Sex differences in the therapy of kidney and ureteral stones

Better understanding of sex differences affecting urolithiasis may help us offer tailored treatment strategies to our patients.

The incidence of urolithiasis is increasing and the male-to-female ratio has decreased from 3 : 1 to 1.3 : 1 between 1970 and 2000. In women, obesity has a larger effect on the risk of developing urolithiasis [odds ratio (OR) 1.35; 95% confidence interval (CI): 1.33-1.37] compared with men (OR 1.04; 95% CI: 1.02-1.06). Urolithiasis is a risk factor for coronary artery disease in men (risk ratio = 1.23; 95% CI: 1.02-1.49) and for stroke in women (risk ratio = 1.12; 95% CI: 1.03-1.21). Women tolerate cystoscopic stent removal and shock wave lithotripsy better than men. For shock wave lithotripsy menopaused women have reported lower visual analog scale scores than menstruating women (P < 0.001). Female sex was an independent predictor of stone impaction (OR 1.15; 95% CI: 1.03-1.27) and postoperative sepsis after ureteroscopy (OR 2.31; 95% CI: 1.14-4.37).

The sex gap in urolithiasis is closing. The changing role of women in society and dietary habits can be responsible for this epidemiologic shift. Women show a higher threshold for pain during urologic procedures, but they suffer from infectious complications more than men. Urolithiasis is a risk factor for cardiovascular events in both sexes.