Dissection of relationship between SGLT-2 inhibitors and severe urinary tract infections after endoscopic urological surgery in type 2 diabetes patients

doi:10.3877/cma.j.issn.1674-3253.2026.02.009

Abstract

Abstract:

Objective

To explore the relationship between sodium-glucose cotransporter 2 (SGLT-2) inhibitors and severe urinary tract infections (UTIs) in patients with type 2 diabetes following endoscopic urological surgery.

Methods

Retrospective analysis of clinical data from 3 patients with type 2 diabetes who suffered severe infections after endoscopic urological surgery while on long-term SGLT-2 inhibitors, and literature review for a summary analysis of cases with severe urinary tract infections following SGLT-2 inhibitor use.

Results

Two patients underwent transurethral prostate enucleation, and one underwent transurethral ureteroscopy with lithotripsy. All three patients were readmitted within 1-2 months post-surgery due to severe UTIs. One patient required unilateral orchiectomy due to a scrotal abscess from a retrograde genital infection, another patient developed methicillin-resistant Staphylococcus aureus infection, and the third patient had a Candida infection. Nineteen cases of severe UTIs associated with SGLT-2 inhibitors were reported in 18 articles, with six occurring after endoscopic urological surgery, the remaining 13 were hospitalized due to various UTI symptoms, and one patient died due to severe infection.

Conclusion

SGLT-2 inhibitors may increase urinary glucose levels in patients with type 2 diabetes, thereby raising the risk of UTIs following endoscopic urological surgery. It is recommended that type 2 diabetes patients scheduled for endoscopic urological surgery avoid SGLT-2 inhibitors perioperatively to prevent severe UTIs.

Key words: SGLT-2 inhibitors, Type 2 diabetes, Urinary tract infection, Endoscopic urological surgery

Lei Hu, Jianfu Zhou, Haoqiang Chen, Xuehua Liu, Zhichao Wang, Songtao Xiang. Dissection of relationship between SGLT-2 inhibitors and severe urinary tract infections after endoscopic urological surgery in type 2 diabetes patients[J]. Chinese Journal of Endourology(Electronic Edition), 2026, 20(02): 179-184.

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References 34

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病例	年龄(岁)	性别	BMI (kg/m²)	SGLT-2抑制剂	糖化血红蛋白(%)	基础疾病	前列腺大小(cm³)	结石大小(cm²)
1	69	男	25	达格列净	7.2	-	4.7×4.3×3.4	-
2	87	男	25	达格列净	7.2	高血压	1.6×4.3×2.9	-
3	48	男	40	恩格列净	9.7	高血压	-	1.0×0.7
病例	术前尿白细胞(个/μL)	术前尿糖	术前尿培养	腔镜术式	手术时间(min)	术后血糖(mmol/L)	术后尿管留置时间(d)
1	18	2+	阴性	前列腺剜除术	110	6.1~10.2	4
2	26	5+	阴性	前列腺剜除术	40	7.4~10.4	4
3	0	4+	阴性	输尿管镜碎石术	70	6.5~10.7	1

病例	年龄(岁)	性别	BMI (kg/m²)	SGLT-2抑制剂	糖化血红蛋白(%)	基础疾病	前列腺大小(cm³)	结石大小(cm²)
1	69	男	25	达格列净	7.2	-	4.7×4.3×3.4	-
2	87	男	25	达格列净	7.2	高血压	1.6×4.3×2.9	-
3	48	男	40	恩格列净	9.7	高血压	-	1.0×0.7
病例	术前尿白细胞(个/μL)	术前尿糖	术前尿培养	腔镜术式	手术时间(min)	术后血糖(mmol/L)	术后尿管留置时间(d)
1	18	2+	阴性	前列腺剜除术	110	6.1~10.2	4
2	26	5+	阴性	前列腺剜除术	40	7.4~10.4	4
3	0	4+	阴性	输尿管镜碎石术	70	6.5~10.7	1

病例	术后出院与再入院时间间隔(d)	入院时尿白细胞(个/μL)	入院时尿糖	入院时尿培养	治疗方式	出院时尿白细胞(个/μL)
1	35	10 058	5+	白色念珠菌	单侧睾丸切除术+抗感染	1 094
2	36	28 512	5+	耐甲氧西林金黄色葡萄球菌	抗感染	24
3	30	5 619	3+	白色念珠菌	输尿管支架取出术+抗感染	2 291

病例	术后出院与再入院时间间隔(d)	入院时尿白细胞(个/μL)	入院时尿糖	入院时尿培养	治疗方式	出院时尿白细胞(个/μL)
1	35	10 058	5+	白色念珠菌	单侧睾丸切除术+抗感染	1 094
2	36	28 512	5+	耐甲氧西林金黄色葡萄球菌	抗感染	24
3	30	5 619	3+	白色念珠菌	输尿管支架取出术+抗感染	2 291

文献	患者年龄	性别	糖尿病	SGLT-2抑制剂	服药时间（月）	手术方式	并发症	病原菌	结局
Wendt等^[4]	76	男	是	达格列净	-	膀胱切除术	尿源性脓毒症	白色念珠菌	存活
Bartolo等^[5]	64	男	是	恩格列净	24	输尿管支架置入术	气肿性肾盂肾炎	白色念珠菌	存活
Bartolo等^[5]	72	男	是	恩格列净	2	膀胱镜检查术	菌血症	白色念珠菌	存活
赵玉红等^[6]	69	女	是	达格列净	0.1	-	-	-	存活
Hazique等^[7]	39	女	是	恩格列净	10	-	复杂性尿路感染	大肠埃希菌	存活
Woloshuk等^[8]	67	女	是	恩格列净	11	输尿管支架置入术	气肿性肾盂肾炎	假丝酵母菌	存活
Suetani等^[9]	69	女	否	达格列净	0.5	-	尿源性脓毒症	大肠埃希菌	存活
Artinyan等^[10]	60	男	否	达格列净	12	-	气肿性肾盂肾炎	大肠埃希菌	存活
Mathiasen等^[11]	69	男	是	恩格列净	12	-	复杂性尿路感染	假丝酵母菌	存活
Melnick等^[12]	47	男	是	卡格列净	-	阴茎假体植入术	菌血症	耐甲氧西林金黄色葡萄球菌	存活
Chauhan等^[13]	90	男	是	恩格列净	-	-	糖尿病酮症酸中毒	-	存活
Raj等^[14]	38	女	是	卡格列净	14	输尿管支架置入术	尿源性脓毒症	白色念珠菌	存活
Zeelenberg等^[15]	72	男	是	达格列净	-	-	-	白色念珠菌	存活
Busuttil等^[16]	83	男	否	恩格列净	0.5	-	气肿性膀胱炎	-	死亡
Hall等^[17]	70	男	是	达格列净	12	-	败血症	大肠埃希菌	存活
Nishikawara等^[18]	75	男	是	伊格列净	12	-	气肿性肾盂肾炎	大肠埃希菌	存活
Echeverria等^[19]	60	女	是	恩格列净	4	-	气肿性肾盂肾炎	大肠埃希菌	存活
Cases-corona等^[20]	53	女	是	恩格列净	0.75	-	气肿性肾盂肾炎	白色念珠菌	存活
Maknojia等^[21]	50	女	是	卡格列净	3	-	气肿性肾盂肾炎	-	存活

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