Women wait longer: gender disparities in timing of urinary decompression for obstructive uropathy due to ureteral stones

Abstract IntroductionWomen have been reported to have a higher risk of stone-related infections and urosepsis than men. However, potential gender-related differences in the management of obstructive uropathy remain unexplored. This study evaluated the impact of gender on waiting times for urinary decompression in patients presenting to the emergency department(ED) with ureteral stone obstruction.Materials and methodsWe retrospectively analyzed data from 303 consecutive patients presenting to the ED of a single referral center with obstructive uropathy due to ureteral stones who underwent urgent urinary decompression between 01/2016 and 09/2025. Demographic, clinical and laboratory data were collected. All patients underwent preoperative imaging with computed tomography(CT) scan. Three time intervals were recorded: time from symptom onset to hospital presentation(StH), from hospital presentation to CT scan(HtC) and from hospital admission to decompression(HtD). Descriptive statistics and multivariable linear regression models were applied.ResultsOf the 303 patients included, 150 were male(49.5%) and 153 female(50.5%). No significant differences were observed in median age, median CCI, stone location and hydronephrosis grade among genders. Female patients presented with significantly higher preoperative body temperature (p<0.001), white blood cells count(p=0.01) and C-reactive protein(CRP) values(p<0.001) than males.Median StH was 24(10–48) hours in females versus 14(8–48) hours in males(p<0.01); median HtC was 13(5–21) hours versus 9(4–14) hours(p=0.01); and median HtD was 21(10–32) hours in females compared with 14(8–27) hours in males (p<0.001).Sepsis occurred more frequently in females than males(29.4%vs13.3%(p<0.001)).At multivariate analysis, female gender(β 6.0; 95%CI 0.4–12.1; p=0.01) and CRP(β −2.7; 95%CI −4.2 to −1.1; p=0.01) were independently associated with longer HtD.ConclusionFemale patients with obstructive uropathy experienced longer diagnostic and treatment delays despite presenting with a more severe inflammatory profile. These findings support the implementation of gender-sensitive triage strategies and earlier diagnostic and urological intervention in women with signs of infection.