Pautz Andrea, Michel Martin C
Department of Pharmacology, University Medical Center, Johannes Gutenberg University, Mainz, Germany.
Handb Exp Pharmacol. 2023;282:57-74. doi: 10.1007/164_2023_667.
Dysfunction of the lower urinary tract in general and the overactive bladder syndrome (OAB) in particular are prevalent and have major impact on the quality of life of the afflicted patients and their partners. We concisely review sex and gender differences in patients and animal models in physiological bladder function, its alterations in disease (mostly OAB), and its responses to treatment. Women appear to have a smaller functional bladder capacity and, therefore, must void more often than men. On the other hand, men have a greater bladder outlet resistance, which is partly attributed to a longer urethra and partly to the presence of the prostate. Sex and gender differences in bladder contractility appear small and were not found consistently. The ability of bladder smooth muscle to relax may be somewhat smaller in females. However, females are heavily underrepresented in experimental studies on bladder function. Stress urinary incontinence is found predominantly in women (particularly those after childbirth). OAB is similarly prevalent in men and women. Females seek treatment much more often and are overrepresented in clinical trials. Treatment responses in OAB patients are similar in both genders for oral medications, but improvements upon injections of onabotulinum toxin type A appear smaller in men. We conclude that there is no evidence for major sex and gender differences in bladder dysfunction as related to OAB and its treatment responses, but female animals are heavily underrepresented in experimental studies.
下尿路功能障碍，尤其是膀胱过度活动症（OAB），十分普遍，对患病患者及其伴侣的生活质量有重大影响。我们简要回顾了患者和动物模型在生理性膀胱功能方面的性别差异、疾病（主要是OAB）中的功能改变及其对治疗的反应。女性的功能性膀胱容量似乎较小，因此，她们比男性更频繁地排尿。另一方面，男性的膀胱出口阻力更大，部分原因是尿道较长，部分原因是前列腺的存在。膀胱收缩性方面的性别差异似乎较小，且结果并不一致。女性膀胱平滑肌的舒张能力可能稍小。然而，在膀胱功能实验研究中，女性的代表性严重不足。压力性尿失禁主要见于女性（尤其是产后女性）。OAB在男性和女性中同样普遍。女性更常寻求治疗，在临床试验中的代表性过高。口服药物治疗时，OAB患者的治疗反应在两性中相似，但注射A型肉毒杆菌毒素后，男性的改善似乎较小。我们得出结论，没有证据表明与OAB及其治疗反应相关的膀胱功能障碍存在重大性别差异，但在实验研究中，雌性动物的代表性严重不足。
