Login to Access Video or Poster Abstract: MP96-02
Sources of Funding: None

Introduction

Due to advances in medical management, most patients with congenital bladder diseases survive into adulthood. These patients are managed by pediatric urology teams, often into adulthood. However, this practice is challenged by policies at children's hospitals, unfamiliarity of pediatric providers with adult disease processes, and increasing patient numbers. Subsequently, many affected young adults fall into a care gap, are lost to follow up, and ultimately resurface in adult emergency rooms with acute problems. We propose a transition clinic for patients with neurogenic bladder disease, using a T-staging system for the transition process, to ensure long term quality care.

Methods

The REACH clinic for neurogenic bladder disease was established in 2014. Patients are categorized according to their transition stage, from T0 to T4. Data collected includes diagnosis, age, gender, T-stage, continence, bladder/bowel management, and previous surgeries. Stages T0 and T1 are seen by pediatric urologists only, T2 and T3 by pediatric and adult urologists, and T4 by adult urologists only. T0 patients are not participating in the transition process yet, T1 patients are being introduced, and T4x are adult patients who did not go through a transition process (Figure 1).

Results

A total of 285 patients have been seen to date. The etiology of neurogenic bladder was spina bifida in approximately 80% of the patients. There were 110 patients in the T0 stage, 26 in T1, 15 in T2, 3 in T3, 19 in T4, and 112 for T4x. Gender distribution was 160:125 female to male. Median ages in years for the stages ranged from 6.2 for T0 to 27 for T4x. Patients in the transition process T0-T4 had significantly less stones and lower rates of bladder augmentation compared with T4x patients._x000D_

Conclusions

Published data confirm that successful transition is linked to early initiation of the process. Successful transition allows for continuation of care, less episodes of preventable emergencies, and establishment of a comprehensive long-term plan. Future studies will evaluate the influence of the REACH clinic on patient follow up, prevention of medical emergencies, and patient and caretaker satisfaction. Questionnaires will determine patient and caretaker priorities and will help focus resources.

Funding

None