a base line common approach- not a rigid routine.