This study aimed to evaluate clinical and metabolic predictors of delayed postoperative recovery in adult males undergoing circumcision for chronic balanoposthitis. Specifically, we investigated the influence of diabetes, glycosuria, and sodium-glucose cotransporter 2 inhibitor (SGLT2i) use on follow-up burden and self-reported sexual health outcomes, in order to clarify their implications within the field of andrology.

We retrospectively reviewed male patients aged >18 years who underwent circumcision for chronic balanoposthitis. Collected data included demographics, comorbidities (diabetes, hypertension), SGLT2i usage, preoperative glycosuria, and fasting glucose. Outcomes included follow-up duration, number of outpatient visits, and self-reported sexual satisfaction. Group comparisons were performed using t-tests and chi-square tests. Logistic regression was used to identify predictors of extended recovery (>3 outpatient visits). Statistical significance was set at p<0.05.

Among 194 patients, 61 (31.4%) had diabetes, 27 used SGLT2i, and 31 had glycosuria. Diabetic patients had significantly higher fasting glucose levels (p<0.001), longer postoperative follow-up (p=0.002), and more outpatient visits (p=0.049). Similar trends were observed in patients with SGLT2i use or glycosuria. Univariate analysis showed that diabetes (OR=1.77), SGLT2i use (OR=2.73, p=0.04), glycosuria (OR=2.63, p=0.038), and hypertension (OR=3.87, p=0.003) were associated with extended follow-up. In multivariate analysis, hypertension remained a significant predictor. Additionally, subjective patient feedback indicated that persistent balanoposthitis in diabetic individuals contributed to erectile discomfort and decreased sexual satisfaction, although formal sexual function scales were not routinely used.

These findings indicate that diabetes, glycosuria, and SGLT2i use are associated with delayed postoperative recovery following circumcision. The prolonged follow-up observed in these patients may be attributed to impaired wound healing and persistent local inflammation in the presence of metabolic dysregulation. Although sexual function was not the primary focus of this study, the presence of chronic inflammation in diabetic men with balanoposthitis may carry broader relevance to male genital health and overall andrological outcomes. These results suggest that preoperative metabolic optimization could play a key role in improving surgical outcomes and overall andrological care in circumcision candidates.

Diabetes, glycosuria, and SGLT2i use were associated with prolonged recovery and increased follow-up burden after circumcision. Importantly, chronic balanoposthitis may have adverse effects on male sexual function, highlighting the andrological relevance of preoperative metabolic control and inflammation management. Incorporating sexual health assessment into perioperative counseling may improve outcomes and patient satisfaction.

Continence 15S (2025) 102089
DOI: 10.1016/j.cont.2025.102089