Transitional urology: from adolescence to adult care
How to ensure that an adolescent with neurogenic bladder, posterior urethral valves or exstrophy, or who has had bladder augmentation, moves to adult care without being lost to follow-up.
Step 1 of 10
Objectives
After this course you will be able to
- Distinguish transition from a simple transfer.
- List the urological conditions that require transition.
- Know when to start transition and how to assess readiness.
- Recognize late complications that emerge in adulthood.
- Define the pediatrician's role in the transition process.
Key message: transition is not a single visit but a process that starts at 12–14 years of age and lasts several years. After an unplanned transfer, a substantial share of adolescents are lost to follow-up.
Basics
What is transition?
Transition is the purposeful, planned movement of an adolescent with a chronic condition from child-centered to adult-oriented health care. The goal is not only to change doctors but for the adolescent to take responsibility for their own health.
| Pediatric care | Adult care |
|---|---|
| Family-centered, parents make the decisions | Patient-centered, the patient makes the decisions |
| Team in one place, long visits | Different specialists, short visits |
| Development and growth are the focus | Fertility, sexual health, work and independence are the focus |
Basics
Who needs transition?
- Neurogenic bladder (spina bifida, sacral anomalies, spinal cord injury).
- Posterior urethral valves and chronic kidney disease.
- Bladder exstrophy and epispadias, cloacal anomalies.
- Patients who have had bladder augmentation, or a Mitrofanoff or MACE stoma.
- Proximal hypospadias, disorders of sex development (DSD).
- Scarred kidneys, kidney transplantation, bilateral high-grade reflux.
Basics
Late complications expected in adulthood
| Area | Risks |
|---|---|
| Kidneys | Progression of chronic kidney disease, hypertension, proteinuria |
| Bladder | Decreased compliance, high pressure, poor adherence to catheterization |
| Augmented bladder | Stones, mucus, metabolic acidosis, B12 deficiency, perforation, long-term risk of malignancy |
| Sexual health and fertility | Erectile and ejaculatory dysfunction, fertility problems, specific risks in pregnancy |
| Psychosocial | Delayed independence, depression, difficulties with education and employment |
In a patient with an augmented bladder, abdominal pain, fever and distension are a surgical emergency until bladder perforation has been ruled out. The risk of death is high.
Assessment
Assessing readiness for transition
Ask the adolescent the following and document it at every visit:
- Can they explain their own diagnosis in plain words?
- Do they know the names and doses of their medications and why they take them?
- Do they catheterize independently and order their own supplies?
- Do they recognize emergencies (fever, urinary retention, abdominal pain with an augmented bladder)?
- Do they book their own appointments and talk to the doctor without a parent present?
Starting at 13–14 years of age, spending part of the visit alone with the adolescent increases independence and trust.
Assessment
Long-term follow-up plan
| What | How and when |
|---|---|
| Renal function | Creatinine or cystatin C, blood pressure, proteinuria: at least once a year |
| Imaging | Kidney and bladder ultrasound: stones, dilation, post-void residual |
| Bladder function | Urodynamics if symptoms change or the upper urinary tract dilates |
| Augmentation | Acid-base status, B12, stones; cystoscopy for hematuria or new symptoms |
| Sexual health | Age-appropriate conversation, information on fertility and contraception |
Patients with spina bifida have a high risk of latex allergy; this should be recorded in the medical records.
Managing the transition
Stages of transition
- 12–14 years: first conversation about transition; explaining the process to the family and the adolescent.
- 14–16 years: readiness assessment, teaching self-care skills, part of the visit alone.
- 16–18 years: choosing the adult team, a joint visit (pediatric and adult physician) if possible.
- 18–21 years: transfer; handover of the medical summary.
- After transfer: confirmation that the first visit took place.
Managing the transition
Transition summary
The document handed over to the adult physician should include:
- Main diagnosis and all operations (date, type, center that performed the surgery).
- Anatomy: augmentation, stoma, catheter size, catheterization schedule.
- Renal function trend, latest imaging and urodynamic results.
- Medications, allergies (latex), recurrent infections and antibiotic susceptibilities.
- A brief emergency plan and contact details.
Managing the transition
The pediatrician's role
- Identify adolescents with chronic urological conditions and start the transition conversation early.
- Monitor general issues such as vaccinations, growth, blood pressure and mental health.
- Maintain communication between the pediatric urologist, nephrologist, neurologist and adult team.
- Guide the family to support the adolescent's independence.
The greatest risk is loss to follow-up. Checking whether the first adult visit took place after transfer is a simple but very effective step.
Quiz
Quiz: Transitional urology
Test yourself: choose one answer.
-
At what age is it recommended to start the transition process?
Transition is a process that lasts several years and should begin with a first conversation at 12–14 years of age.
-
A 19-year-old patient with an augmented bladder has acute abdominal pain and fever. Which diagnosis should be considered first?
Perforation of an augmented bladder is life-threatening and requires urgent surgical assessment until it is ruled out.
-
Which metabolic problem should be monitored after ileal augmentation?
The bowel segment absorbs ions from urine (metabolic acidosis), and use of the terminal ileum can cause B12 deficiency.
-
Which allergy should be specifically recorded in the records of a patient with spina bifida?
Patients with spina bifida have a high risk of latex allergy, and it must be taken into account in all medical procedures.
Course completed
Related articles for parents
Sources
- Blum RW, Garell D, Hodgman CH, et al. Transition from child-centered to adult health-care systems for adolescents with chronic conditions. J Adolesc Health. 1993;14(7):570–576.
- Got Transition. Six Core Elements of Health Care Transition 3.0. National Alliance to Advance Adolescent Health, 2020.
- EAU Guidelines on Paediatric Urology, 2025: Neurogenic bladder; Posterior urethral valves.
This material is intended for medical professionals and is based on current clinical guidelines. Decisions about an individual patient are made by the treating doctor.