Effects of obesity and weight loss in patients with nononcological urological disease.

PURPOSE: We reviewed the effects of obesity and long-term weight loss on nononcological urological disease, particularly urinary stone formation, erectile dysfunction, female sexual dysfunction, voiding dysfunction and urinary incontinence.
MATERIALS AND METHODS: A literature search was conducted using Ovid's MEDLINE, accessed through Emory University's Health Sciences Library web site. The subject headings obesity, weight loss surgery, urolithiasis, sexual dysfunction, erectile dysfunction, benign prostatic hyperplasia and urinary incontinence were used as indices for the search. Articles published earlier than 10 years before the literature review (performed in summer of 2007) were not used.
RESULTS: There is ample evidence to support an increased risk of urolithiasis in obese patients. However, the effects of long-term weight loss on urinary stone formation have not been studied as extensively in the literature. It is unclear whether the decreased food intake after surgical weight loss procedures may negate the associated risk of malabsorption and decrease the risk of urolithiasis in the long term. The incidence and severity of erectile dysfunction in men increase with obesity. Female sexual dysfunction also appears to be positively correlated with obesity, although the literature is less clear as to the extent to which this is true. Despite a scarcity of relevant data, preliminary evidence indicates that weight loss improves sexual function in men and women. Obesity is associated with an increased incidence of benign prostatic hyperplasia and subsequent lower urinary tract symptoms in men, as well as an increased incidence of stress urinary incontinence in women. Despite a lack of relevant data, there is preliminary evidence that stress urinary incontinence and benign prostatic hyperplasia may be reversible after weight loss.
CONCLUSIONS: Despite the abundant evidence that indicates a correlation between obesity and several urological diseases, there is a paucity of data regarding the effects of long-term weight loss on these conditions. However, the preliminary data indicate that the detrimental effects of obesity are reversible, and that long-term weight loss may decrease the incidence and severity of urological disease. Therefore, further research is needed to elucidate the impact of long-term surgical and medical weight loss on urolithiasis, lower urinary tract symptoms and incontinence, and sexual dysfunction.