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Background: Transitional Cell Carcinoma (TCC) occurs significantly more often in males than females. Essential for the prognosis of recovery is depth infiltration (muscle-invasive or non-muscle invasive) and tumor-differentiation at initial diagnosis. The current study aimed to explore sex-related differences after initial diagnosis of TCC in Germany. Materials and Methods: Data of 729 patients who underwent transurethral bladder tumor resection (TUR-B) were retrospectively analyzed, including TNM Classification of Malignant Tumors (TNM), histopathological grading, risk group according to the European Association of Urology (EAU), and use of photodynamic diagnosis (PDD) and early intravesical chemotherapy (IVC) with Mitomycin C (MMC). Results: 539 male and 190 female patients with TCC underwent TUR-B. Approximately 75% of cancers were non-muscle invasive bladder cancer (NMIBC). Females evidenced significantly higher rates of muscle-invasive TCC (MIBC; p=0.02). Carcinoma-in-situ was significantly more common among males (p=0.01). Recurrence occurred in 17.9% of males and 18.9% of females. Progression developed in 9.4% of patients, with a non-significant sex difference. EAU low-risk NMIBC females showed significantly higher rates of progression in case of TCC recurrence (p=0.03). There was no association between sex and EAU risk group or TCC recurrence. IVC and PDD were not associated with TCC recurrence among males and females. Conclusion: Females were significantly more likely to evidence muscle-invasive stages at first diagnosis, particularly those with a tumor infiltration depth of pT3. In the NMIBC subgroup, males showed a significantly higher prevalence of carcinoma-in-situ. Sex was not associated with recurrence rates or progression. PDD and chemo-early instillation with MMC was equally effective in both sexes. Additional prospec-tive and multicenter studies with standardized diagnostic criteria are needed to evaluate long-term disease courses and effective therapies.