Sex and Gender Influence Urinary Symptoms and Management in Multiple System Atrophy

Objective Multiple system atrophy (MSA) is characterized by urinary dysfunction, yet the influence of sex and gender on uri-nary symptoms and treatment is unclear. We sought to characterize sex and gender differences in the symptomatology, evalua-tion, and management of urinary dysfunction in patients with MSA.Methods Patients with MSA evaluated at our institution were reviewed and stratified by sex.Results While the prevalence of urinary symptoms was similar in male and female patients, incontinence was more common in females. Despite this, males and females underwent postvoid residual (PVR) measurement at similar rates. While catheteriza-tion rates were similar when PVR was measured, males were more than twice as likely to be catheterized than females in the ab-sence of PVR measurement.Conclusion Urinary symptoms are common in MSA, but their 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.