Sex Disparities in Normal Pressure Hydrocephalus Diagnosis and Urinary Outcomes

Importance Idiopathic normal pressure hydrocephalus (iNPH) is characterized by dementia, gait disturbance, and urinary incontinence (UI). While gait and cognitive impairments trigger a focused workup, UI is often excused by female patients and doctors as normal aging in women. Objectives The objectives of this study were to evaluate sex differences in time from UI documentation to iNPH diagnosis and describe differences in postoperative UI outcomes following ventriculoperitoneal shunt placement. Study Design This was a single-center, retrospective study of patients treated for iNPH who presented with the complete triad of symptoms. The primary outcome was the time from UI documentation to iNPH diagnosis compared between sexes with a 2-tailed Student t test. Sex differences in diagnostic timing and 3-month postoperative outcomes (gait, cognition, and UI) were analyzed with χ 2 tests. Results Eighty-two patients (38 male and 44 female) were included in the analysis. Females experienced a longer time to diagnosis than males (40.3 vs 16.8 mo; P =0.001). Following surgery, no significant sex differences were observed in gait ( P =0.32), cognitive ( P =0.17), or UI improvement ( P =0.11), but females had lower rates of complete UI resolution (13.6% vs 36.8%; P =0.020). In females, but not males, 3-month UI improvement (12.5 vs 46.8 mo; P =0.02) and resolution (1.7 vs 35.4 mo; P =0.002) correlated with shorter time to diagnosis. Conclusions Females with UI face a longer time to iNPH diagnosis and lower rates of complete symptom resolution. Increased awareness of iNPH in this population is essential for timely screening and improved outcomes.