Nishimura Nobutaka, Miyake Makito, Miyamoto Tatsuki, Ichii Daiki, Naoi Makito, Narita Kosuke, Kohashi Mikiko, Tomioka Atsushi, Torimoto Kazumasa, Kawashima Ryotaro, Miyazaki Kazuki, Iwao Tomoharu, Inoue Kuniaki, Matsubara Toshihiko, Fujimoto Kiyohide
Department of Urology, Nara Medical University, Nara 634-8522, Japan.
Department of Urology, Kouseikai Takai Hospital, Tenri 632-0006, Japan.
Diagnostics (Basel). 2025 Jul 20;15(14):1824. doi: 10.3390/diagnostics15141824.
Sodium-glucose cotransporter-2 inhibitors (SGLT2is), by elevating urinary glucose levels, may predispose patients to urinary tract infections (UTI). However, limited evidence is available regarding the association between SGLT2is and postoperative outcomes after transurethral resection of bladder tumors (TURBT). We evaluated the impact of SGLT2is on post-TURBT pyuria and febrile UTI (fUTI), as well as oncological outcomes. We retrospectively reviewed the data of 812 patients with and without diabetes mellitus (DM) who underwent TURBT between January 2019 and May 2024. The patients were categorized into three groups: non-DM (Nara Medical University cohort, = 344), DM non-SGLT2i (multi-institutional cohort, = 363), and DM SGLT2i (multi-institutional cohort, = 105). We compared fUTI-free survival, fUTI-related hospitalization-free survival, and persistent pyuria duration as well as oncological outcomes using the inverse probability of treatment weighting (IPTW)-adjusted Kaplan-Meier method and Cox regression analysis. No significant differences in fUTI-free or hospitalization-free survival were observed between the non-DM and DM groups, whereas the DM group had prolonged pyuria compared to the non-DM group (1-year pyuria rate: 36.6% vs. 18.2%; < 0.001). In contrast, the DM SGLT2i group had significantly shorter fUTI-free survival (1-year fUTI-free survival: 83.0% vs. 90.0%; = 0.013) and longer pyuria persistence (1-year pyuria rate: 70.6% vs. 28.9%; < 0.001) than the DM non-SGLT2i group. Additionally, the DM SGLT2i group was significantly associated with shorter UTUC-free survival than the DM non-SGLT2i group ( = 0.0072). SGLT2i was an independent prognostic factor for fUTI and prolonged pyuria in IPTW-adjusted Cox regression analysis. No significant differences were observed in fUTI-free survival, hospitalization-free survival, or persistent pyuria duration among the different SGLT2i types. Temporal discontinuation of SGLT2i in the peri-TURBT period may prevent persistent postoperative pyuria and the risk of fUTI.
钠-葡萄糖协同转运蛋白2抑制剂（SGLT2i）通过提高尿糖水平，可能使患者易患尿路感染（UTI）。然而，关于SGLT2i与经尿道膀胱肿瘤切除术（TURBT）术后结局之间的关联，现有证据有限。我们评估了SGLT2i对TURBT术后脓尿和发热性UTI（fUTI）以及肿瘤学结局的影响。我们回顾性分析了2019年1月至2024年5月期间接受TURBT的812例有或无糖尿病（DM）患者的数据。患者分为三组：非DM组（奈良医科大学队列，n = 344）、DM非SGLT2i组（多机构队列，n = 363）和DM SGLT2i组（多机构队列，n = 105）。我们使用治疗权重逆概率（IPTW）调整的Kaplan-Meier方法和Cox回归分析比较了无fUTI生存、无fUTI相关住院生存、持续性脓尿持续时间以及肿瘤学结局。非DM组和DM组之间在无fUTI或无住院生存方面未观察到显著差异，而DM组与非DM组相比脓尿持续时间延长（1年脓尿率：36.6%对18.2%；P < 0.001）。相比之下，DM SGLT2i组的无fUTI生存显著缩短（1年无fUTI生存率：83.0%对90.0%；P = 0.013），脓尿持续时间更长（1年脓尿率：70.6%对28.9%；P < 0.001），高于DM非SGLT2i组。此外，DM SGLT2i组与DM非SGLT2i组相比，无上尿路尿路上皮癌（UTUC）生存显著缩短（P = 0.0072）。在IPTW调整的Cox回归分析中，SGLT2i是fUTI和脓尿延长的独立预后因素。不同SGLT2i类型之间在无fUTI生存、无住院生存或持续性脓尿持续时间方面未观察到显著差异。在TURBT围手术期暂时停用SGLT2i可能预防术后持续性脓尿和fUTI风险。
