GLP-1RAs and Bariatric Surgery Improve Morbid Obesity's Urological Complications, Boosting Testosterone and Kidney Function

Morbid obesity (BMI ≥35 kg/m² with comorbidities or ≥40 kg/m²) is a major risk factor for a spectrum of urological disorders, including urinary incontinence, overactive bladder, erectile dysfunction, hypogonadism, nephrolithiasis, and increased risk/aggressiveness of renal cell carcinoma and prostate cancer. Current management often involves addressing symptoms individually, but a holistic approach targeting the underlying obesity is crucial. While bariatric surgery offers durable weight loss, the emergence of glucagon-like peptide-1 receptor agonists (GLP-1RAs) like semaglutide and tirzepatide has revolutionized pharmacotherapy for obesity, prompting a need to understand their impact on these specific urological outcomes.

This systematic review evaluated the effects of bariatric surgery and glucagon-like peptide-1 receptor agonists on urological complications in adults with morbid obesity (BMI ≥35 kg/m²). Researchers systematically searched MEDLINE, Embase, Scopus, and the Cochrane Library for studies published between January 2000 and June 2025. Two independent reviewers screened 84 studies involving over 165,000 participants that met the inclusion criteria. Risk of bias was assessed using AMSTAR version 2 and the GRADE methodology to ensure the quality and reliability of the synthesized evidence.

The systematic review of 84 studies involving >165,000 participants revealed significant findings regarding obesity's impact and treatment effects on urological health. Obesity was found to increase renal cell carcinoma risk by a relative risk of 1.5-2.0 and prostate cancer mortality by a hazard ratio of 1.19-1.24, though paradoxically reducing prostate cancer incidence. Bariatric surgery demonstrated substantial improvements:

Urinary incontinence and overactive bladder improved or resolved in 50-70% of women post-surgery. Erectile dysfunction and hypogonadism also improved, with International Index of Erectile Function (IIEF) scores increasing by 4-6 points and testosterone levels rising by 30-50%. Furthermore, glucagon-like peptide-1 receptor agonists (GLP-1RAs) were shown to increase testosterone (standardized mean difference: 1.39 ng/mL) and enhance erectile function. Specifically, tirzepatide reduced urinary albumin-to-creatinine ratio by 19-47% and preserved estimated glomerular filtration rate, indicating significant kidney protective effects. However, Roux-en-Y gastric bypass was associated with an increased nephrolithiasis risk, rising 2.5-4-fold.