BJU international · 2025
Male sex is a risk factor for detrusor pressure jeopardising the upper urinary tract in patients with spinal cord injury.
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Birkhäuser Veronika, Anderson Collene E, Kozomara Marko, Brinkhof Martin W G, Gross Oliver, Leitner Lorenz, Liechti Martina D, Mehnert Ulrich, Stächele Lara, Kessler Thomas M
Аннотация
OBJECTIVE: To evaluate sex differences in maximum storage detrusor pressure (Pdetmax storage), focusing on Pdetmax storage ≥40 cmH2O, an established risk factor for upper urinary tract damage, within the first year after spinal cord injury (SCI).
PATIENTS AND METHODS: 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.
RESULTS: Of 97 patients, 34% were female. Within the first year after SCI, 9% of females presented with a Pdetmax storage ≥40 cmH2O, compared to 55% of males (P < 0.001). Females had lower Pdetmax 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).
CONCLUSIONS: Females rarely reached a Pdetmax storage ≥40 cmH2O during the first year after SCI and had lower Pdetmax 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.
PATIENTS AND METHODS: 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.
RESULTS: Of 97 patients, 34% were female. Within the first year after SCI, 9% of females presented with a Pdetmax storage ≥40 cmH2O, compared to 55% of males (P < 0.001). Females had lower Pdetmax 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).
CONCLUSIONS: Females rarely reached a Pdetmax storage ≥40 cmH2O during the first year after SCI and had lower Pdetmax 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.