National Trends and Disparities in Surgical Management of Neurogenic Bladder

AIM: Neurogenic bladder (NGB) includes a heterogeneous group of patients with impaired bladder control. Surgical management ranges from continent procedures that preserve urinary control to incontinent diversions. Prior studies report NGB treatment disparities but are limited to single institutions or specific etiologies. We examined national trends and disparities in continent versus incontinent urinary diversions among NGB patients. METHODS: We conducted a retrospective cross-sectional analysis using the 2016-2022 National Inpatient Sample. ICD-10 codes classified NGB hospitalizations by congenital (e.g. cerebral palsy, spina bifida) or acquired etiologies (e.g. multiple sclerosis, paraplegia). Outcomes included major continent (bladder augmentation, neobladder, catheterizable channels) or incontinent surgeries (ileal conduit, vesicostomy, cutaneous ureterostomy, colon conduit). Patient demographics, comorbidities, and hospital characteristics were compared by urinary diversion type. Multivariable analyses identified factors associated with incontinent diversions. RESULTS: An unweighted total of 312,486 NGB hospitalizations were identified, including 19,539 congenital and 133,700 acquired NGB hospitalizations. Among these, 1523 admissions underwent a major urinary diversion procedure, 60% of which were incontinent. Patients undergoing incontinent diversions were older and more likely to have public health insurance. On multivariable analysis, older age, male sex, public insurance, and pre-existing colostomy were factors independently associated with incontinent diversion. NGB etiology itself was not associated with diversion type. Hospital characteristics also did not differ by diversion type. CONCLUSIONS: Our findings highlight the potential influence of demographic and socioeconomic factors on surgical management of NGB. As the first national study encompassing diverse NGB etiologies and major inpatient surgeries, these results underscore possible disparities in access to continent urinary diversions and the need for strategies to ensure equitable care for all NGB patients.