Neurogenic lower urinary tract dysfunction (NLUTD) in people with MS (PwMS) is still considered to be underdiagnosed and undertreated, despite the well-known negative effects on quality of life, morbidity, and other MS-specific symptoms.
Various algorithms and guidelines for screening and indicating specific neuro-urological diagnostics have been published; however, gender-specific issues have not yet been addressed. 
The study aimed to investigate urodynamic findings in PwMS with regard to gender-specific differences.

Retrospective multicentre study of 283 people with MS aged over 18 who underwent urodynamics due to their NLUTD and signed a written consent form. The following urodynamic results were evaluated and compared between the sexes: bladder sensation categorically (normal, increased, reduced) and numerically (first desire to void and strong desire to void), maximum cystometric bladder capacity (MCBC), presence of detrusor overactivity (DO) and detrusor-sphincter dyssynergia (DSD), voided volume (VV), maximum urinary flow rate (Qmax), and bladder compliance.

The cohort consisted of 90 (31.8%) men and 193 (68.2%) women, with a mean EDSS of 4.48 (SD 1.65, min 2, max 8). The mean age was 48.7 years (SD 10.57, min 22, max 73). There were no differences between the sexes in terms of EDSS and age. Men had significantly more frequent DO during the storage phase (Chi² test 5.51, p=0.019); there was no difference in DSD. Women had a significantly higher Qmax in ml/s (mean 14.0, SD 7.4, min 2 max 37, median 14.0, Q1 9.0, Q3 19.0) than men (mean 11.5, SD 7.2, min 2 max 41, median 10.0, Q1 7.9, Q3 16.0) (Z = -2.148, p = 0.032).
Bladder sensitivity did not differ between the sexes, either categorically (Chi² 0.603, p=0.740) or numerically, regarding the onset of the first or strong desire to void (Z= -1.282, p= 0.20; SDV Z= -0.454, p= 0.650). The MCBC in ml was 391.6 (SD 146.4, min 41, max 669) for men and 406.8 (SD 144.4, min 96.0, max 735) ml for women, and, like compliance in men (mean 76.0, SD 76.1, min 4 max 398, median 58.5, Q1 43.5, Q3 82.3) vs. in women (mean 90.4, SD 103.7, min 2 max 837, median 70.0, Q1 44.0, Q3 98.3) in ml/cmH²O, and VV in men (mean 321.4.0, SD 174.6, min 2 max 669, median 320.0, Q1 186.0, Q3 455.0) vs. in women (mean 326.4, SD 160.2, min 9 max 715, median 319.5, Q1 214.0, Q3 432.0) in ml, it did not show any significant difference.

Bladder sensitivity and parameters of storage function such as compliance, MCBC and VV showed no significant differences between the sexes. Women, like the healthy group, had a better Qmax. Men experienced more frequent DO than women.

The influence of non-neurogenic abnormalities of the lower urinary tract must be further investigated to minimise statistical confounders and to enable definitive conclusions regarding the necessity of gender-specific differences in algorithms for the diagnosis of NLUTD in pwMS.