Male sex is a risk factor for detrusor pressure jeopardising the upper urinary tract in patients with spinal cord injury.

Abstract

To evaluate sex differences in maximum storage detrusor pressure (Pdet_max storage), focusing on Pdet_max storage ≥40 cmH₂O, an established risk factor for upper urinary tract damage, within the first year after spinal cord injury (SCI). A cohort of patients with neurogenic lower urinary tract dysfunction due to acute traumatic or ischaemic SCI, managed according to the European Association of Urology Guidelines on Neuro-Urology, prospectively underwent urodynamic investigations at 1, 3, 6 and 12 months after SCI at a university SCI centre. Pearson's chi-squared tests and multivariable regression analyses were used to compare outcomes between females and males. Of 97 patients, 34% were female. Within the first year after SCI, 9% of females presented with a Pdet_max storage ≥40 cmH₂O, compared to 55% of males (P < 0.001). Females had lower Pdet_max storage than males, with a grand mean (standard deviation [SD]) of 13 (9) vs 30 (20) cmH₂O (coefficient = 18 cmH₂O, 95% confidence interval [CI] 13-24 cmH₂O; P < 0.001). Females also had lower detrusor overactivity leak-point pressure (DOLPP) than males, with a grand mean (SD) of 15 (4) vs 35 (21) cmH₂O (coefficient = 20 cmH₂O, 95% CI 11-29 cmH₂O; P < 0.001). The cumulative incidence of antimuscarinic therapy and reported urinary incontinence was similar between sexes (female vs male: 55% vs 70%, P = 0.12; 53% vs 43%, P = 0.42, respectively). Females rarely reached a Pdet_max storage ≥40 cmH₂O during the first year after SCI and had lower Pdet_max storage and DOLPP than males. However, the prevalence of urinary incontinence was similar between the sexes, suggesting the need for a more sex-tailored approach to patient management.