Urology · 2025
Association Between Social Determinants of Health and Choice of Urinary Reconstruction in Children.
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Griffin Kristine L, Lun Jeremy M, Bain Alexandra, Srinivas Shruthi, Halaweish Ihab, Wood Richard J, DaJusta Daniel, Fuchs Molly E
Аннотация
OBJECTIVE: To examine if social determinants of health (SDH) are associated with the type of urological reconstruction performed in patients with neurogenic bladder secondary to myelomeningocele and anorectal malformations.
METHODS: A single-institution retrospective review was performed in children with incontinent urinary reconstruction (IUR) or continent urinary reconstruction (CUR) and a diagnosis of myelomeningocele, anorectal malformation, or spinal cord pathology from years 2014-2021. Demographic, clinical, and SDH data were collected and compared to reconstruction type. Categorical variables were analyzed via Fisher Exact Test. Ordinal variables were analyzed using Cochran-Armitage Test for Trend.
RESULTS: From 2014 to 2021, 208 patients underwent urological reconstruction. Patients had a diagnosis of anorectal malformation (32.2%), myelomeningocele (30.8%), spinal cord pathology (18.8%), other diagnosis (18.3%), or cloacal exstrophy (4.8%). Of the cohort, 154 (74%) had a CUR, and 54 (26%) underwent IUR. Median age at reconstruction was higher in those who underwent CUR (6.7years [IQR 5.3, 9.8]) than for IUR (5.6 [IQR 1.5, 10.5]) (P=.01). There was no difference between insurance type for IUR vs CUR (P=.11). There was no association between Child Opportunity Index (COI) and reconstruction type (P=.5). Patients who underwent IUR were more likely to have experienced food insecurity (P=.02), missed at least one appointment (P=.02), or have unmarried parents (P=.03). Those who lived out of state more often pursued CUR (P=.01).
CONCLUSION: There was an association between SDH and type of urologic reconstruction performed in pediatric patients. Social factors must be considered in preoperative planning for urinary reconstruction.
METHODS: A single-institution retrospective review was performed in children with incontinent urinary reconstruction (IUR) or continent urinary reconstruction (CUR) and a diagnosis of myelomeningocele, anorectal malformation, or spinal cord pathology from years 2014-2021. Demographic, clinical, and SDH data were collected and compared to reconstruction type. Categorical variables were analyzed via Fisher Exact Test. Ordinal variables were analyzed using Cochran-Armitage Test for Trend.
RESULTS: From 2014 to 2021, 208 patients underwent urological reconstruction. Patients had a diagnosis of anorectal malformation (32.2%), myelomeningocele (30.8%), spinal cord pathology (18.8%), other diagnosis (18.3%), or cloacal exstrophy (4.8%). Of the cohort, 154 (74%) had a CUR, and 54 (26%) underwent IUR. Median age at reconstruction was higher in those who underwent CUR (6.7years [IQR 5.3, 9.8]) than for IUR (5.6 [IQR 1.5, 10.5]) (P=.01). There was no difference between insurance type for IUR vs CUR (P=.11). There was no association between Child Opportunity Index (COI) and reconstruction type (P=.5). Patients who underwent IUR were more likely to have experienced food insecurity (P=.02), missed at least one appointment (P=.02), or have unmarried parents (P=.03). Those who lived out of state more often pursued CUR (P=.01).
CONCLUSION: There was an association between SDH and type of urologic reconstruction performed in pediatric patients. Social factors must be considered in preoperative planning for urinary reconstruction.