title: Patient and disease-specific factors and their influence on urinary reconstruction choice at a referral center.
abstract: OBJECTIVE
  To evaluate potential socioeconomic and demographic factors that may influence or be associated with various types of urinary reconstruction (UR) following a radical cystectomy (RC) accounting for existing clinical variables.
  
  
  METHODS
  There were 828 patients that underwent a RC and UR between 2000 and 2013. After excluding patients that did not meet medical or surgical criteria for a continent urinary reconstruction (CUR-orthotopic neobladder or continent catheterizable pouch), there were 714 patients available for analysis. Socioeconomic and demographic data along with disease-specific variables were recorded preoperatively and analyzed to determine a correlation with a particular type of UR.
  
  
  RESULTS
  Non-continent urinary reconstruction (ileal conduit or cutaneous ureterostomies) and CUR accounted for 78.3 % (559/714) and 21.7 % (155/714) of UR following RC, respectively. On univariate analysis, younger age, marital status, employment status, type of insurance, ASA score, and preoperative glomerular filtration rate were significantly associated with CUR (p < 0.01). Travel distance, race, and education level were not factors for UR type. Additionally, there was no significant difference between males and females receiving a CUR. On multivariate analysis, older age [odds ratio (OR) 0.85, p < 0.01], marital status (OR 0.28, p < 0.01), insurance status (OR 0.22, p = 0.04), and higher ASA score (OR 0.50, p < 0.01) remained independent predictors of those less likely to receive a CUR.
  
  
  CONCLUSIONS
  Predictable socioeconomic and demographic influences exist between the choice of UR after RC. Increasing age corresponds to a decreasing likelihood of receiving a CUR. No significant difference was seen between men and women in undergoing a CUR.
authors.affiliation: Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Dr, Tampa, FL, 33612, USA. adam.luchey@moffitt.org.
authors.forename: Adam M
authors.initials: AM
authors.lastname: Luchey
authors.affiliation: Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Dr, Tampa, FL, 33612, USA.
authors.forename: Gautum
authors.initials: G
authors.lastname: Agarwal
authors.affiliation: Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Dr, Tampa, FL, 33612, USA.
authors.forename: Patrick N
authors.initials: PN
authors.lastname: Espiritu
authors.affiliation: Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Dr, Tampa, FL, 33612, USA.
authors.forename: Jorge L
authors.initials: JL
authors.lastname: Lockhart
authors.affiliation: Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Dr, Tampa, FL, 33612, USA.
authors.forename: Julio M
authors.initials: JM
authors.lastname: Pow-Sang
authors.affiliation: Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Dr, Tampa, FL, 33612, USA.
authors.forename: Philippe E
authors.initials: PE
authors.lastname: Spiess
authors.affiliation: Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Dr, Tampa, FL, 33612, USA.
authors.forename: Wade J
authors.initials: WJ
authors.lastname: Sexton
authors.affiliation: Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Dr, Tampa, FL, 33612, USA.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Poch
mesh_terms: D000368:Aged; D015653:Cystectomy / Q000523:psychology*; D003657:Decision Making; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D012017:Referral and Consultation; D012189:Retrospective Studies; D012307:Risk Factors; D012959:Socioeconomic Factors; D001749:Urinary Bladder Neoplasms / Q000523:psychology / Q000601:surgery*; D016476:Urinary Reservoirs, Continent
keywords: Cystectomy; Demographics; Socioeconomic status; Urinary bladder neoplasms; Urinary diversion