SGLT2 Inhibitors in Patients with Urogenital Malformations and Urinary Diversions: Risks, Benefits, and Clinical Considerations

TL;DR

This paper reviews the risks and benefits of using SGLT2 inhibitors in patients with urogenital malformations or urinary diversions, emphasizing the need for personalized care.

Contribution

The paper provides a focused clinical review on the underexplored use of SGLT2 inhibitors in patients with urological abnormalities.

Findings

Patients with urological conditions may face higher risks of infections and complications from SGLT2 inhibitors.

Despite risks, SGLT2 inhibitors can offer renal and cardiovascular benefits to these patients.

Individualized assessment and multidisciplinary care are crucial for managing SGLT2 inhibitor therapy in this population.

Abstract

Background: Sodium-glucose cotransporter-2 inhibitors (SGLT2i) are increasingly used in patients with type 2 diabetes, chronic kidney disease, and heart failure. However, their safety and efficacy in patients with congenital or surgically altered urogenital anatomy remains underexplored. Methods: We conducted a narrative review of current evidence regarding the use of SGLT2i in patients with urinary tract malformations, urinary diversions, and functional voiding disorders. Key risks, clinical considerations, and management strategies were synthesized from the existing literature and case reports. Results: Patients with benign prostatic hyperplasia, vesicoureteral reflux, neurogenic bladder, nephrostomies, and ileal conduits may face increased risks of urinary tract infections, fungal colonization, and therapy-related complications due to persistent glycosuria and altered urinary flow. Nevertheless, these patients may still benefit from SGLT2i’s systemic renal and cardiovascular effects. Individualized risk assessment, close monitoring, and multidisciplinary management are essential. Conclusions: Patients with urological abnormalities represent a high-risk but potentially high-reward population for SGLT2i therapy. A cautious, tailored approach is necessary, and future dedicated research is urgently needed to better guide clinical practice.