Sex and Gender Differences Influence Urinary Symptoms and Management in Multiple System Atrophy
Elke Schipani Bailey1, Sara Hooshmand1, Negin Badihian1, Paola Sandroni1, Eduardo Benarroch1, James Bower1, Phillip Low1, Wolfgang Singer1, Elizabeth Coon1
1Mayo Clinic
Objective:
We sought to characterize sex and gender differences in the symptomatology, evaluation and management of urinary dysfunction in patients with MSA.
Background:
Multiple system atrophy (MSA) is characterized by urinary dysfunction, yet the influence of sex and gender on urinary symptoms and treatment is unclear.
Design/Methods:
Patients with MSA evaluated with autonomic testing at Mayo Clinic between 1998 and 2012 were reviewed for urinary symptoms, diagnostics, and management, and stratified by sex.
Results:
While the prevalence of urinary symptoms was similar between males and females (91.9% vs 89.1%), incontinence was more common amongst females (68.1% vs 50.6% for males, p < 0.001). Despite this, males and females were referred for urodynamic studies at similar rates (27.0% vs 27.7%). Males were more likely to have an elevated postvoid residual on urodynamic studies (72.9% vs 50.5%) which was not driven by comorbid BPH. While male and female patients were initiated on catheterization at similar rates when urodynamic studies were performed, males were more than two times more likely to be catheterized than females without urodynamic evaluation (27.3% vs 10.9%, p < 0.001).
Conclusions:
Urinary symptoms are common in MSA, but the presentation differs between males and females. The difference in catheterization rates may be driven by a gender disparity in referrals for PVR, which can guide treatment. This may provide an opportunity for standardized evaluation of urinary symptoms for males and females.