Caring for the Adolescent and Adult Patient with Congenital and Childhood GU Conditions

• 07 Jan 2021 10:00:43 AM
• |Transition Urology

Dear All,

With better understanding and more effective management of Urological disorders in children, Many children survive childhood and proceed to Adolescent and even Adult life with many requiring periodical assessments to address their health and their inabilities. Thus the concept that these children should not be transitioned when reaching Adolescent age developed. The earliest hospital to take such a course was Boston’s Children Hospital and such Practice Commenced in 1954. Prof. Innes Williams never transferred his patients to the care of Adult urologists but had beds for them under his care at the institute of Urology. Mr. Scott with whom I had an opportunity to be trained in 1970-71 had 3 adult beds in his ward where his Paediatric patients were housed. They all firmly believed that these children when they transitioned to adult life are better taken care of by their primary treating Doctor rather than transferring them to Adult Urologist. This view is now being aired by some Paediatric Urologists. Christopher Woodhouse took over the Legacy of Prof. Innes Williams and started managing these children in transition. Thus came the Concept of Adolescent Urology.

In India, this problem was nonexistent as the speciality of Paediatric Urology was itself in its infancy. Though some of the Urologists took special interest in managing children with Urological abnormalities, majority could be called only as General Urologists. Hence the need for Adolescent Urologist was not felt. Over the years, many paediatric Surgeons also took interest in practicing Paediatric Urology and thus the lacunae for their treatment when they became Adolescents were palpably felt. This resulted in confusion as these transitioned children where neither under the Care of their primary treating surgeon but had to be transferred to Adult Urologists with little or no knowledge as how they should be managed when occasions arose. Fortunately, this issue of who should be the primary doctor for children with Urological Anomalies is beginning to be addressed with the present generation of paediatric Urology. Who should be a paediatric Urologist has been well addressed in a publication in 2008 in Indian Journal of Urology by Late Shyam Joshi. Though he conceded that a Paediatric Urologist could be both Urologists and Paediatric Surgeons, he emphasized the need of at least one year spent at a centre where considerable case load in Paediatric Urology is performed. He was the one to suggest ‘Certification Course’ in Paediatric Urology and this could be after completion of training either as a Paediatric Surgeon or as Urologist. This concept has begun to function with few centres now providing such candidates adequate training. In Future, this should be the norm as to who can practice Paediatric Urology.

Adolescent Urology has caught on and there are many centres around the globe specializing and practicing in this field.

A book on ‘Adolescent Urology and Long Term Outcomes’ and this was edited by Christopher Woodhouse and was published in 2015. The authors of Chapters are legends in this field. A book, that is worth reading by all Urologists. This subject has expanded leaps and bounds in recent years with many articles highlighting the need for such a Sub-Sub Speciality. In 2018, Dan Wood and Hadley M Wood – Joint SIU ICUD Int Consultation, edited the book ‘Congenital Lifelong Urology - Caring for the Adolescent and Adult Patient with Congenital and Childhood GU Conditions’, published by SIU in 2019.

https://www.siu-urology.org/themes/web/assets/files/ICUD/congenital_lifelong_urology_nov_7__2019_v2.pdf

Before Embarking on Reading of this elaborate book on this subject, I would appreciate that we read the following to get some clear cut concepts albeit briefly.

Adolescent Urology: Developing Life Long care for Congenital anomalies

Dan Wood (2014)

https://www.nature.com/articles/nrurol.2014.71 (PDF available)

Lifelong Congenital Urology: The Challenges for Patients and Surgeons

Dan Wood*, Serdar Tekgul et al, 2019 (PDF Downloaded)

The basics of Transition in Congenital Lifelong Urology

Matthieu Peycelon* and Rosalia Misseri (2020)

https://link.springer.com/article/10.1007/s00345-020-03116-z (PDF available)

I am sure these informations will benefit all of us and add to the progress of Urology. The confusion as to who should tackle these problems in Adolescents and even Adults are yet to be resolved.

Would appreciate the views of our esteemed members regarding their personal views as to who should treat these adolescents and Adults who have transitioned from childhood.

With warm regards,

Venu

Comments(1)

• 

  Dr. Roy Chally

  11 Jan 2021 08:08:51 PM

  Congenital urological problems could present in adult life for the first time to the urologist for care. Obviously we are not going to send the patient to the paediatric urologist. 

    Patients with congenital urological problems operated in childhood could present in adulthood with complications. For paediatric urologist to take care of such problems they will have to invest in adult urological equipments. An adult urologist competent in reconstructive should be able to take care of these problems quite effectively. The paediatric urologist caring for the child for many years has an emotional bonding with the child and family.  These children need psychological support and if this was provided early in life, then in adulthood, switch of Urologists can be smooth.