We agree that the retrospective nature of the study introduces biases that prevent making definitive proclamations about race and its effect on urethroplasty success. Unfortunately, one ofthese limitations includes the number of dilations or DVIUs that patients have received in the past. Often times patients are unsure how many endoscopic procedures they have undergone because it has been so numerous. This limitation would be useful to explore in future studies as an additional factor that might be compounding quality and access of care. Further investigation may reveal potential disparities as certain populations may receive excessive endoscopic procedures and delayed treatment with urethroplasty. Ultimately, we agree with the assertion that larger studies would be helpful to identify a true association and that our analysis is hypothesis generating. Nonetheless, we are unique in our patient population having a high rate of African-American and black patients being treated at our hospital in the deep South. It would probably take a concerted effort between institutions like ours to assess differences in patient populations. Additionally, a collaboration with professional networks that can collect sociodemographic variables would provide an even more robust evaluation of health disparities in our population. Each of these points discussed show the promising efforts within the scientific and healthcare communities to divulge the disparities that exist and expunge them.
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