The Fate of Transitional Urology Patients Referred to a Tertiary Transitional Care Center

Abstract

OBJECTIVE To determine the changes in management of children with neurogenic bladder (NGB) or genitourinary congenital anomalies as they moved to our transitional care clinic at the Center for Restorative Pelvic Medicine, a multidisciplinary center led by an adult urologic team dedicated to the long-term care of these patients. MATERIALS AND METHODS We retrospectively reviewed charts of patients with NGB or genitourinary congenital abnormalities referred between 2010 and 2013. Analysis included patient characteristics, causes of NGB, bladder management, recurrent urinary tract infection, stones, renal function, upper tract studies, video urodynamics, and change in management. RESULTS Twenty-four patients with an average age of 22.0 ±2.7 years were included in analysis. Management was altered in 70.8% of patients (n = 17). Surgical management was instituted in 58.3% (n = 14 of 24) of patients and included bladder augmentation or urinary diversion (n = 7), intravesical botulinum toxin A injections (n = 5), cystolitholapaxy, or cystolithotomy (n = 2). Conservative management was changed in 12.5% (n = 3) of patients and included initiating anticholinergic medication (n = 2) or self-catheterization (n = 1). Follow-up was 8.9 ± 12.1 months. CONCLUSION There is an immense need for transitional care of patients with NGB or genitourinary congenital abnormalities as they grow into adulthood. Nearly 71% of our patients had a change in their bladder management with 38% undergoing a major surgery. This study emphasizes the necessity for a dedicated adult urologic team in conjunction with a comprehensive team to care for these complex patients because their urologic care and needs may vary significantly from their childhood.

Clinical outcomes of non‐surgical management of detrusor leak point pressures above 40 cm water in adults with congenital neurogenic bladder

“…Consistent with prior literature, we find that most adult patients with NGB with dLPP/PMDP > 40 are safely managed with non‐surgical therapy, provided there are no contraindications and close follow‐up is ensured . Success was evidenced by preservation of upper urinary tract function and significant decrease in dLPP/PMDP and increase in compliance.…”

“…The concept of maintaining low Pdet and improving bladder compliance for upper urinary tract preservation is well entrenched in the pediatric urologic literature; these findings have since been extrapolated to adult patients with NGB . However, the transition of pediatric patients with congenital NGB to adult urologic care continues to pose challenges for this complex group of patients . Recently work has been undertaken to identify and promote effective transitional care of adolescent patients .…”

“…However, the transition of pediatric patients with congenital NGB to adult urologic care continues to pose challenges for this complex group of patients . Recently work has been undertaken to identify and promote effective transitional care of adolescent patients . Further complicating this transition is the finding that bladder physiology evolves during this time …”

“…Although as children these ACU patients could rely on their parents to help remind them to catheterize and take their anticholinergics, as adults up to 20‐25% live independently or in a group home setting . Additionally, ACU patients suffer from poor health insurance or a lack of local access to qualified specialty care . Together, these factors may combine to compromise non‐operative management of poor bladder compliance in the ACU patient and/or may lead the urologist to reflexively recommend indwelling catheter or urinary diversion.…”

The transition process of spina bifida patients to adult-centred care: An assessment of the Canadian urology landscape

“…5 A recent study conducted by Chan et al exemplifies the importance of routine urological followup into adulthood when studying a group of individuals with congenital urological disorders. 6 After attending a transitional care clinic, 71% of adolescent/adult patients required a change in their bladder management and 38% underwent a major surgery. 6 The objective of this study was to survey Canadian pediatric urologists in order to identify and analyze the current medical practices employed across Canada when transitioning patients with SB from pediatric to adult care, in addition to assessing their attitudes towards this process.…”