Professional Documents
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Overview
What is transitional urology? When is it appropriate to consider transition? How to transition urological care Neurogenic bladder
protecting kidney function
Neurogenic bladder
managing bladder function
Growing Up
Children with spina bifida grow up to become adults Preparation for adulthood is essential
Encourage them to look after themselves and take part in normal family lifefrom the beginning
Growing Up
How do things change? Urologically
Sexually
Growing Up
CHALLENGE
Transition of care for this growing population
Growing Up
Renal failure remains the most common cause of death Pulmonary and cardiac disease are becoming more common Increased risk of atherosclerosis
Problem
TRANSITION
Transitional urology
Subspecialty care with a focus on adolescents and adults with congenital anomalies or chronic urological issues Requires specialty expertise in:
anatomy/congenital anomalies reconstructive urology knowledge of long-term effects of prior interventions/operations
Transitional Urology
May also need support of social work or financial services to help patients navigate medical coverage issues
Also functions as patient advocate/liaison for other subspecialists within urology and other specialties (cardiology, neurology, etc.)
Control of micturition
Normal urodynamics
Measure:
Bladder pressure (Pves) Rectal (abdominal) pressure (Pabd)
Calculate:
Detrussor Pressure Pdet = Pves - Pabd
NEUROGENIC BLADDER
Urinary problem in which the bladder does not empty properly due to a neurological condition such as spina bifida
The primary goal of the urologist is always to maintain and preserve renal function
What can go wrong with the kidneys? Infections Hydronephrosis Stones Loss of function
Prevention
Treatment
Stones
Decreased mobility Calcium metabolism Electrolyte abnormalities Anatomical abnormalities
x
Drink water Prevent infection Cath or void as directed (TAKING CARE OF YOUR BLADDER TAKES CARE OF YOUR KIDNEYS!!) Take your medicine See your doctor
Check renal function, check bladder function
Treat infections
Bladder function
Stores urine
Bladder Outlet
Stores urine
OUTLET
Bladder function
May worsen due to outlet resistance or a tethered cord Outlet resistance increases
Not always a positive
GOALS
Maintain healthy kidneys Continence
Treatments of incontinence
Behavioral: timed voiding, catheterization, avoid bladder irritants in diet Pharmacologic: anticholinergics
Surgical:
Decrease storage pressure Botox, bladder augmentation Increase outlet resistance sling, artificial sphincter
Combination
ACCESS SUPPLIES
COST
Only oxybutinin is generic
Diversion of Urine
Continent Abdominal Stoma with reservoir (Serum creatnine <2 mg%) Free external diversion in Renal failure Cutaneous ureterostomy Ileal conduit
Treatment of neurogenic bladder: Surgery Augmentation: Long-term concerns Catheterization Stricture Continence Tumors
Summary
Bladder function changes Goals/priorities of the patient change Risks of interventions change Critical to have a urologist who:
Understands the issues Can counsel you on realistic expectations Has surgical and medical expertise in this field AND IS WITH YOU FOR THE LONG HAUL!