Evaluating the potential ethical and legal challenges of transitional care in urological surgery - A tale of two continents.

Transitional urology services have been shown to be essential in promoting health, reducing morbidity and mortality, and lowering healthcare costs, with no ethical grounds for objection. There is a need for an integrative framework in transitional care, focusing on autonomy, trust, equality, and human rights, as well as to address disparities faced by adolescents with congenital and acquired urological conditions in countries without formalised transitional care. European countries without a formal transition and congenital adult service may find themselves in breach of the European Convention on Human Rights (ECHR) and, where applicable, the EU Charter of Fundamental Rights, due to the principle of primacy, and therefore this cohort is being unjustly discriminated against as both minors and as those with a form of disability. Following the UK's departure from the European Union, the EU Charter of Fundamental Rights no longer applies; however, the ECHR remains incorporated into UK domestic law via the Human Rights Act 1998. In North America, relevant legal protections - including the Americans with Disabilities Act (1990) and the Accessible Canada Act (2019) - create ethical and legal obligations to provide equitable care, though without the same primacy-based enforcement mechanisms as European convention law. In advocating for the establishment of dedicated specialists and tailored services, logistical and ethical challenges must be considered when managing these patients within an under-resourced healthcare system. Addressing these challenges requires multidisciplinary collaboration. By recognising and actively working to overcome these obstacles, healthcare systems can better support individuals with congenital anomalies throughout their lives.