Urological manifestations in obesity

The global prevalence of obesity continues to rise, with effects ranging across urology. This review summarizes recent evidence on obesity and its impact on various urological conditions, including malignancy, infections, stone disease, functional urology and male reproductive health, chronic kidney disease, and pediatric urology, to guide comprehensive management in this population.

Obesity has a paradoxical survival benefit in patients with renal cell carcinoma, while its impact drives aggressive prostate cancer. Obesity increases kidney stone risk, with sodium-glucose co-transporter 2 inhibitors and glucagon-like peptide-1 (GLP-1) receptor agonists showing divergent effects on lithogenesis and urinary tract infections. It is a modifiable risk factor for overactive bladder and stress urinary incontinence, both of which improve with weight loss/ bariatric surgery. Robotic surgery mitigates obesity-related perioperative risk. Hypogonadism secondary to obesity is a major reversible cause of male infertility. Glucagon-like peptide-1 receptor agonists (GLP-1 RA) reverse metabolic hypogonadism and helps in slowing chronic kidney progression. Maternal and childhood obesity may impair testicular descent and can also increase the risk of nocturnal enuresis.

Obesity's urological effects are heterogeneous, paradoxical from pediatric to adults, mediated by insulin resistance, chronic inflammation, and hormonal dysregulation. Weight loss and the use of GLP-1 RA may offer a unique strategy for optimizing and treating urological conditions.