(208) Associations Between SGLT-2 Inhibitor Usage and Urologic Diagnoses: Implications for Sexual Health and Lower Urinary Tract Symptoms
Authors: Roth B , Khooblall P , Vallabhaneni S , Bole R , Gill B , Bajic P 
Published: February 2024

Abstract

Introduction
Sodium-glucose co-transporter-2 (SGLT-2) inhibitors are used for the treatment of hyperglycemia in patients with type 2 diabetes. Due to the amount of glucose that is being filtered, SGLT-2 inhibitors may be associated with or cause concern for balanitis, balanoposthitis, and increased lowery urinary tract symptoms (LUTS), such as overactive bladder (OAB).

Objective
In this retrospective, IRB approved study, we sought to characterize the frequency of new urologic visits and urologic diagnoses, such as balanitis or balanoposthitis, LUTS, and OAB, among others, in patients who had been recently started on SGLT-2 inhibitors.

Methods
We reviewed records from our institution from 2007 to 2022 of patients who had been to a urology outpatient visit within 2 years. Patients were stratified based on whether they had been prescribed an SGLT-2 inhibitor within two years of the scheduled urology appointment at the time of analysis. Data was collected and analyzed utilizing two-tailed t test and Chi-squared analyses in Microsoft Excel (Microsoft Corporation, Redmond, WA, USA

Results
A total of n = 337,342 patients met our inclusion criteria. Of these, n= 41102 had been prescribed a SGLT-2 inhibitor between 2007-2022. N= 296240 had not been prescribed SGLT2 inhibitors but had seen a urologist in the outpatient setting and served as control. The frequency of any of the urologic diagnoses listed in Table 1 or circumcision, dorsal slit, or buried penis repair within 2 years was 835/41102 (2.03%) for the SGLT-2 group and 4484/296240 (1.51%) for the non-SGLT2 group, respectively (p&lt;0.0001). Urology appointments made within one year had the same frequency and statistical significance between groups. Frequency of balanitis((27/41102, 0.0657%) vs (94/296240, 0.0317%)) (p=0.0007) and balanoposthitis ((9/41102, 0.0218%) vs (20/296240, 0.00675%)) (p=0.002) was higher in the SGLT-2 group. Similarly, OAB was 111/41102 (0.27%) in the SGLT-2 group and 488/296240 (0.1%) in the non-SGLT-2 group (p&lt;0.0001). Finally, urinary frequency ((306/41102, 0.74%) vs (1268/296240,0.43%)) (p&lt;0.0001) and urinary urgency ((213/41102, 0.53%) vs (998/296240, 0.34%)) (p&lt;0.0001) were found more often in the SGLT-2 group. Urinary incontinence (p=0.145), urologic surgery within 1 year of visit (p=0.135), and recurrent urinary tract infection (p=0.812) were not different between groups. Full results are listed in Table 1.

Conclusions
Our results demonstrate that patients prescribed SGLT-2 inhibitors were found to have a variety of new penile inflammatory and lower urinary tract diagnoses following medication usage. Overactive bladder, specifically, seems to occur more often than other conditions allowing SGLT-2 usage. Additionally, urologic visits within a year of medication were significantly associated with SGLT-2 usage, reflecting that patients on SGLT-2 inhibitors may face substantial urologic sequalae. Based on these results, we suggest that urologists, endocrinologists, and primary care physicians should work collaboratively to monitor patients on SGLT-2 inhibitors. Further, urologists should be aware of the association between these drugs, sexual health issues and LUTS, and plan accordingly when patients on SGLT-2 inhibitors enter their care.

Disclosure
Any of the authors act as a consultant, employee or shareholder of an industry for: Coloplast, Boston scientific.