Adolescents and adults in pediatric urology clinics

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Abstract

Objective

Adolescents represent a significant proportion of the patients seen by pediatric urologists (PU). Adolescents that require long-term follow-up (FU) eventually need to be transferred to adult care. This research aims to describe the disease profile of adolescent and adult patients from a referral PU clinic, in order to allow future medical education and cost planning.

Patients and methods

A retrospective review was made of cases seen in a PU referral clinic from January 1st to December 31st 2011. Patients were classified as child (≤12 years old), adolescent (12 < age ≤ 18 years old) or adult (>18 years old). Diagnoses and presentations were analyzed.

Results

521 patients were seen: 404 children (77.5%), 103 adolescents (19.8%) and 14 adults (2.7%). Clinical profiles differed between the three groups. 43.7% of the adolescents and all adults were FU cases or patients with late sequelae of congenital diseases. Some diseases predominated largely in adolescents.

Conclusions

Adolescents represent a significant proportion of our PU clinics. Half of them are FU cases or present sequelae from previous treatments/diseases. Some adolescents do not adapt to adult care, and persist being followed up by PU.

Introduction

In Brazil, since 1988, by law (Estatuto da Criança e do Adolescente – Brazilian Children and Adolescents Protective Law), patients from 0 to 18 years old should be treated in pediatric facilities. Post-pubertal adolescents represent a significant proportion of pediatric urology (PU) patients, presenting as new, late referral and follow-up (FU) cases, who frequently show sequelae of congenital diseases or their treatments. Adolescents' disease epidemiology differs from children's. Their psychological profile, sexual and social expectations and the dynamics of adolescence demand special efforts from the health team. Those particularities mean that pediatric specialists should be specifically educated to treat adolescents.

Adolescent patients who require long-term FU or are likely to present permanent sequelae or significant future health risks deriving from their present clinical situation, must be transferred to adult care in accordance with their ages. This demands specific psychological and logistical preparation of the patients, their families and the health services. Ideally, the patient should be offered a transition period while he/she is treated simultaneously by pediatric and adult specialists. The transfer of graduated pediatric patients to adult care is stressful for patients, families and for the health team, and demands a lot from the institution management structure.

The availability of specialists in adolescent urology is very limited [1]. An alternative model would allow specific adult patients to remain under treatment by pediatric teams, considering their extensive training and better clinical experience concerning congenital malformations and their sequelae. This kind of knowledge is limited in most adult urologists (GU). Nevertheless, it may not be ideal for pediatric specialists to assume full responsibility for adult patients, as their training may not be sufficient to detect or to solve problems and conditions that specifically pertain to adults.

This research project intends to describe the epidemiology and disease profiles of adolescents and adults being seen in clinics in a referral PU department, in order to allow future planning of medical education and distribution of institutional resources.

Section snippets

Methods

We reviewed the registers for all patients seen in the PU clinic in Servidores do Estado Federal Hospital, Rio de Janeiro, Brazil (teaching institution, quaternary referral for PU) from January 1st to December 31st 2011. The ages of the patients were registered and stratified as child (pre-pubertal, defined as ≤12 years of age), adolescent (defined as 12 < age ≤ 18 years old) or adult (>18 years old). Adolescents were classified as new diagnosis, late referral (patients presenting symptoms

Results

Servidores do Estado hospital offers specialized PU clinics (subordinated to the Department of Pediatric Surgery and integrated with pediatric surgery specialists) and GU clinics. Specialists in PU integrate freely with GU specialists, in order to collaborate on resident education (GU residents rotate in PU) and to treat specific cases (PU specialists collaborate with GU to treat adults with congenital problems or sequelae from congenital conditions). There is no formal transition clinic for

Discussion

The specific health needs of adolescents, compared with children or adults, have been emphasized by many. Zimmer-Gunbeck and colleagues suggested that 19% of the adolescents seen by health teams were unsatisfied with their consultations [2]. Adolescent health consultations may be focused on adolescence itself (discussing specific issues like sexual maturation, contraception, drug usage) or on adolescent-specific diseases, demanding specific education of the doctors involved. Relating to PU,

Conclusion

Adolescents represent a significant proportion of PU clinics in Brazil. Their clinical profile is different from that of children. Roughly half of the adolescents are FU cases or present sequelae from previous treatments/diseases. Some adults, mainly EEC or NB cases do not adapt to adult care, return to pediatric clinics and persist being followed up by PU. There is an urgent need to educate PU to treat adolescents by approaching not only their specific diseases, but also the specific needs of

Conflict of interest/funding

None.

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