Although sodium-glucose linked transporter-2 inhibitors (SGLT2i) provide important glycemic and cardiorenal benefits, concerns remain regarding urinary tract infection (UTI) risk, particularly in patients with urinary diversion. A retrospective single-center cohort study published in International Urology and Nephrology evaluated whether SGLT2i therapy was associated with increased UTI risk in patients with diabetes mellitus (DM) who underwent cystectomy with ileal urinary diversion.

The analysis included 123 patients with DM and ileal urinary diversion treated between March 1996 and November 2023, including 18 patients (14.6%) who received SGLT2i therapy. Median follow-up was 35 months (IQR, 12–83). The primary endpoint was UTI occurrence, assessed using incidence rates and infection-free survival (IFS). Secondary outcomes included asymptomatic bacteriuria and glucosuria.

Findings

• A total of 121 UTIs were documented during follow-up.
• UTI incidence rates were similar between patients receiving and not receiving SGLT2i therapy (0.206 vs 0.210 UTI/patient/year; p=0.959).
• UTIs in the SGLT2i and non-SGLT2i groups accounted for 5.0% and 95.0% of documented infections, respectively.
• Median infection-free survival was 9 months (IQR, 3-31) in the SGLT2i group and 17 months (IQR, 5-74) in the non-SGLT2i group, with no significant difference between groups (p=0.489).

SGLT2i therapy was not associated with increased UTI risk in this cohort of patients with DM and ileal urinary diversion after cystectomy.