You have accessJournal of UrologyUrodynamics/Incontinence/Female Urology: Neurogenic Voiding Dysfunction1 Apr 20121660 TRANSITIONING CARE IN ADULTS WITH MYELOMENINGOCELE - LESSONS LEARNED FROM A TERTIARY NEUROGENIC BLADDER CLINIC Benjamin Dillon, Casey Seideman, Dominic Lee, and Gary Lemack Benjamin DillonBenjamin Dillon Dallas, TX More articles by this author , Casey SeidemanCasey Seideman Dallas, TX More articles by this author , Dominic LeeDominic Lee Dallas, TX More articles by this author , and Gary LemackGary Lemack Dallas, TX More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.1492AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Myelomeningocele (MMC) is diagnosed typically in-utero or in infancy, but can have profound lifelong effects. Bladder dysfunction most frequently results from MMC, and the initial care is intended to optimize voiding, while reducing the risk for renal damage over time. Transferring care when patients reach the age of 18 to adult urologists with an expertise in this area poses challenges. We report on a series of MMC patients referred to an adult neurogenic bladder (NGB) tertiary clinic. METHODS An IRB-approved neurogenic bladder database was surveyed for patients referred with MMC, who reported closure at birth. Demographic and urodynamic (UD) parameters were captured. Urodynamics were carried out per ICS guidelines. Upper tracts were surveyed by ultrasound at the time of initial evaluation. RESULTS Over the period 1/2005-7/2011, 36 (19 Female, 17 Male) adults with MMC were referred to the tertiary care NGB clinic. Their mean age was 57 (median 30), and 57% (20/35) were previously treated by adult urologists prior to presentation at our center. Referring providers were most often adult (36%), or pediatric urologists (28%), or other physicians (16%). In 44% of cases, patients were referred for a current urological problem (most commonly incontinence, recurrent infection, fistula, bladder pain), and only 9 of patients were referred for routine follow-up. Seventeen (47%) of patients had prior urological surgeries. One patient was noted to chronic renal insufficiency. Upper tract imaging revealed abnormalities in 11 of 28 patients (6 with hydronephrosis, 1 with nephrolithiasis, 4 with atrophy of one or both kidneys). 22 % of patients have required further urological surgeries. Reduced compliance was noted in 47% of patients, detrusor overactivity in 29%, urge incontinence in 24% patients and PVR >100 in 35% of those undergoing UD. CONCLUSIONS Despite dissemination of information locally about the need for ongoing care for MMC patients and a very active local specialty MMC hospital, transition to adult urologists familiar with the care of MMC patients remains inadequate. In most cases, patients are referred with specific problems rather than for routine care. Significant urodynamic abnormalities are present in a substantial number of patients. These findings support the development of a transition clinic to reduce morbidity related to urologic disease in adults with MMC. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e670 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Benjamin Dillon Dallas, TX More articles by this author Casey Seideman Dallas, TX More articles by this author Dominic Lee Dallas, TX More articles by this author Gary Lemack Dallas, TX More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...