# Association Between Social Determinants of Health and Choice of Urinary Reconstruction in Children — GCMD Library

Dr. Megan Read Ivaturi from Nationwide Children's Hospital discusses a study on how social determinants of health influence the choice of urinary reconstruction in children. The research, a single-institution retrospective study of 208 patients, reveals that while insurance type and childhood opportunity index had no impact, factors like food insecurity, missed appointments, and unmarried parents were associated with incontinent reconstruction. Interestingly, patients traveling from out of state were more likely to receive continent diversions. This highlights the critical role social stability and access to follow-up play in surgical decision-making and sustainable patient care.

Kristine L Griffin, Jeremy M Lun, Alexandra Bain, Shruthi Srinivas, Ihab Halaweish, Richard J Wood, Daniel DaJusta, Molly E Fuchs

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.

Type: video · 1 min · posted 2026-06-09
Canonical: https://library.globalcastmd.com/watch/association-between-social-determinants-of-health-and-choice-of-urinary-reconstruction-in-children-12168

## Chapters
- [0:00](https://library.globalcastmd.com/watch/association-between-social-determinants-of-health-and-choice-of-urinary-reconstruction-in-children-12168?t=0) Study Design and Population
- [0:31](https://library.globalcastmd.com/watch/association-between-social-determinants-of-health-and-choice-of-urinary-reconstruction-in-children-12168?t=31) Key Findings
- [0:54](https://library.globalcastmd.com/watch/association-between-social-determinants-of-health-and-choice-of-urinary-reconstruction-in-children-12168?t=54) Clinical Implications

## Statements
- "The study was a single institution retrospective study of 208 patients with neurogenic bladder, anorectal malformations, myelomeningocele, and other spinal cord pathology who underwent urinary reconstruction between 2014 and 2021" — Megan Reedy Vituri (epidemiological) [0:11](https://library.globalcastmd.com/watch/association-between-social-determinants-of-health-and-choice-of-urinary-reconstruction-in-children-12168?t=11)
- "About 74% of patients underwent continent reconstruction and 26% underwent incontinent reconstruction" — Megan Reedy Vituri (epidemiological) [0:32](https://library.globalcastmd.com/watch/association-between-social-determinants-of-health-and-choice-of-urinary-reconstruction-in-children-12168?t=32)
- "There was no difference in reconstruction type based on insurance type" — Megan Reedy Vituri (epidemiological) [0:38](https://library.globalcastmd.com/watch/association-between-social-determinants-of-health-and-choice-of-urinary-reconstruction-in-children-12168?t=38)
- "There was no difference in reconstruction type based on childhood opportunity index" — Megan Reedy Vituri (epidemiological) [0:38](https://library.globalcastmd.com/watch/association-between-social-determinants-of-health-and-choice-of-urinary-reconstruction-in-children-12168?t=38)
- "Patients who had incontinent reconstruction were more likely to have food insecurity" — Megan Reedy Vituri (epidemiological) [0:38](https://library.globalcastmd.com/watch/association-between-social-determinants-of-health-and-choice-of-urinary-reconstruction-in-children-12168?t=38)
- "Patients who had incontinent reconstruction were more likely to have missed appointments" — Megan Reedy Vituri (epidemiological) [0:38](https://library.globalcastmd.com/watch/association-between-social-determinants-of-health-and-choice-of-urinary-reconstruction-in-children-12168?t=38)
- "Patients who had incontinent reconstruction were more likely to have unmarried parents" — Megan Reedy Vituri (epidemiological) [0:38](https://library.globalcastmd.com/watch/association-between-social-determinants-of-health-and-choice-of-urinary-reconstruction-in-children-12168?t=38)
- "Patients who traveled from out of state were more likely to have a continent diversion" — Megan Reedy Vituri (epidemiological) [0:49](https://library.globalcastmd.com/watch/association-between-social-determinants-of-health-and-choice-of-urinary-reconstruction-in-children-12168?t=49)
- "Social stability and the ability to engage with follow-up may be influencing what surgeons offer families as well as what families can realistically manage" — Megan Reedy Vituri (opinion) [0:57](https://library.globalcastmd.com/watch/association-between-social-determinants-of-health-and-choice-of-urinary-reconstruction-in-children-12168?t=57)
- "The best reconstruction isn't just one that's technically feasible, it also needs to be sustainable for patients and their families" — Megan Reedy Vituri (opinion) [1:08](https://library.globalcastmd.com/watch/association-between-social-determinants-of-health-and-choice-of-urinary-reconstruction-in-children-12168?t=68)

## Transcript
Do social factors quietly determine what urinary reconstruction our patients end up getting? My name is Megan Reedy Vituri with the Center for Colorectal and Pelvic Reconstruction at Nationwide Children's Hospital, and this is an article you should know about. This was a single institution retrospective study of 208 patients with neurogenic bladder, anal rectum malformations, myelomaningocele, and other spinal cord pathology who underwent urinary reconstruction between 2014 and 2021. Our team compared continent versus incontinent. Conversions and asked the question, how are social determinants of health playing a role? So what did they find? About 74% underwent continent reconstruction and 26% underwent incontinent reconstruction. There was no difference based on insurance type or childhood opportunity index, but patients who had incontinent reconstruction were more likely to have food insecurity, missed appointments and unmarried parents. And interestingly, patients who traveled from out of state were more likely to have a continent diversion. So what's the takeaway? This isn't just about surgical preference or anatomy. Social stability and the ability to engage with follow-up may be influencing what we offer our families as well as what families can realistically manage. If social factors are steering our decision making, we need to know this upfront. The best reconstruction isn't just one that's technically feasible, it also needs to be sustainable for patients and their families. So would this change the way you think about counseling your families or choosing a reconstruction pathway in your practice? Let us know in the comments below.

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Not medical advice · citation policy: https://library.globalcastmd.com/ai