Presentation Authors: Devin Rogers BS*, Rajeev Chaudhry MD, Pittsburgh, PA, Patrick Fox MD, Charlotte, NC, Mary Killian MD, Pittsburgh, PA
Introduction: Disparities in healthcare have significant impacts on disease presentations and outcomes. The most common cause of congenital lower urinary tract obstruction, posterior urethral valves (PUV), varies in its severity. In spite of ablation, up to 40% of patients develop renal insufficiency by adolescence. We hypothesized that socioeconomic (SE) factors might influence the presentation or progression of disease in our PUV population.
Methods: IRB approval was obtained for a retrospective review of all patients seen in the Pediatric Urology clinic with a diagnosis of PUV over a 20 year period. Of the 148 patients identified, 8 were excluded for incomplete records. Clinical and SE characteristics of these patients were recorded. Patients were first classified by age of diagnosis (AOD), then by progression to renal replacement therapy (RRT). Late presentation was defined as an AOD more than six months.
Results: Overall 14% of patients progressed to RRT. In the early group, 19 patients required RRT (p=0.001). Those patients were significantly more likely to have other comorbidities, extra medical costs, and to have undergone vesicostomy. Trends were noted for Medicaid (p=0.126) and Child Advocacy Center involvement (p=0.121). While they were more likely to have had a cystometrogram (CMG) (p=0.078), only 31% of those receiving a transplant underwent CMG. Patients with delayed diagnosis had a significantly lower median peak Cr, fewer comorbidities and extra medical costs. They were less likely to use Medicaid (p=0.146), and had shorter mean follow up (p=0.0617). Only 1 progressed to RRT. There were no differences between groups by AOD or progression to RRT for race, county of residence, pediatrician on record, immunization status, or legal involvement.
Conclusions: This study demonstrates a significant difference in progression to RRT based on AOD. It supports prior literature that later presenters are on the milder end of the PUV disease spectrum. Though there was no difference in SE factors based on presentation, trends were noted for disease progression. Our study is limited by its retrospective nature, the small sample size, length of follow up, and the information captured within the electronic medical record. Prospective and analysis into late adulthood may provide more information on presentation and long-term outcomes.