Needs of children with a chronic bladder in preparation for transfer to adult care

Transitional Care for Patients with Congenital Colorectal Diseases: An EUPSA Network Office, ERNICA, and eUROGEN Joint Venture

BACKGROUND

Transition of care (TOC; from childhood into adulthood) of patients with anorectal malformations (ARM) and Hirschsprung disease (HD) ensures continuation of care for these patients. The aim of this international study was to assess the current status of TOC and adult care (AC) programs for patients with ARM and HD.

METHODS

A survey was developed by members of EUPSA, ERN eUROGEN, and ERNICA, including patient representatives (ePAGs), comprising of four domains: general information, general questions about transition to adulthood, and disease-specific questions regarding TOC and AC programs. Recruitment of centres was done by the ERNs and EUPSA, using mailing lists and social media accounts. Only descriptive statistics were reported.

RESULTS

In total, 82 centres from 21 different countries entered the survey. Approximately half of them were ERN network members. Seventy-two centres (87.8%) had a self-reported area of expertise for both ARM and HD. Specific TOC programs were installed in 44% of the centres and AC programs in 31% of these centres. When comparing centres, wide variation was observed in the content of the programs.

CONCLUSION

Despite the awareness of the importance of TOC and AC programs, these programs were installed in less than 50% of the participating centres. Various transition and AC programs were applied, with considerable heterogeneity in implementation, content and responsible caregivers involved. Sharing best practice examples and taking into account local and National Health Care Programs might lead to a better continuation of care in the future.

LEVEL OF EVIDENCE

III.

Co-designed healthcare transition interventions for adolescents and young adults with chronic conditions: a scoping review

PURPOSE

To determine the scope of published literature on healthcare transition (HCT) interventions that have been co-designed with adolescents and young adults with chronic conditions, and to undertake feasibility assessments.

METHODS

Using Scopus, CINAHL, Medline-Ovid, Cochrane and PsycINFO databases, publications that included a HCT intervention to support paediatric to adult healthcare transition were included. Study location, design, population, description of the intervention, co-design methods, feasibility evidenced using Bowen and colleagues' framework, and outcome measures were extracted for review.

RESULTS

A total of 21 studies were included, relating to 17 co-designed HCT interventions that ranged across multiple medical specialties. There was no standard HCT intervention; characteristics, format and delivery mode varied. Only three studies reported a detailed description of the co-design method(s) used and none reported on the facilitators or barriers. Among the studies, five of Bowen and colleagues' eight dimensions of feasibility were measured.

CONCLUSIONS

Despite the co-design process being neither described or evaluated extensively, all co-designed HCT interventions included in this review were considered to be feasible. Nevertheless, HCT interventions varied in their format and delivery method making it difficult to compare between them. Furthermore, interventions were often condition-specific and not representative of the extensive range of chronic conditions.Implications for RehabilitationHealthcare transition interventions can improve adherence to care, health outcomes, ongoing rehabilitation, and quality of life of adolescents and young adults with chronic conditions.Healthcare transition interventions should maximise long-term functioning and prioritise rehabilitation aimed at enhancing independence and self-management skills, while reducing hospitalisations.The engagement of individuals with lived experience in the co-design of interventions has been strongly advocated as it brings unique knowledge and experience to the research process.Minimal attention has been given to the involvement of adolescents and young adults with chronic conditions in the development of healthcare transition interventions, however, healthcare transition interventions co-designed with adolescents and young adults with chronic conditions are both feasible and acceptable.

Scoping review of neurogenic bladder patient-reported readiness and experience following care in a transitional urology clinic

OBJECTIVE

To generate a scoping review that summarizes thematically on all reported patient perceptions on readiness and experiences during transitional urologic care for patients with neurogenic bladder and or congenital genitourinary conditions that require continuity of care into adulthood.

METHODS

A systematic literature search was performed in October 2021. Records were screened and identified for studies relevant to reported readiness and experience in urologic transitional care among patients needing life-long urologic care. The methodological quality of the cross-sectional studies was assessed using AXIS. The included studies were clustered according to patient readiness in transition and patient experience-satisfaction in the urologic transition process. This scoping review was part of a systematic review registered on PROSPERO CRD42022306229 and was conducted in compliance with the PRISMA extension for scoping reviews.

RESULTS

A total of 12 articles were included that assessed patients with neurogenic bladder that reported either readiness or patient experience following the transitional care process. The patient readiness was assessed in six studies, determined using the TRAQ score with a range of 3-4/5. Older age, high health literacy, and parental or families' transition process awareness were associated with readiness. Generally, patients experience better satisfaction with pediatric care than with adult care facilities. Most patients felt that sexuality and fertility were not adequately tackled during the transition. The reported barriers to successful transition were patient, provider, and system factors, including lack of insurance coverage/financial management, patient preference, long-term bond with the pediatric providers, and communication by the adult provider. Based on AXIS, all of the studies identified for this scoping review did not determine the sample size, and most of the studies did not categorize the responders, which could introduce bias to the interpretation of their results.

CONCLUSION

This scoping review summarizes the readiness and experience of neurogenic bladder patients who underwent the urologic transitional process. Overall, understanding the patient, provider, and system factors associated with better readiness and enhancing the patient experience will ensure a better transition process.

Barriers in transitioning urologic patients from pediatric to adult care

As the advances in medicine continue to emerge, more children with congenital or pediatric-onset chronic urologic conditions are surviving well into adulthood. This imposes an ever rising there is a need for adequate transition of these patients from pediatric to adult care. Despite position statements from multiple heath care organizations and several models proposed in literature, different issues and gaps in urologic transition continue to exist. Major barriers in this transition are adolescence, a challenging time that is characterized by impulsive behavior and risk taking, and the longstanding relation between both patients and paediatric providers. Both pediatric and adult care providers need to be aware of the special needs of maturing youth with chronic care problems related to education, self-management, legal issues and psychological support during care transition. Furthermore, they need to understand and address the currently existing obstacles for adequate transition. There is need for active communication with each other and the patient to develop sustainable relationships that can support the transitioning process. It is therefore in the greatest interest of the care provider to make this transition as smooth as possible. This paper aims to point out the currently perceived barriers in care transition within the urological context, reflect on previous implemented models for care transition and present proposals for improvement.

The need for specialized training for adults with congenital urologic conditions: differences in opinion among specialties

Introduction

The aim of this study was to survey pediatric urology fellowship directors (PFD) and adult reconstruction fellowship directors (AFD) to assess who they believe has sufficient training to care for adults with congenital urologic conditions (ACUC).

Material and methods

An online survey was created to assess attitudes towards specific training to care for ACUC. The survey was administered to 27 PFD and 26 AFD [16 from genitourinary reconstructive surgery (GURS) and 10 from female pelvic medicine and reconstructive surgery (FPMRS)]. Both groups were asked if specific training is warranted, and if general urologists, pediatric urologists or adult reconstructive urologists were sufficiently trained to care for ACUC.

Results

A total of 26 (96%) PFD and 10 (39%) AFD completed the survey. All PFD were fellowship trained in pediatrics. Of the AFD, 5 were GURS trained, 4 were FPMRS trained and 1 was not fellowship trained. The majority (65% PFD, 90% AFD) believed specific training is warranted. Few believed general urologists have sufficient training (8% PFD, 20% AFD). Most PFD believed pediatric urologists have sufficient training (85%), but a minority believed those with adult reconstructive training do (40%). Conversely, a minority of AFD believed that pediatric urologists have sufficient training (40%), while those with adult reconstructive training do (FPMRS: 67%, GURS: 60%).

Conclusions

Both pediatric and adult reconstructive urologists believe specific training to care for adults with congenital urologic conditions is warranted. Neither group considers the other to be ideally suited to care for this complex patient group. This suggests both groups may have something to learn from each other.

Transitional Urology

The field of transitional urology has taken on an increasing importance in recent years as more individuals with congenital urologic issues are living and thriving into adulthood. This article reviews the transitional process itself including barriers to successful transition and the consequences of failing to properly transition. Also provided is a broad overview of the urologic issues faced by patients who may benefit from lifelong care and the providers who will be helping them with transition and assuming their care.

Spina bifida

N/A

5 years after introduction of a transition protocol: An evaluation of transition care for patients with chronic bladder conditions

INTRODUCTION

In recent years, more attention has been given to the transition of adolescents in urological care. In 2010, the current team investigated the needs of children with chronic bladder conditions, in preparation for transfer to adult care. A transition protocol was developed and implemented. The current study evaluated current transition care, in order to further improve the transition process.

OBJECTIVE

To give insight into the current transition care of adolescents with chronic bladder conditions since the introduction of a transition protocol in 2011.

STUDY DESIGN

A total of 124 patients with chronic bladder conditions, born 1980-2003, received a questionnaire. The study population was divided in a pre-transfer (n = 97) and post-transfer group (n = 27). The questionnaire was based on that used for a national study and was supplemented with specific urological questions. The questions for the pre-transfer patients investigated their level of independence, what subjects were discussed with the healthcare professionals, and their expectations and wishes regarding transfer to adult urology care. The post-transfer group was asked for their opinions about their transfer process.

RESULTS

A total of 61% (n = 76/124) responded (pre-transfer 61/97 patients and post-transfer 1527 patients). Their knowledge about their condition and related issues was generally good. The subjects 'future', 'relationships', 'sexuality' and 'fertility' were discussed more with the nurse practitioner than with the pediatric urologist in comparison with 2010. The last three subjects were only discussed with one third of the adolescents (Summary table). The bond with the pediatric urologist was the most common reason to continue care at the Pediatric Urology department. Adolescents aged >18 years were better prepared for transfer to adult urology than in 2010. The majority of the post-transfer patients were transferred because of being aged >17 years. Most patients in the post-transfer group were pleased with the current transition process.

DISCUSSION

The results showed that changes occurred after implementation of the personal patient transition protocol. The mean age of the pre-transfer group was younger compared to 2010; this influenced some of the results. Therefore, they were divided into two age groups, for more reliable outcomes. More attention to subjects like relationships and sexuality could further improve the satisfaction of adolescents in transition.

CONCLUSION

The older adolescents seemed better prepared for their transfer from pediatric to adult urology than in 2010. The majority was satisfied with the current transition protocol. Tailor-made transition care seemed to be the best option.

Transition of care in patients with anorectal malformations: Consensus by the ARM-net consortium

OBJECTIVES

To develop the first consensus to standardize the management of patients with Anorectal Malformations (ARMs) transitioning from childhood to adulthood.

METHODS

A dedicated task force of experts performed an extensive literature review and multiple meetings to define the most important aspects of transition of care. The findings were discussed with all ARM-net consortium members and a set of practical recommendations agreed upon at the annual meeting in 2016.

RESULT

We defined seven domains that are essential to provide an effective and practical transition process. Within each domain we have developed a set of key recommendations that are important to be considered for ARM patients entering the age of transition.

CONCLUSIONS

It is crucial that transition begins at an early age with regular and well-structured follow-up. Cooperation with a selected multidisciplinary team of pediatric and adult practitioners is required to prepare patients and families for effective transition to adult care and to reduce long term morbidity.

TYPE OF STUDY

Review/Consensus paper.

LEVEL OF EVIDENCE

III.

Factors influencing the transition from pediatric to adult care: A scoping review of the literature to conceptualize a relevant education program

OBJECTIVE

To give a comprehensive overview of the factors that influence the transition from pediatric services to adult care, and to conceptualize a relevant education program.

METHOD

An evaluation grid was used to analyze the literature and classify factors depending on whether they were related to the patients, to the health care organization, to health care personnel, to the interaction between medical staff and patient, or to the illness and its treatment.

RESULTS

We based our analysis on a selection of 20 publications. The following factors were identified and classified in an integrative framework: self-management skills, trust in adult care, the feeling of self-efficacy, social support, the patient's gender and social position, the trust between child carers and adult carers, interdisciplinary cooperation, and the medical staff's consideration of the patient's projects.

CONCLUSIONS AND PRACTICE IMPLICATIONS

The current analysis makes it possible to formulate educational aims and to design a way of integrating them to a transition plan. However, the collected studies mainly focus on knowledge of the illness, on treatment, and on the health care system. Psychosocial dimensions at play at the time of the transition - such as identity development - are not sufficiently explored in the research.

Adolescence transitional care in neurogenic detrusor overactivity and the use of OnabotulinumtoxinA: A clinical algorithm from an Italian consensus statement

AIMS

OnabotulinumtoxinA (onaBNTa) for treating neurogenic detrusor overactivity (NDO) is widely used after its regulatory approval in adults. Although the administration of onaBNTa is still considered off-label in children, data have already been reported on its efficacy and safety. Nowadays, there is a lack of standardized protocols for treatment of NDO with onaBNTa in adolescent patients in their transition from the childhood to the adult age. With the aim to address this issue a consensus panel was obtained.

METHODS

A panel of leading urologists and urogynaecologists skilled in functional urology, neuro-urology, urogynaecology, and pediatric urology participated in a consensus-forming project using a Delphi method to reach national consensus on NDO-onaBNTa treatment in adolescence transitional care.

RESULTS

In total, 11 experts participated. All panelists participated in the four phases of the consensus process. Consensus was reached if ≥70% of the experts agreed on recommendations. To facilitate a common understanding among all experts, a face-to-face consensus meeting was held in Rome in march 2015 and then with a follow-up teleconference in march 2017. By the end of the Delphi process, formal consensus was achieved for 100% of the items and an algorithm was then developed.

CONCLUSIONS

This manuscript represents the first report on the onaBNTa in adolescents. Young adults should be treated as a distinct sub-population in policy, planning, programming, and research, as strongly sustained by national public health care. This consensus and the algorithm could support multidisciplinary communication, reduce the extent of variations in clinical practice and optimize clinical decision making.

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

INTRODUCTION

Due to medical advances over the past three decades, the vast majority of children with spina bifida (SB) now survive into adulthood. As a result, there is a need to implement a well-defined urological transition process for these patients from the pediatric to adult environment. The objective of this study was to identify and analyze the current medical practices employed and the attitudes regarding transition by Canadian pediatric urologists caring for the SB population.

METHODS

A survey consisting of 14 questions pertaining to physician demographics, current practice, and attitudes towards the transition process of SB patients was distributed at the 2015 annual Pediatric Urologists of Canada (PUC) conference. The survey respondents remained anonymous, and the data were collected and analyzed.

RESULTS

A total of 28 surveys were collected from urologists across Canada (25 full-time pediatric, three also providing adult care), representing a >75% response rate. The transition process was suggested to begin at the age of 18 or older by 43% (12/28) of pediatric urologists. The majority, 86% (24/28), do not currently use a questionnaire or a checklist to determine transition readiness of patients. Forty-six percent (13/28) of pediatric urologists do not provide ongoing urological care to their patients after referral has been made to adult-centred care. In the province of Ontario, in which 39% (11/28) of the pediatric urologists practice, 82% (9/11) are full-time pediatric urologists and 78% (7/9) do not provide ongoing care to SB patients after the age of 18.

CONCLUSIONS

A significant minority of Canadian pediatric urologists perceive that the transition process should begin at the age of 18 or older. As such, it can be inferred that transfer of care and transition are synonymous, not independent. Simplistically, this suggests that transition represents an event rather than a longitudinal process. The fact there is no defined ongoing urological care as a component of this process, suggests the potential for substandard quality of care after these patients graduate to the adult sector. Different provincial healthcare systems and funding plans may further hinder this transition of care by denying provider continuity based on reimbursement plans.

The transition of young adults with lifelong urological needs from pediatric to adult services: An international children's continence society position statement

INTRODUCTION

Children with urinary tract disorders managed by teams, or individual pediatricians, urologists, nephrologists, gastroenterologists, neurologists, psychologists, and nurses at some point move from child-centered to adult-centered health systems. The actual physical change is referred to as the transfer whilst the process preceding this move constitutes transition of care. Our aims are twofold: to identify management and health-service problems related to children with congenital or acquired urological conditions who advance into adulthood and the clinical implications this has for long-term health and specialist care; and, to understand the issues facing both pediatric and adult-care clinicians and to develop a systems-approach model that meets the needs of young adults, their families and the clinicians working within adult services.

METHODS

Information was gleaned from presentations at an International Children's Continence Society meeting with collaboration from the International Continence Society, that discussed problems of transfer and transitioning such children. Several specialists attending this conference finalized this document identifying issues and highlighting ways to ease this transition and transfer of care for both patients and practitioners.

RESULTS

The consensus was, urological patients with congenital or other lifelong care needs, are now entering adulthood in larger numbers than previously, necessitating new planning processes for tailored transfer of management. Adult teams must become familiar with new clinical problems in multiple organ systems and anticipate issues provoked by adolescence and physical growth. During this period of transitional care the clinician or team assists young patients to build attitudes, skills and understanding of processes needed to maximize function of their urinary tract-thus taking responsibility for their own healthcare needs. Preparation must also address, negotiating adult health care systems, psychosocial, educational or vocational issues, and mental wellbeing.

CONCLUSIONS

Transitioning and transfer of children with major congenital anomalies to clinicians potentially unfamiliar with their conditions requires improved education both for receiving doctors and children's families. Early initiation of the transition process should allow the transference to take place at appropriate times based on the child's development, and environmental and financial factors. Neurourol. Urodynam. 36:811-819, 2017. © 2016 Wiley Periodicals, Inc.

Transitioning adolescent and young adults with chronic disease and/or disabilities from paediatric to adult care services - an integrative review

AIMS AND OBJECTIVES

This paper aims to provide an updated comprehensive review of the research-based evidence related to the transitions of care process for adolescents and young adults with chronic illness/disabilities since 2010.

BACKGROUND

Transitioning adolescent and young adults with chronic disease and/or disabilities to adult care services is a complex process, which requires coordination and continuity of health care. The quality of the transition process not only impacts on special health care needs of the patients, but also their psychosocial development. Inconsistent evidence was found regarding the process of transitioning adolescent and young adults.

DESIGN

An integrative review was conducted using a five-stage process: problem identification, literature search, data evaluation, data analysis and presentation.

METHODS

A search was carried out using the EBSCOhost, Embase, MEDLINE, PsycINFO, and AustHealth, from 2010 to 31 October 2014. The key search terms were (adolescent or young adult) AND (chronic disease or long-term illness/conditions or disability) AND (transition to adult care or continuity of patient care or transfer or transition).

RESULTS

A total of 5719 records were initially identified. After applying the inclusion criteria a final 61 studies were included. Six main categories derived from the data synthesis process are Timing of transition; Perceptions of the transition; Preparation for the transition; Patients' outcomes post-transition; Barriers to the transition; and Facilitating factors to the transition. A further 15 subcategories also surfaced.

CONCLUSIONS

In the last five years, there has been improvement in health outcomes of adolescent and young adults post-transition by applying a structured multidisciplinary transition programme, especially for patients with cystic fibrosis and diabetes. However, overall patients' outcomes after being transited to adult health care services, if recorded, have remained poor both physically and psychosocially. An accurate tracking mechanism needs to be established by stakeholders as a formal channel to monitor patients' outcomes post- transition.

Reference values for frequency volume chart and uroflowmetry parameters in adolescent and adult enuresis patients

AIMS

Reference values of Frequency Volume Chart (FVC) and uroflowmetry parameters for adolescent and adult enuresis patients are lacking. In this study, we aim to describe those parameters, in order to interpret findings from FVCs and uroflowmetries in those patients.

METHODS

Retrospective, descriptive cohort study, concerning 907 patients aged 11 years and older, suffering from enuresis of at least one wet night per fortnight, treated in a secondary/tertiary centre, between 2003 and 2013. The main FVC parameters of interest were: maximum voided volume (MVV), 24 hr urine production and nocturnal urine volume (NUV) including first morning void (FMV). Nocturnal polyuria (NP) was defined based on both International Children's Continence Society (ICCS, 2014) and International Continence Society (ICS, 2002) definitions. Data of all patients were collected from the medical files.

RESULTS

Age had an impact on diurnal and nocturnal FVC parameters. Median MVV excluding FMV was 250 ml in the youngest, 11-year-old males and 363 ml in the eldest, ≥18-yr-old males. For females, these values were 230 ml and 310 ml. Median 24 hr urine production increased from 1,025 ml to 1,502 ml (males) and from 1,007 ml to 1,557 ml (females). Median NUV showed an increase from 387 ml to 519 ml (males) and from 393 ml to 525 (females). Forty-two percent of men and 30% of women had a small MVV (for age). Prevalence of NP differed when assessed by the ICS or the ICCS definition: following ICS guidelines, NP was present in 96% of our male and 93% of our female population, compared to 27% and 41%, respectively, following ICCS guidelines.

CONCLUSIONS

Both small MVV and NP were found frequently in our adolescent and adult enuresis patients, which is in line with the current thoughts on causal factors. NP prevalence is quite different when using ICS or ICCS definitions, respectively. We would like to encourage the development of an unambiguous definition of NP to use both in pediatric and adult urology. Neurourol. Urodynam. 36:463-468, 2017. © 2016 Wiley Periodicals, Inc.

Passing the baton: The pediatric surgical perspective on transition

BACKGROUND/PURPOSE

Transition of care from pediatric to adult providers is garnering intense national interest in pediatrics but is largely driven by nonsurgeons. We sought to describe the preferences of pediatric surgeons and their current transition practice patterns for various populations and wondered whether gender, experience, or practice setting affected surgeons' perspectives.

METHODS

All American Pediatric Surgical Association (APSA) members were surveyed electronically. Responses were voluntary and confidential.

RESULTS

Survey response rate was 22%. Most surgeons (95%) treated patients up to 22 years of age, and many cared for older patients (23-26 years, 49%; 27-30 years, 25%; 31-40 years, 18%; >40 years, 13%). Developmentally delayed adults comprised a significant portion of this population (54%). Congenital conditions such as Hirschsprung disease (25%), anorectal malformations (22%) and cystic fibrosis (22%) were most commonly reported. About half (52%) of respondents reported institutional limits for age. Lack of qualified adult surgeons was felt to be the greatest barrier to transition (p<0.001). Experience, gender and practice type did not significantly affect opinions of transition.

CONCLUSIONS

Pediatric surgeons care for adult patients with a variety of surgical conditions, particularly those with developmental delay and congenital anomalies. The perception of a deficit of qualified adult providers warrants further exploration. Understanding the barriers to surgical transition represents a critical step in improving the quality and appropriateness of care transitions.

Transitional care in pediatric urology

The transition from childhood to adolescence and into adulthood occurs as a natural component of human development. As children progress through school and gain independence, health care practitioners must facilitate a parallel transition from pediatric to adult providers. Modern medicine has succeeded in extending the life expectancy for many children with complex conditions, and adult providers are participating in their medical care through adulthood. Transitioning pediatric urology care to adult urology care is unique to every individual and his or her underlying condition, while the transition process is universal. The objectives of all pediatric urologists include preservation of the kidneys and lower urinary tracts, safe urine storage, safe urine drainage, urinary continence, fertility, sexual function, and genital cosmesis. For some children, these objectives can be attained during childhood, while other children require lifelong maintenance and management. Children with posterior urethral valves, exstrophy-epispadias complex, cloaca, vesicoureteral reflux, neurogenic bladder, disorders of sex development, cancer, hypospadias, nephrolithiasis, undescended testes, varicoceles, ureteropelvic junction obstruction, solitary kidney, and upper tract anomalies all require long-term evaluation and management. The obstacles of altering a patient and caregiver paradigm, locating adult urologists with special expertise, coordinating care with other adult specialties such as nephrology, and navigating the adult health care environment can impede the transition process.

Assessment of the introduction of an adolescent transition urology clinic using a validated questionnaire

BACKGROUND

Adolescents with complex urological conditions are at risk of bladder dysfunction, metabolic disturbances, neoplastic changes and deterioration in renal function. Hence they require appropriate transition to the adult service to ensure lifelong urological care is adequately provided.

OBJECTIVE

Barriers and difficulties to the transition process have been identified in the literature. To overcome these difficulties an Adolescent Transition Urology Clinic (ATUC) was established in 2009 where the patients are seen by a paediatric and an adult urologist, a urology nurse and if needed an adolescent gynaecologist. Our aim was to assess the ATUC and present the patient's perspective to this new service using a validated questionnaire.

MATERIALS AND METHODS

Data of all patients seen at the ATUC over the study period were prospectively recorded. Patients who completed the transition were contacted and asked to complete two online urological transition questionnaires: 1) The Care Transition Measure 15 (CTM-15) which is a validated questionnaire to assess the quality of care during transition from the patients' perspective. 2) The Transition Care Experience (TCE) which was created for the purpose of this study.

RESULTS

Thirty patients attended the ATUC over 4.5 years, with 26 (87%) completing the transition to the adult urological care. Of the 26 patients there were 14 (54%) males with a mean age of 18 years. The most common underlying urological condition was neurogenic bladder (85%). Nineteen (73%) patients completed the questionnaires. Only 1 (5%) patient thought that attending the ATUC was not beneficial, 17 (89%) would recommend the ATUC to other adolescents and 9 (47%) patients considered 18 as the appropriate transition age. Overall, 74% thought that written information would have been useful and 21% considered the adult hospital as an inappropriate environment for young adults. After attending the ATUC, 2 (11%) patients thought their preferences were not met and 3 (16%) patients were not confident that they can take care of their health.

DISCUSSION

Transition of patients with complex urological conditions should aim to facilitate transferring the care from the parent to the patient and preparing the adolescent to adult life by addressing their sexual and reproductive functions. Inadequate transition can have serious health consequences. On-going communication between the paediatric and the adult urologist facilitates the transition process even after the transfer of care has occurred. The CTM-15 has been considered as "the only available measure of quality of care during transition from the patients' perspective". Our study suggests that the large majority of adolescent attending the clinic are confident in looking after their complex urological condition. In addition one patient in 5 found the adult hospital environment an inappropriate place for adolescents and they would have preferred longer follow up in a children's hospital. The value of written information after clinic consultation seems to be a useful adjunct that might facilitate the complex transition process.

CONCLUSION

This is the first report evaluating the transition of adolescents with complex urological conditions using a validated transition questionnaire. The combined paediatric/adult urology clinic is beneficial in addressing the patients' needs and allowing smooth transition of these complex patients to the adult service.

[Does talking about it make a difference? Opinions of chronically ill young adults after being transferred to adult care]

INTRODUCTION

The goal of transition in healthcare for young people with chronic illnesses is to maximize their functioning and potential. The purpose of this pilot study was to assess whether young adults with chronic illnesses found that the transition to adult care was easier when the transition was discussed in advance with their pediatric specialist.

METHODS

Two groups were created according to whether patients had discussed (n=70) or not (n=22) the transition with their pediatric specialist and compared regarding demographic and health-related variables. All the significant variables at the bivariate level were included in a backward stepwise logistic regression.

RESULTS

Youth who had discussed the transition were significantly more likely to feel ready for the transfer (72.9% vs 45.5%) and accompanied (58.6% vs 27. %) during transfer, to have consulted their specialist for adults (60.0% vs 31.8%), and seen their doctor without the presence of their parents (70.0% vs 40.9%). At the multivariate level, only feeling accompanied during transfer (adjusted odds ratio (aOR): 3.56) and having consulted their specialist for adults (aOR: 4.14) remained significant.

CONCLUSIONS

Preparing chronically ill youths for transfer to adult care appears to be beneficial for them. However, transfer is only a small part of the much broader transition that is preparation for adult life. A well-planned transition should allow these young people to reach their full potential.

The fate of transitional urology patients referred to a tertiary transitional care center

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.