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.

性别之间膀胱癌结果的差异再次得到强调。膀胱癌在癌症中并不常见，女性的膀胱癌结果明显比男性差。此外，男性膀胱癌的发病率是女性的三到四倍。可能解释这些性别差异的因素包括临床医生和患者对血尿作为膀胱癌症状的重要性的理解、由此导致的血尿女性诊断和转诊的延误以及医疗保健的获取。值得注意的是，这些因素似乎存在地域差异，并且在所有医疗保健系统中并不一致。同样，关于非肌肉浸润性或肌肉浸润性膀胱癌患者的性别特异性治疗反应的数据也不一致。微生物组、膀胱壁厚度和尿液停留时间差异的影响仍有待阐明。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，但可能是疾病发生率、分期和组织学中性别二态性的基础。这些生物学现象对性别特异性结果差异的贡献是可能的，尽管可能具有治疗特异性，并且需要进一步的了解。尽管存在这些方面，我们仍发现利用生物学差异来改善治疗结果的机会，以及需要进行的基础和转化研究领域。在政策和医疗保健提供层面，可以在患者意识、临床医生教育、转诊途径和基于指南的护理等领域进行改进。我们的目标是共同强调缩小膀胱癌结局中性别差距的机会。