Prenatal Urologic Consultation for Prenatal Hydronephrosis: True Equity or Hidden Disparity?

INTRODUCTION

Prenatal urologic consultation (PUC) is now offered to many prospective parents for fetal prenatal hydronephrosis (PH). This study aims to describe patient- and community-level differences in prenatal and postnatal urologic care patterns for patients with PH and to identify potentially modifiable factors that would improve timely access to care.

METHODS

We identified all patients with PH aged <6 mos seen at a single freestanding children's hospital from January 2021 to December 2022. Data were collected on patient gender, race/ethnicity, characteristics of upper tract dilatation, timing of delivery, and socioeconomic status. Patients with and without PUC were compared.

RESULTS

Two hundred and fifty patients met inclusion criteria. One hundred seventy-nine (71.6%) were male, 122 (48.8%) were White, and 56 (22.4%) had PUC. Patients with PUC had postnatal evaluation earlier than those without PUC (0.62 [0.2-5.0] versus 2.1 [0.1-12.8] months (P < 0.0001) but were equally likely to have bilateral PH (41.1% versus 41.2%, P = 0.73). Patients speaking English (54/229; 23.6%) and other languages (LOE; 2/21; 9.5%) were equally likely to have PUC. Children living in the least (Area Deprivation Index [ADI], 1-2) and moderately disadvantaged areas (ADI, 3-8) were equally (odds ratio [OR] = 1.52; 95% confidence interval [CI]: 0.55-4.23) and three times (OR = 2.99; 95% CI: 1.16-7.67) as likely to have PUC as those living in the most disadvantaged areas (ADI, 9-10), respectively. Of preterm infants, 25% of those living in ADI 1-2 had PUC, compared with 0% of those living in ADI 9-10 (OR = 3.32; 95% CI, 0.57-11.4), and 24% of those speaking English had PUC, compared with 0% of those with LOE (OR = 1.98; 95% CI, 0.09-45.6). The likelihood of PUC for patients with bilateral PH was similar for patients living in ADI 1-2 (6/33; 18.2%) and ADI 9-10 (2/19; 10.5%; OR = 1.89 [95% CI, 0.34-10.45]) and for those speaking English (23/96; 24%) and LOE (0/7; 0%; OR = 4.80 [95% CI, 0.26-87.2]).

CONCLUSIONS

PUC is associated with earlier postnatal urologic evaluation, but-in our series-not with PH laterality, language, race, or lowest levels of neighborhood disadvantage. However, the proportion with and without PUC in certain subgroups was notably low. Further research centering on patient groups with low PUC utilization may identify patient- and community-level factors associated with differential access to care.