Transitional Urology is designed to fill a critical gap that exists in the published literature by comprehensively addressing the urological challenges facing adolescents and adults with complex congenital anomalies of the genitourinary system. It provides a valuable resource to pediatricians and pediatric urologists facing urological management issues beyond their expertise in their aging patients as well astechnical guidance to adult urologists who may have had little or no experience caring for patients with a congenital condition. This work will service as a field guide to congenitalism, providing a “how to” approach to guide the urologist using real clinical examples for the most common and challenging urological problems encountered. It also provides a framework for the transition process from pediatric to adult-centered care, with a special emphasis on the multidisciplinary nature needed to provide patient-centered care. Specific conditions that require special consideration, including myelomeningocele, exstrophy, posterior urethral valves, and hypospadias are highlighted. Topics considered common in the general urology practice- like infertility and sexual dysfunction areaddressed within the context of patients with neurological or anatomical complexity. In addition, this text reviews urological complaints for which basic clinical algorithms are well-established within the context of a congenitally-abnormal bladder.Chapters discuss how and when special testing like video urodynamnics and positional fluoroscopy may be warranted to provide critical diagnostic guidance. The text also review how typical age-related urological phenomena, like elevated PSA, hypogonadism, and BPH, may present in this subset of patients and how treatment of these conditions may be different than the general population.?
The basics.- The transition process: Initial assessment and defining goals and development of the multidisciplinary team.- Approach to the myelodysplasia patient.- Approach to the exstrophy patient.- Approach to the posterior urethral valve patient.- Approach to the hypospadias cripple.- Genital/urethra.- Sexual function/fertility in myelodysplasia.- Male (ejac/erectile).- Female (incl POP).- Revision genitoplasty, sexual function, fertility and pelvic organ prolapse in exstrophy + management of pregnancy.- Natural history of adults with hypospadias + urethral reconstruction, fertility, and chordee in hypospadias.- Issues in the long-term management of adolescents and adults with disorders of sexual differentiation (management of gonads, genital reconstruction, late presentation of the undiagnosed DSD).- Lower tract problems in adulthood for patients with bladder reconstructions.- New or escalating recurrent UTIsTBD.- Progressive renal deterioration – distinguishing urological from nephrological causes. Include nephrology input on renal protection.- New or worsening incontinence.- Trouble-shooting urostomies (leakage/stenosis) – indications for and approaches to revision surgery.- Cancer risk and surveillance in the patient with a augmentation cystoplasty or urostomy.- Upper tract considerations.- Renal transplant in patients with abnormal lower tracts.- Management of calculi in patients with malabsorption or osteodystrophy.- Late presentation of patient with primary bladder neck obstruction and/or PUV.- Age-related urological problems in the complex urological patient.- BPH and neurogenic bladder.- Prostate cancer screening/treatment.- Hypogonadism.- Urological follow-up of childhood malignancies eg Wilms Tumor and Rhabdomyoscarcomas.
Hadley M. Wood, MD, FACS
Assistant Professor of Surgery
Center for Genitourinary Reconstruction
Glickman Urological and Kidney Institute
Dan Wood, PhD FRCS Urol
University College London Hospitals
Adolescent and Reconstructive Urology