Urinary continence disparities in patients with anorectal malformations

Purpose: While fecal incontinence is a primary concern for many children with anorectal malformations (ARM), urinary incontinence is also prevalent in this population. Racial, ethnic, and socioeconomic dis-parities in urinary continence have been observed in other conditions, but have not been previously eval-uated in ARM. We aimed to evaluate urinary continence and associated demographic and socioeconomic characteristics in individuals with ARM. Methods: We performed a multicenter retrospective study of ARM patients evaluated at sites partici-pating in the Pediatric Colorectal and Pelvic Learning Consortium (PCPLC). We included all patients with ARM 3 years and older. The primary outcome was urinary continence which was categorized as complete (no accidents), daytime (accidents at night), partial (rare or occasional accidents), and none (frequent ac-cidents or no continence). We evaluated for associations between urinary continence and race, sex, age, insurance status, and adoption status, employing Kruskal-Wallis and trend tests. Secondary outcomes in-cluded bladder management strategies such as clean intermittent catheterization and continence surgery. P-value < 0.05 was considered significant. Results: A total of 525 patients with ARM were included. Overall, 48% reported complete urinary con-tinence, and continence was associated with greater age. For school-aged children (age >= 5 years), 58% reported complete continence, while 30% reported none. Public insurance and adoption status were as-sociated with decreased likelihood of incontinence. Conclusions: We observed a novel finding of disparities in urinary continence for children with ARM related to insurance and adoption status. Further investigation regarding the etiologies of these inequities is needed in order to affect clinical outcomes. (c) 2021 Elsevier Inc. All rights reserved.