Lifelong specialist input is essential for many paediatric patients with congenital genitourinary tract conditions.  Improving life expectancies associated with modern medical standards has seen increasing numbers face the prospect of transfer from paediatric to adult urologic care. Transition of care is a complex multidisciplinary process with demonstrated potential for negative health outcomes where unsuccessful. Despite several published guidelines for urological transition, loss of eligible patients to adult follow-up and subsequent representation with major complications remain a significant concern. To this end, a dedicated collaborative Urology Transition Clinic (UTC) was established between our hospital and its sister regional children's hospital in 2013 to facilitate the effective transition of our paediatric urology patients to an adult urology service. We report our single-centre transitional care experience at ten years of operation.

The UTC comprises quarterly collaborative outpatient clinics with adult and paediatric urologists, alongside an annual multidisciplinary meeting for patient handover attended by adult and paediatric urology, nephrology, continence medicine and allied health. These authors performed a retrospective analysis of a prospectively gathered transitional care database capturing all patients reviewed in the transition clinic from 2013-2023. Supplementary data regarding demographics, diagnosis, emergency department presentation, treatment, complications and present management were extracted from electronic and paper medical records for descriptive analysis.

109 patients have been successfully transitioned since 2013. All patients referred for transition were reviewed at a dedicated transition clinic. The leading indications for transition were spina bifida (45.9%, n=50), posterior urethral valves (8.3%, n=9) and bladder exstrophy (7.3%, n=8). 38.5% (n=42) of patients had undergone bladder augmentation by 2023. Urinary diversion was offered in a single case but declined. Since transition, 20.2% (n=22) subsequently presented to our emergency department with an acute urological issue, while 10.1% (n=11) have required haemodialysis. 96.3% (n=105) remain in active specialist follow-up (internal or external) or were discharged to primary care. Three patients (2.8%) declined to attend ongoing follow-up and one patient (0.9%) passed away from a non-urological cause.

Our successful transition rate compares to other reports from frontier institutions in transition urology, and our surgical intervention and change in management rates on transition are comparable to other reported rates in the literature [1-3].

The establishment of a dedicated, collaborative UTC has successfully facilitated appropriate and efficient continuity of care for paediatric patients seeking ongoing adult urology follow-up.

Blubaum A, Lewis J, Frimberger D, Slobodov G. 9-Year Evaluation of a Transitional Care Program for Congenital Neurogenic Bladder Patients. Urology. 2023;180:285-290. doi:10.1016/j.urology.2023.06.023
Dönmez MI, Selvi I, Tantekin A, Oktar T, Ziylan O. Outcomes of a newly established transitional urology outpatient clinic: a real-world experience. Int Urol Nephrol. 2023;55(12):3021-3031. doi:10.1007/s11255-023-03732-9
Chan R, Scovell J, Jeng Z, Rajanahally S, Boone T, Khavari R. The fate of transitional urology patients referred to a tertiary transitional care center. Urology. 2014;84(6):1544-1548. doi:10.1016/j.urology.2014.08.022