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Transition in enuresis patients: Identifying the gaps and opportunities for the future
Sevasti Karamaria1, Reiner Mauel2, Mauro Van den Ende3
1Department of Internal Medicine and Pediatrics, Ghent University, Ghent, Belgium.
Insights
This study proposes a stepwise approach for transitioning children with nocturnal enuresis (bedwetting) from pediatric to adult care. Early intervention and patient/parent education are crucial for managing persistent symptoms and ensuring continuity of care.
Area of Science:
- Urology
- Pediatrics
- Healthcare Transition
Background:
- Nocturnal enuresis affects 1%-2% of adolescents and adults, often requiring multidisciplinary care.
- Existing pediatric to adult healthcare transition programs lack standardization for enuresis patients.
- Limited research exists specifically on enuresis transition programs.
Purpose of the Study:
- To investigate the need for standardized transition programs for enuresis patients.
- To explore best practices from transition programs of related conditions.
- To propose a framework for enuresis care transition.
Main Methods:
- Literature search for enuresis transition programs (yielded no results).
- Rescue search for transition programs in related conditions (chronic diseases, CKD, bladder dysfunction, etc.).
- Analysis of research publication trends in enuresis and nocturia.
Main Results:
- Transition programs for related conditions highlight multidisciplinary care, transition coordinators, and patient/parent involvement.
- Research on enuresis and nocturia is predominantly pediatric (50%), with adult studies led by urologists (37%), indicating a care gap.
- No specific enuresis transition literature was identified.
Conclusions:
- A stepwise transition approach for enuresis is proposed, tailored to clinical subtypes and complexity.
- Transition should begin at age 12-14, involving patient/parent education and communication with future adult care providers.
- The approach addresses refractory cases, those with persistent lower urinary tract symptoms (LUTS)/nocturia, and emphasizes continuity of care.
Background:
Nocturnal enuresis is generally considered a children's condition, yet it may persist 1%-2% in adolescence and early adulthood. Refractory patients often demand follow-up by multidisciplinary teams, which is only restricted to some of the expert tertiary centers. However, there are no standardized transition programs/guidelines when follow-up must be passed from pediatric to adult healthcare providers.
Aim, Materials & Methods:
To investigate this issue, we conducted a literature search on enuresis transition, which resulted in no articles. We, therefore, proceeded in a rescue search strategy: we explored papers on transition programs of conditions that may be related and/or complicated by enuresis, nocturia, or other urinary symptoms (chronic diseases, CKD, bladder dysfunction, kidney transplant, neurogenic bladder).
Results:
These programs emphasize the need for a multidisciplinary approach, a transition coordinator, and the importance of patient and parent participation, practices that could be adopted in enuresis. The lack of continuity in enuresis follow-up was highlighted when we investigated who was conducting research and publishing on enuresis and nocturia. Pediatric disciplines (50%) are mostly involved in children's studies, and urologists in the adult ones (37%).
Discussion:
We propose a stepwise approach for the transition of children with enuresis from pediatric to adult care, depending on the clinical subtype: from refractory patients who demand more complex, multidisciplinary care and would benefit from a transition coordinator up to children/young adults cured of enuresis but who persist in having or present lower urinary tract symptoms (LUTS)/nocturia later on. In any case, the transition process should be initiated early at the age of 12-14 years, with adequate information to the patient and parents regarding relapses or LUTS/nocturia occurrence and of the future treating general practitioner on the enuresis characteristics and comorbidities of the patient.
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