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Wood D, Welk B, Khavari R, Stoffel J, Elliott S, Stampas A, Sadeghi Z, Elliott C, Lenherr S. Growing Up With Neurogenic Bladder: Navigating the Challenges and Controversies in Pediatric to Adult Transition and Lifelong Care: A Report From the Neurogenic Bladder Research Group (NBRG). Neurourol Urodyn 2024. [PMID: 39315672 DOI: 10.1002/nau.25590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2024] [Accepted: 09/05/2024] [Indexed: 09/25/2024]
Abstract
OBJECTIVE Young adults with spina bifida (and other congenital neurologic diseases) have their own aspirations that may include education, employment, relationships and having children. As they move from pediatric to adult care, they must eventually transition to an adult healthcare team. The objective of this paper is to review the challenges and controversies in the transitional and adult care of people with congenital neurourological diseases. METHODS The Research Group convened a meeting of its members and invited guests to better understand the healthcare challenges faced by these patients as they become adults. The group examined potential research opportunities focused on people with these diagnoses and themes related to their healthcare. RESULTS Trust and clear communication are essential for effective patient transition. Ideally parents are involved in the transition to help reinforce independent self-care and responsibility. Adolescents require education about sexual health and independence, which may not be part of the core skillset of a urologist. The healthcare team must promote self-management and autonomy as early as practical. One of the major limitations is that adult care lacks the coordination of pediatric care, and patients may not have a "medical home." Multidisciplinary clinics are ideal but face logistical barriers in adult medicine. Additional barriers include limited physicians with the required specialized training. In the adult system, financial constraints are a key challenge for patients and providers. CONCLUSION Collaboration, supported by institutions and new research, is vital for improving the neurourological care of young adults with complex diseases. TRIAL REGISTRATION This study reports on the proceedings of a meeting, and therefore clinical trial registration was not necessary.
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Affiliation(s)
- Dan Wood
- University of Colorado School of Medicine, Colorado, USA
| | - Blayne Welk
- Department of Surgery, Western University, Ontario, Canada
| | - Rose Khavari
- Houston Methodist, West Cornell Medical College, Texas, USA
| | - John Stoffel
- Department of Urology, University of Michigan, Ann Arbor, Michigan, USA
| | - Sean Elliott
- University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Argy Stampas
- Memorial Hermann, UT Health, Houston, Texas, USA
| | - Zhina Sadeghi
- Reconstructive Urology, Urology Department, University of California, Irvine, California, USA
| | - Chris Elliott
- Division of Urology, Santa Clara Valley Medical Center, San Jose, California, USA
- Department of Urology, Stanford University Medical Center, Stanford, California, USA
| | - Sara Lenherr
- University of Utah Health, Salt Lake City, Utah, USA
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Roth JD, Miller MA, O'Neil JO, Wiener JS, Wood HM. Transitioning young adults with spina bifida: Challenges and paths to success. J Pediatr Urol 2024; 20:200-210. [PMID: 37788943 DOI: 10.1016/j.jpurol.2023.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 09/13/2023] [Accepted: 09/14/2023] [Indexed: 10/05/2023]
Abstract
INTRODUCTION AND BACKGROUND Recent medical advances, including closure of myelomeningocele defects, shunting of hydrocephalus, and focusing on renal preservation have led to many individuals with spina bifida (SB) living into adulthood. This has led to more individuals with SB transitioning their care from pediatric-based to adult-based care models. OBJECTIVE We seek to explore the process of transition, with a focus on difficulties in transitioning individuals with SB. Additionally, we explore new problems that arise during the period of transition related to sexual function and dysfunction. We also discuss some of the difficulties managing neurogenic bladder and the sequalae of their prior urologic surgeries. STUDY DESIGN Each of the authors was asked to provide a summary, based on current literature, to highlight the challenges faced in their area of expertise. CONCLUSIONS Transitioning care for individuals with SB is especially challenging due to associated neurocognitive deficits and neuropsychological functioning issues. Sexual function is an important component of transition that must be addressed in young adults with SB. Management of neurogenic bladder in adults with SB can be challenging due to the heterogeneity of the population and the sequelae of their prior urologic surgeries. The aim is to ensure that all individuals with SB receive appropriate, evidence-based care throughout their lifetime.
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Affiliation(s)
- Joshua D Roth
- Department of Urology, Riley Hospital for Children, Indiana University School of Medicine, United States.
| | - Matthew A Miller
- Department of Pediatrics, Riley Hospital for Children, Indiana University School of Medicine, United States
| | - Joseph O O'Neil
- Department of Pediatrics, Riley Hospital for Children, Indiana University School of Medicine, United States
| | - John S Wiener
- Division of Urology, Duke University School of Medicine, United States
| | - Hadley M Wood
- Department of Urology, Cleveland Clinic, United States
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Rague JT, Hirsch J, Rosoklija I, Meyer T, Streur C, Kielb S, Cheng EY, Bowen DK, Yerkes EB, Chu DI. Male perspectives on clinical communication about sexual health in spina bifida. Dev Med Child Neurol 2024; 66:389-397. [PMID: 37421342 PMCID: PMC10772204 DOI: 10.1111/dmcn.15709] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 05/17/2023] [Accepted: 06/20/2023] [Indexed: 07/10/2023]
Abstract
AIM To assess perspectives on clinical communication about sexual health in young adult males with spina bifida. METHOD Semi-structured interviews were conducted between February and May 2021 with males at least 18 years of age with spina bifida to assess their perspectives and experiences of sexual health communication with clinicians. Demographic and clinical characteristics were obtained from chart review and a survey of patients. Interviews were transcribed verbatim, and conventional content analysis was used for transcript coding. RESULTS Twenty individuals participated with a median age of 22 years 6 months (range 18-29 years). Sixteen had myelomeningocele. Most identified as heterosexual (n = 17) and not sexually active (n = 13). Barriers and facilitators of successful interactions were identified. Barriers for participants included general discomfort with talking about sex and variability in individual preferences for how conversations occur. Facilitators included participants' comfort with their urologist and discussing sex in relation to disability. Suggestions for improving discussions included (1) notifying individuals that discussion about sex will occur before clinic visits; (2) creating space for discussions; (3) respecting individuals' readiness to discuss; and (4) making discussions disability specific. INTERPRETATION Young adult males with spina bifida are interested in discussing sexual health with their clinicians. Great variability exists about conversation preferences, emphasizing the need to individualize clinical communication about sex. Current health guidelines for males may not be in line with individuals' wishes. WHAT THIS PAPER ADDS Great variability exists in individual preference around sexual health communication. Patient-level barriers hinder successful conversations about sex. Individuals have great insight into how conversations about sex can be improved.
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Affiliation(s)
- James T Rague
- Division of Urology, Ann & Robert H Lurie Children’s Hospital of Chicago, Chicago, IL, USA
| | - Josephine Hirsch
- Division of Urology, Ann & Robert H Lurie Children’s Hospital of Chicago, Chicago, IL, USA
| | - Ilina Rosoklija
- Division of Urology, Ann & Robert H Lurie Children’s Hospital of Chicago, Chicago, IL, USA
| | - Theresa Meyer
- Division of Urology, Ann & Robert H Lurie Children’s Hospital of Chicago, Chicago, IL, USA
| | - Courtney Streur
- Division of Urology, CS Mott Children’s Hospital, University of Michigan, Ann Arbor, MI, USA
| | - Stephanie Kielb
- Department of Urology, Northwestern Feinberg School of Medicine, Chicago, IL, USA
| | - Earl Y Cheng
- Division of Urology, Ann & Robert H Lurie Children’s Hospital of Chicago, Chicago, IL, USA
| | - Diana K Bowen
- Division of Urology, Ann & Robert H Lurie Children’s Hospital of Chicago, Chicago, IL, USA
| | - Elizabeth B Yerkes
- Division of Urology, Ann & Robert H Lurie Children’s Hospital of Chicago, Chicago, IL, USA
| | - David I Chu
- Division of Urology, Ann & Robert H Lurie Children’s Hospital of Chicago, Chicago, IL, USA
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Hensel DJ. Discussing sexual health in spina bifida: An individualized, patient-centered approach. Dev Med Child Neurol 2024; 66:280-281. [PMID: 37584570 DOI: 10.1111/dmcn.15726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 07/20/2023] [Indexed: 08/17/2023]
Abstract
This commentary is on the original article by Rague et al. on pages 389–397 of this issue.
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Affiliation(s)
- Devon J Hensel
- Indiana University School of Medicine - Pediatrics, Indianapolis, IN, USA
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Lutz CM, Onwuka A, Fuchs ME, Carey M, Griffey J, Hobensack VL, Sharpe Scandinaro J, McCracken K. Sexual and reproductive health education for patients with myelomeningocele. Dev Med Child Neurol 2023; 65:1105-1111. [PMID: 36631940 DOI: 10.1111/dmcn.15494] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Revised: 11/16/2022] [Accepted: 11/18/2022] [Indexed: 01/13/2023]
Abstract
AIM To evaluate the sexual and reproductive health education received by patients with myelomeningocele, the most severe form of spina bifida. METHOD A survey designed to assess the sexual and reproductive health education given by a healthcare provider to patients with myelomeningocele was offered to all English-speaking patients aged 12 years or older with a myelomeningocele clinic visit. RESULTS In total, 67 surveys were completed. Menstruation and menstrual management were discussed at a rate of 85% in females. Few patients had discussions with a provider about fertility (42%), sexuality (37%), risk of sexually transmitted infections (45%), or had a relationship with a reproductive healthcare provider (54%). Differences by sex were observed for contraceptive education. The rate of discussions increased with age. A total of 67% of female patients and 33% of male patients requested a referral to a reproductive healthcare provider. INTERPRETATION Sexual and reproductive health education is part of comprehensive care for all patients and those with disabilities should not be excluded. The lack of consistent education received by patients supports the need for increased attention to this topic. We encourage multidisciplinary myelomeningocele clinics to establish a process for delivering complete and patient-specific sexual and reproductive health education.
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Affiliation(s)
- Carley M Lutz
- Center for Surgical Outcomes Research, Center for Innovation in Pediatric Practice, The Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, OH, USA
| | - Amanda Onwuka
- Center for Surgical Outcomes Research, Center for Innovation in Pediatric Practice, The Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, OH, USA
| | - Molly E Fuchs
- Department of Urology, Nationwide Children's Hospital, Columbus, OH, USA
| | - Margaret Carey
- Myelomeningocele Clinic, Nationwide Children's Hospital, Columbus, OH, USA
| | - Judy Griffey
- Myelomeningocele Clinic, Nationwide Children's Hospital, Columbus, OH, USA
| | | | | | - Kate McCracken
- Department of Pediatric and Adolescent Gynecology, Nationwide Children's Hospital, Columbus, OH, USA
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Houtrow AJ. Advancing sexual health care in spina bifida multidisciplinary clinics and beyond. Dev Med Child Neurol 2023; 65:1002-1003. [PMID: 36698252 DOI: 10.1111/dmcn.15527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Accepted: 01/05/2023] [Indexed: 01/27/2023]
Abstract
This commentary is on the original article by Lutz et al. on pages 1105–1111 of this issue.
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Affiliation(s)
- Amy J Houtrow
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, School of Medicine, Pittsburgh, PA, USA
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Hensel DJ, Misseri R, Wiener JS, Roth JD, Whittam BM, Cain MP, Szymanski KM. Solo and Partnered Sexual Behavior Among an International Sample of Adults With Spina Bifida. J Sex Med 2022; 19:1766-1777. [PMID: 36216747 DOI: 10.1016/j.jsxm.2022.08.201] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 08/19/2022] [Accepted: 08/26/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Spina bifida (SB) may differentially impact adults' participation in solo and partnered sexual behaviors, but little research investigates this topic. AIM Describe solo and partnered sexual behaviors among an international sample of adult men and women with SB. MAIN OUTCOME MEASURES Ever participated (no/yes) and recent participation (>1 year ago/within last year) in solo masturbation, cuddled with a partner, held hands with a partner, kissed a partner, touched a partner's genital, had genitals touched by a partner, gave a partner oral sex, received oral sex from a partner, vaginal sex, anal sex, and sex toy use. METHODS Data were drawn from a larger cross-sectional, internet-based survey assessing the sexual behaviors of an international sample of men and women with SB. We used logistic regression to examine the impact of background (gender, age, independent living, and relationship status) and health (shunt status, ambulation, and genital sensation) factors on each outcome. RESULTS The sample consisted of 345 respondents aged 18-73 years from 26 nations. Very few (<3%) had no lifetime experience with any solo or partnered behaviors; 25.0% reported participating in all behaviors at some point in their lives. The median number of past year sexual behaviors (of 16 total) was 7. Lifetime and recent participation were associated with demographic and health factors. CLINICAL IMPLICATIONS Despite impairment, adults with spina bifida do participate in solo and partnered sexual behaviors. Medical personnel who work with this population should include discussions about sexuality as part of routine care. STRENGTHS & LIMITATIONS Although this research measured solo and partnered sexual behavior in large international sample of adults with spina bifida, it is limited by its cross-sectional retrospective design and non-clinical convenience sample. CONCLUSION Despite disability, many adults with SB participate in solo and partnered sexual behavior. Medical and psychosocial supports are needed to help adults in this population enjoy sexuality in a healthy and safe manner. Hensel DJ, Misseri R, Wiener JS, et al. Solo and Partnered Sexual Behavior Among an International Sample of Adults With Spina Bifida. J Sex Med 2022;19:1766-1777.
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Affiliation(s)
- Devon J Hensel
- Section of Adolescent Medicine, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA; Department of Sociology, Indiana University Purdue University-Indianapolis, Indianapolis, IN, USA.
| | - Rosalia Misseri
- Division of Pediatric Urology, Riley Hospital for Children at Indiana University Health, Indianapolis, IN, USA
| | - John S Wiener
- Division of Urologic Surgery, Department of Surgery, Duke University Medical Center, Durham, NC, USA
| | - Joshua D Roth
- Division of Pediatric Urology, Riley Hospital for Children at Indiana University Health, Indianapolis, IN, USA
| | - Benjamin M Whittam
- Division of Pediatric Urology, Riley Hospital for Children at Indiana University Health, Indianapolis, IN, USA
| | - Mark P Cain
- Division of Pediatric Urology, Riley Hospital for Children at Indiana University Health, Indianapolis, IN, USA
| | - Konrad M Szymanski
- Division of Pediatric Urology, Riley Hospital for Children at Indiana University Health, Indianapolis, IN, USA
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