İstanbul Faculty of Medicine, Department of Urology, Division of Pediatric Urology, İstanbul University, Istanbul, Turkey.
School of Medicine, Department of Urology, Koç University, Istanbul, Turkey.
Int Urol Nephrol. 2023 Dec;55(12):3021-3031. doi: 10.1007/s11255-023-03732-9. Epub 2023 Aug 4.
To evaluate the demographic and clinical characteristics of patients who visited our transitional urology (TU) outpatient clinic formed by pediatric urologists with urology background within the first year upon its establishment.
Files of 130 consecutive patients who visited our TU outpatient clinic, which was established in 01 March 2021, between 01 March 2021 and 01 March 2022 were retrospectively collected. Patients were divided into two groups: those with a previous follow-up in our pediatric urology department (Group I, n: 81, 62.3%) and those who were followed up in other clinics during childhood (Group II, n: 49, 37.7%) afterwards. Demographic characteristics, complaints at admission, previous medical history, and management plans at the recent clinical visit were noted. We defined a successful and smooth transition from childhood to adult care as not being without follow-up within the first year after the age of 18 years and not requiring extraordinary medical assistance (e.g., emergency room visits, hospitalization, intensive care unit admissions) from the last urological control to the TU outpatient clinic visits.
The most common diagnoses were vesicoureteral reflux (n: 32, 24.6%), neuropathic bladder accompanied by spina bifida (n: 31, 23.8%), obstructive uropathy (n: 25, 19.2%), hypospadias (n: 20, 15.3%), non-neurogenic lower urinary tract dysfunction (n: 19, 14.6%), and bladder exstrophy (n: 8, 6.1%). The distribution of primary diagnosis in the two patient groups was similar. The median time from the last pediatric urology visit to the current TU clinical visit was significantly longer in Group II (12 vs. 60 months, p < 0.001),consequently, the median patient age at admission was significantly higher in Group II (21 vs. 23 years, p = 0.020). The rate of a successful and smooth transition was 86.4% in Group I, whereas Group II had a completely unsuccessful transition period. Upon admission to TU outpatient clinic, the requirement of a surgical intervention was lower in Group I (21% vs. 38.8%, p = 0.028).Also,the need for medical treatment changes was higher in Group II (9.9% vs. 53.1%, p < 0.001).
Our findings emphasize the importance of patient referral to a TU clinic that deal with lifelong problems of congenital genitourinary diseases. Delays in receiving medical or surgical treatments during transition from childhood to adulthood may be associated with higher need for subsequent surgical interventions in this vulnerable patient population.
评估在我们由具有泌尿科背景的儿科泌尿科医生成立的过渡泌尿科 (TU) 门诊就诊的患者的人口统计学和临床特征，该门诊成立于 2021 年 3 月 1 日。
回顾性收集了 2021 年 3 月 1 日至 2022 年 3 月 1 日期间在我们的 TU 门诊就诊的 130 例连续患者的病历。患者分为两组：在我们的儿科泌尿科就诊过的患者（组 I，n=81，62.3%）和之后在其他诊所就诊的患者（组 II，n=49，37.7%）。记录人口统计学特征、入院时的主诉、既往病史以及最近临床就诊时的管理计划。我们将成功和顺利地从儿童期过渡到成人期护理定义为在 18 岁以后的一年内没有失访，并且从最后一次泌尿科控制到 TU 门诊就诊期间不需要额外的医疗援助（例如急诊就诊、住院、重症监护病房入院）。
最常见的诊断是：膀胱输尿管反流（n=32，24.6%）、伴有脊柱裂的神经源性膀胱（n=31，23.8%）、梗阻性尿路病（n=25，19.2%）、尿道下裂（n=20，15.3%）、非神经源性下尿路功能障碍（n=19，14.6%）和膀胱外翻（n=8，6.1%）。两组患者的主要诊断分布相似。组 II 中从上次儿科泌尿科就诊到目前 TU 临床就诊的中位时间明显较长（12 个月 vs. 60 个月，p<0.001），因此组 II 中患者的中位入院年龄明显较高（21 岁 vs. 23 岁，p=0.020）。组 I 的成功和顺利过渡率为 86.4%，而组 II 则完全过渡失败。在 TU 门诊就诊时，组 I 的手术干预需求较低（21% vs. 38.8%，p=0.028）。此外，组 II 的医疗治疗方案变更需求较高（9.9% vs. 53.1%，p<0.001）。
我们的研究结果强调了患者转诊到处理先天性泌尿生殖系统疾病终身问题的 TU 门诊的重要性。从儿童期到成年期过渡期间延迟接受医疗或手术治疗可能与这一脆弱患者群体后续手术干预需求增加有关。
