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 disparities in urinary continence have been observed in other conditions, but have not been previously evaluated 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 participating 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 accidents 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 included 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 continence, 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 associated 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.

中文翻译：

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肛门直肠畸形患者的尿失禁差异

目的

虽然大便失禁是许多患有肛门直肠畸形 (ARM) 的儿童的主要问题，但尿失禁在该人群中也很普遍。在其他情况下已观察到尿失禁的种族、民族和社会经济差异，但之前未在 ARM 中进行过评估。我们旨在评估 ARM 患者的尿失禁以及相关的人口统计学和社会经济特征。

方法

我们对参与儿科结直肠和骨盆学习联盟 (PCPLC) 的站点进行了评估的 ARM 患者的多中心回顾性研究。我们纳入了所有 3 岁及以上的 ARM 患者。主要结果是尿失禁，分为完全（无事故）、白天（夜间事故）、部分（罕见或偶然事故）和无（经常事故或无尿失禁）。我们使用 Kruskal-Wallis 和趋势测试评估了尿失禁与种族、性别、年龄、保险状况和收养状况之间的关联。次要结果包括膀胱管理策略，如清洁间歇导尿和失禁手术。P 值 < 0.05 被认为是显着的。

结果

共纳入 525 名 ARM 患者。总体而言，48% 的人报告完全尿失禁，并且尿失禁与年龄较大有关。对于学龄儿童（年龄 ≥ 5 岁），58% 报告完全失禁，而 30% 报告没有。公共保险和收养状况与尿失禁的可能性降低有关。

结论

我们观察到与保险和收养状况相关的 ARM 儿童尿失禁差异的新发现。为了影响临床结果，需要进一步调查这些不公平的病因。