Lambert Sarah M
Department of Urology, Columbia University, New York, New York; Division of Pediatric Urology, New York Presbyterian Hospital, Morgan Stanley Children's Hospital, New York, New York.
Semin Pediatr Surg. 2015 Apr;24(2):73-8. doi: 10.1053/j.sempedsurg.2015.01.004. Epub 2015 Jan 8.
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.
从童年到青少年再到成年的转变是人类发育的自然组成部分。随着儿童在学校成长并获得独立，医疗从业者必须推动从儿科医生到成人医生的同步转变。现代医学成功地延长了许多患有复杂病症儿童的预期寿命，成人医生在他们成年后的医疗护理中发挥着作用。将小儿泌尿外科护理过渡到成人泌尿外科护理因每个人及其潜在病情而异，而过渡过程是普遍存在的。所有小儿泌尿外科医生的目标包括保护肾脏和下尿路、安全储尿、安全排尿、尿失禁、生育能力、性功能以及生殖器美观。对于一些儿童来说，这些目标可以在儿童期实现，而其他儿童则需要终身维护和管理。患有后尿道瓣膜、膀胱外翻-尿道上裂综合征、泄殖腔畸形、膀胱输尿管反流、神经源性膀胱、性发育障碍、癌症、尿道下裂、肾结石、隐睾、精索静脉曲张、肾盂输尿管连接部梗阻、孤立肾和上尿路畸形的儿童都需要长期评估和管理。改变患者和护理人员模式、寻找具有特殊专业知识的成人泌尿外科医生、与肾脏病学等其他成人专科协调护理以及适应成人医疗环境等障碍可能会阻碍过渡过程。
