Racial variation in timing of pyeloplasty: prenatal versus postnatal diagnosis.
OBJECTIVE
We have previously shown that nonwhite patients with ureteropelvic junction obstruction undergo pyeloplasty at a younger age than white patients. The mechanisms behind this finding are unclear, since there is no known racial variation in the natural history of ureteropelvic junction obstruction. We used a detailed clinical database to explain this phenomenon.


METHODS
We retrospectively reviewed all patients undergoing primary pyeloplasty at our institution between 1992 and 2008. More than 360 data points were abstracted for each patient, including self-reported race, socioeconomic status, symptom duration and presentation.


RESULTS
Of 847 patients undergoing pyeloplasty during the study period 741 met inclusion criteria. Nonwhite patients underwent surgery at a younger age (0.6 years) than whites (2.6 years, p <0.0001). When stratified by timing of clinical presentation (prenatal vs postnatal), there was no significant difference in race among patients presenting prenatally (0.37 vs 0.36 years, p = 0.22). Nonwhite patients presenting postnatally were significantly younger than white patients (6.3 vs 8.2 years, p = 0.03). This finding appeared to be due to differences in age at initial clinical presentation (5.4 vs 7.0 years, p = 0.03) and in time from initial clinical presentation to urological evaluation (0.6 vs 3.2 months, p = 0.03). These differences persisted after correcting for other factors, including markers of socioeconomic status.


CONCLUSIONS
Consistent with previous studies, we found that nonwhite patients underwent primary pyeloplasty at a younger age than whites. This difference is limited to patients presenting after birth. Prenatally diagnosed patients underwent surgery at similar ages regardless of race.
Department of Urology, Children's Hospital Boston, Harvard Medical School, Boston, Massachusetts 02115, USA.
Jonathan C
JC
Routh
Melanie
M
Pennison
Ilina
I
Rosoklija
Sarah
S
Dobbins
Paul J
PJ
Kokorowski
Katherine C
KC
Hubert
Lin
L
Huang
Caleb P
CP
Nelson
D001741:Black or African American; D001213:Asian; D002648:Child; D002675:Child, Preschool; D005260:Female; D054625:Healthcare Disparities; D006630:Hispanic or Latino; D006801:Humans; D007223:Infant; D007682:Kidney Pelvis / Q000601:surgery*; D008297:Male; D011296:Prenatal Diagnosis; D012189:Retrospective Studies; D013997:Time Factors; D014517:Ureteral Obstruction / Q000175:diagnosis / Q000601:surgery*; D044465:White People