Adolescent UrologyDan Wood, PhD, FRCS(Urol),
Consultant in Adolescent and Reconstructive Urology, University CollegeLondon Hospitals.
Declaration of conflicting interests:
This article is designed to give a broad overview of the specialist elements of adolescent urology. It emphasises the need for multidisciplinary care of thosepatients born with congenital disorders and treated in childhood. Theimportance of ensuring long-term follow-up and minimising potential damageto the kidneys as well as other metabolic follow-up is discussed.
The definition of adolescent urology should be obvious – however, it is moredifficult than it would at first appear and there are a number of reasons for this. Since the creation of the specialty by Christopher Woodhouse, outcomesin paediatric urology have continued to improve. Whereas major congenitalanomalies, or indeed surgery to correct them, may have previously resulted indeath or major disability – good quality, long-term survival is now areasonable expectation for patients and parents. Interventions such as earlyself-catheterisation and an improved understanding of the need for multidisciplinary care have contributed to these advances . There are anumber of sequelae that result from this and which start to impact on our definition. Firstly, when does adolescence start and therefore when does itend – or in this context should it end at all? Secondly, how should a childmove from paediatric care to adult care? Additionally, what are the problemswith this and who should be involved in long-term care? What are the long-tem outcomes of either congenital disease or its treatment? What about newdisorders identified in adolescence? We do encounter these but they arelargely beyond the scope of this review. If more children need long-term carehow do we manage that? The list goes on – and this article will aim to discusssome of these concerns. No matter how we look at it though, paediatricpatients who have been well cared for in early life have a right to expectcontinued and expert care throughout their adult life. With increasing numbersof patients reaching adulthood new opportunities for clinicians wishing todevelop an interest in adolescent urology will arise and new challenges willbecome clear as part of this expansion.