Introduction <p>The purpose of this study is to investigate the impact of sodium-glucose cotransporter-2 inhibitors (SGLT2i) on lower urinary tract symptoms (LUTS) in individuals with type 2 diabetes mellitus (T2DM). While SGLT2i are effective antidiabetic agents with cardiovascular and renal benefits, concerns remain about their impact on LUTS.</p> Methods <p>This prospective observational study included 47 patients with T2DM without organic urinary tract disease or autonomic neuropathy. The Overactive Bladder (OAB)-Validated 8-question (OAB-V8) questionnaire was administered at baseline and reassessed at months 1 and 3 of SGLT2i treatment. The associations of alterations in symptom scores with metabolic parameters were assessed using Spearman’s rank correlation.</p> Results <p>The mean overall OAB-V8 score decreased from 10.1 ± 5.0 to 8.8 ± 6.5 at month 1 (<i>p</i> = 0.01), with no significant difference at month 3 (<i>p</i> = 1.00). Subgroup analyses suggested transient improvement in patients with OAB (n = 17), with scores decreasing from 15.4 ± 4.0 to 12.4 ± 5.7 at month 1 (<i>p</i> = 0.04), followed by a return to baseline at month 3 (16.0 ± 9.0; <i>p</i> = 0.69). Patients without OAB (n = 30) showed stable scores at month 1 (7.1 ± 2.3 to 6.9 ± 6.1; <i>p</i> = 0.24) and dropped significantly by month 3 (6.6 ± 5.4; <i>p</i> = 0.03). Changes in overall scores were independent of body mass index or glycated hemoglobin levels, both in patients with and without OAB.</p> Conclusions <p>Short-term SGLT2i therapy did not appear to worsen OAB symptoms in patients with T2DM. The results of the subgroup analyses should be viewed cautiously and validated in studies with larger populations. These results provide preliminary reassurance but highlight the need for larger, controlled studies with longer follow-up.</p>