This study aimed to investigate the relationship between socioeconomic factors, surgical outcomes, and urinary incontinence in individuals with myelomeningocele (MMC), a severe form of spina bifida [1]. The hypothesis was that socioeconomic status and age at surgery would significantly impact postoperative outcomes, including urinary incontinence.

This cross-sectional epidemiological study involved 96 participants diagnosed with MMC who underwent reconstructive surgery at Imam Khomeini Hospital in Sari, Mehrad Urology Center, and Children’s Medical Center in Tehran between January 2021 and January 2023. Data were collected using checklists focusing on demographic and clinical characteristics. Descriptive statistics and statistical tests such as Chi-square tests and Fisher's exact test were utilized to assess relationships among variables.

The study revealed that 55.7% of participants were female, with an average age of 12.62 years (SD = 9.56). Approximately 90% reported urinary issues, and about 40% underwent a second surgery. Significant correlations were found between urologist visit frequency and family income with postoperative follow-up (p < 0.05). There was also a significant relationship between surgical age and postoperative complications, as well as between urinary/defecation control and sensory/movement problems related to the second surgery. No significant correlation was observed between tethered cord surgery and urinary incontinence, nor between shunt surgery and urinary incontinence. The incidence of sensory, movement, and reflex disorders was 57.7%, 61.9%, and 35.6%, respectively. The central provinces of Iran had the highest prevalence of MMC, while Tehran province had the highest surgery rate.

The findings highlight the impact of socioeconomic factors and surgical timing on postoperative outcomes in MMC patients [2, 3]. The high prevalence of urinary issues underscores the need for comprehensive urological care. The lack of correlation between certain surgical interventions and urinary incontinence suggests that other factors may influence urinary outcomes

This study emphasizes the importance of socioeconomic and age-related factors in determining postoperative outcomes for MMC patients, particularly regarding urinary incontinence. It underscores the necessity for tailored surgical and postoperative care strategies to improve quality of life and reduce healthcare costs associated with MMC. Future studies should focus on developing more effective interventions to address urinary incontinence and other complications in this population.

Schindelmann KH, Paschereit F, Steege A, Stoltenburg-Didinger G, Kaindl AM. Systematic classification of spina bifida. Journal of Neuropathology & Experimental Neurology. 2021;80(4):294-305.
Foy AB, Sawin KJ, Derflinger T, Heffelfinger AK, Koop JI, Cohen SS, et al. Sociodemographic disparities in fetal surgery for myelomeningocele: a single-center retrospective review. Journal of Neurosurgery: Pediatrics. 2021;29(4):366-70.
Kalluri AL, Jiang K, Abu-Bonsrah N, Ammar A, Reynolds R, Alomari S, et al. Socioeconomic characteristics and postoperative outcomes of patients undergoing prenatal vs. postnatal repair of myelomeningoceles. Child's Nervous System. 2024;40(4):1177-84.