title: 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.
  
  
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Urology, Houston Methodist Hospital, Houston, TX.
authors.forename: Robert
authors.initials: R
authors.lastname: Chan
authors.affiliation: Scott Department of Urology, Baylor College of Medicine, Houston, TX.
authors.forename: Jason
authors.initials: J
authors.lastname: Scovell
authors.affiliation: Scott Department of Urology, Baylor College of Medicine, Houston, TX.
authors.forename: Zachary
authors.initials: Z
authors.lastname: Jeng
authors.affiliation: Scott Department of Urology, Baylor College of Medicine, Houston, TX.
authors.forename: Saneal
authors.initials: S
authors.lastname: Rajanahally
authors.affiliation: Department of Urology, Houston Methodist Hospital, Houston, TX.
authors.forename: Timothy
authors.initials: T
authors.lastname: Boone
authors.affiliation: Department of Urology, Houston Methodist Hospital, Houston, TX. Electronic address: rkhavari@houstonmethodist.org.
authors.forename: Rose
authors.initials: R
authors.lastname: Khavari
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003266:Continuity of Patient Care; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D011787:Quality of Health Care; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D018570:Risk Assessment; D062606:Tertiary Care Centers / Q000458:organization & administration*; D060305:Transition to Adult Care / Q000458:organization & administration*; D016896:Treatment Outcome; D001750:Urinary Bladder, Neurogenic / Q000175:diagnosis / Q000628:therapy*; D014564:Urogenital Abnormalities / Q000175:diagnosis / Q000628:therapy*; D055815:Young Adult