Beyond Glycemic Control: Semaglutide Use in Non-Diabetic Female Patients with Overactive Bladder Receiving BOTOX is Associated with Improved Urinary Outcome

Semaglutide, a GLP-1 (glucagon-like peptide-1) receptor agonist, is widely prescribed for weight loss in non-diabetic populations. Given the link between obesity and over-active bladder (OAB), we explored whether GLP-1 use would improve urinary out-comes beyond its weight loss benefit for non-diabetic adults undergoing BOTOX treatment for OAB. Using the TriNetX database, we conducted a retrospective cohort study of non-diabetic OAB patients treated with BOTOX alone or with concurrent GLP-1 therapy. Propensity score matching (1:1) adjusted for age, race, ethnicity, hypertension, and BMI/obesity. After matching, 992 patients were included in each group. GLP-1 use was associated with a lower incidence of urinary retention (8.6% vs. 4.9%, risk difference 3.66%, p = 0.0044) and urinary tract infection (13.3% vs. 8.8%, risk difference 4.54%, p = 0.00224), with corresponding improved one-year retention-free and UTI-free survival on Kaplan Meier (KM) analysis. Antispasmodic initiation rates were similar (11.8% vs. 10.3%, risk difference 1.55%, p = 0.6921), and KM analysis showed no significant difference. These findings suggest that GLP-1 receptor agonist use may improve select urinary outcomes in non-diabetic adults undergoing BOTOX treatment for OAB and support further investigation into its potential adjunctive role in OAB management with longer follow-up.