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

Objective To evaluate sex differences in maximum storage detrusor pressure (Pdet max storage), focusing on Pdet max storage ≥40 cmH 2 O, 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 Pdet max storage ≥40 cmH 2 O, 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) cmH 2 O (coefficient = 18 cmH 2 O, 95% confidence interval [CI] 13–24 cmH 2 O; 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) cmH 2 O (coefficient = 20 cmH 2 O, 95% CI 11–29 cmH 2 O; 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 Pdet max storage ≥40 cmH 2 O 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.