再次突出了男女间膀胱癌结果的差异。在癌症中是不常见的，膀胱癌结果在女性中明显比男性差。此外，男性患膀胱癌的概率比女性高三到四倍。解释这些性别差异的因素可能包括临床医生和患者对血尿作为膀胱癌症状重要性的认识，导致女性血尿的诊断和转诊延迟，以及健康保健的获取。值得注意的是，这些因素似乎存在地理变化，在所有保健系统中并不一致。同样，关于非肌层侵袭性和肌层侵袭性膀胱癌患者的性别特异性治疗反应的数据不一致。尚待阐明微生物群、膀胱壁厚度和尿液滞留时间差异的影响。激素信号传导、基因表达、免疫学和肿瘤微环境之间的相互作用仍然复杂，但可能是性别异质性在病发率、阶段和组织学上的基础。这些生物现象对性别特异性结果差异的贡献可能是概率性的，尽管可能是治疗特定，但还需要进一步的理解。尽管存在这些方面，我们确定了利用生物差异来改善治疗结果的机会，以及进行基础和转化研究的领域。在政策和医疗保健提供的层面上，在患者意识、临床医生教育、转诊途径和基于指南的护理等方面都可以进行改进。我们共同的目标是突出在缩小膀胱癌结果性别差距方面的机会。© 2023 Springer Nature Limited.

The differences in bladder cancer outcomes between the sexes has again been highlighted. Uncommon among cancers, bladder cancer outcomes are notably worse for women than for men. Furthermore, bladder cancer is three to four times more common among men than among women. Factors that might explain these sex differences include understanding the importance of haematuria as a symptom of bladder cancer by both clinicians and patients, the resultant delays in diagnosis and referral of women with haematuria, and health-care access. Notably, these factors seem to have geographical variation and are not consistent across all health-care systems. Likewise, data relating to sex-specific treatment responses for patients with non-muscle-invasive or muscle-invasive bladder cancer are inconsistent. The influence of differences in the microbiome, bladder wall thickness and urine dwell times remain to be elucidated. The interplay of hormone signalling, gene expression, immunology and the tumour microenvironment remains complex but probably underpins the sexual dimorphism in disease incidence and stage and histology at presentation. The contribution of these biological phenomena to sex-specific outcome differences is probable, albeit potentially treatment-specific, and further understanding is required. Notwithstanding these aspects, we identify opportunities to harness biological differences to improve treatment outcomes, as well as areas of fundamental and translational research to pursue. At the level of policy and health-care delivery, improvements can be made across the domains of patient awareness, clinician education, referral pathways and guideline-based care. Together, we aim to highlight opportunities to close the sex gap in bladder cancer outcomes.© 2023. Springer Nature Limited.