Urological Complications of Morbid Obesity and the Role of Bariatric Surgery and Glucagon-Like Peptide-1 Receptor Agonists in Their Management: A Systematic Review

Abstract

Morbid obesity (body mass index (BMI) ≥40 kg/m² or ≥35 kg/m² with comorbidities) predisposes patients to multiple urological disorders, including urinary incontinence, overactive bladder, erectile dysfunction, hypogonadism, nephrolithiasis, obesity-related kidney disease, renal cell carcinoma, and aggressive prostate cancer. Bariatric surgery is the most effective durable treatment for severe obesity. Glucagon-like peptide-1 receptor agonists, including semaglutide and tirzepatide, have revolutionised obesity pharmacotherapy. This systematic review evaluates the urological complications of morbid obesity and the effects of bariatric surgery and glucagon-like peptide-1 receptor agonists on these outcomes. We searched MEDLINE, Embase, Scopus, and the Cochrane Library (January 2000 to June 2025) for studies reporting urological outcomes in adults with BMI ≥35 kg/m². Two reviewers independently screened and extracted data. We assessed risk of bias using the A Measurement Tool to Assess Systematic Reviews (AMSTAR) version 2 and the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE). Eighty-four studies (>165,000 participants) met the inclusion criteria. Obesity increases renal cell carcinoma risk (relative risk: 1.5-2.0) and prostate cancer mortality (hazard ratio: 1.19-1.24) but paradoxically reduces prostate cancer incidence. Urinary incontinence and overactive bladder improve or resolve in 50-70% of women after bariatric surgery. Erectile dysfunction and hypogonadism improve after bariatric surgery, with International Index of Erectile Function (IIEF) scores increasing 4-6 points and testosterone rising 30-50%. Glucagon-like peptide-1 receptor agonists increase testosterone (standardised mean difference: 1.39 ng/mL) and improve erectile function. Tirzepatide reduces urinary albumin-to-creatinine ratio by 19-47% and preserves estimated glomerular filtration rate. Roux-en-Y gastric bypass increases nephrolithiasis risk 2.5-4-fold via enteric hyperoxaluria, whereas sleeve gastrectomy does not. Robot-assisted surgery in obese patients achieves complication rates comparable to those of non-obese patients after comorbidity adjustment. Bariatric surgery improves obesity-related urological morbidity, but Roux-en-Y gastric bypass increases stone risk. Glucagon-like peptide-1 receptor agonists offer a promising alternative with evidence for testosterone restoration, improved erectile function, and renal protection. Preoperative urological assessment, procedure selection, and multidisciplinary care are essential.

Khalil W, Bibi K, Fareed T, et al. (June 16, 2026) Urological Complications of Morbid Obesity and the Role of Bariatric Surgery and Glucagon-Like Peptide-1 Receptor Agonists in Their Management: A Systematic Review. Cureus 18(6): e110952. doi:10.7759/cureus.110952