There is enough evidence to support weight loss in order to improve urinary incontinence. Nevertheless, weight loss and maintaining a lower weight are not easy to achieve in the general population. Our study aims to evaluate whether bariatric surgery has a positive effect on the symptoms of urinary incontinence in female patients. We performed a prospective study on obese female patients before and after bariatric surgery, over a period of 9 years. Patients with a BMI ≥ 33 kg/m² were included if they described involuntary loss of urine and no previous surgery for urinary incontinence was performed. The patients underwent laparoscopic surgery, either gastric sleeve, bypass or banding, performed by four surgeons in our hospital. The type of incontinence was not assessed at the initial visit carried out by the surgeon. All patients who declared being incontinent were referred to the urologist where they received the ICIQ—UI-SF questionnaire before their bariatric surgery and during follow -up visits. The sum of points obtained at questions 3, 4 and 5 was used to evaluate the severity of incontinence, as well as the impact on the quality of life. Our evaluation collected data on age, time since onset of symptoms, pad usage, number and type of deliveries, concomitant conditions and medications. The type of incontinence was assessed by the urologist before bariatric surgery as urge, stress or mixed incontinence. At follow-up visits, the patients were also asked to fill out a 10-point VAS questionnaire evaluating their perception on the evolution of incontinence symptoms. Data were analyzed using t-test statistical analysis. Our objective defined changes in incontinence as cure, improved, no change and worse. We included 54 women from whom initial data and at least 18 months of follow-up were available. We observed that about 50% of all women undergoing bariatric surgery have some degree of urinary incontinence. The ICIQ score improved from 13.31 ± 5.18 before surgery to 8.30 ± 4.49 points after surgery (p < 0.0001). Before surgery, 38 patients (70%) described severe incontinence compared to only 20 patients (37%) after surgery. A total of 16 women (31%) reported complete cure of urinary incontinence after bariatric surgery. Data from the VAS questionnaire show improvement in 46 cases (85%). Pad usage improved from 7.04 ± 2.79 to 3.42 ± 2.77 (p < 0.001) per day. The number of patients using more than one pad per day decreased from 35 (65%) to 9 (17%). The type of incontinence did not seem to be relevant, but our sample size was too small to lead to statistically significant results. There was no impact on the outcome of incontinence of number/type of delivery, age or BMI. Our data show that bariatric surgery is able to cure urinary incontinence in one of three obese women. A significant improvement was obtained in more than two-thirds of the patients, regardless of the type of incontinence. For an obese female with urinary incontinence, treatment for obesity should prevail and incontinence should be treated only if symptoms remain.

Intradetrusor abobotulinumtoxinA (aboBoNT-A) is used off-label for refractory idiopathic overactive bladder (OAB), but real-world data on persistence are scarce. This study aimed to describe persistence and reasons for discontinuation in all treated patients and to report outcomes in those who continued treatment. We retrospectively reviewed all toxin-naïve patients who received a first injection of aboBoNT-A (500 Speywood units, 30 sites, trigone included) at a single center between 2013 and 2022; each injection was followed for at least 6 months. Of 232 patients, 97 (41.8%) received at least one repeat injection; the main reasons for stopping were loss to follow-up (17.7%), procedure cost (13.4%), adverse events (9.9%) and lack of efficacy (8.6%). Effectiveness and safety were assessed only in these 97 patients, at their last injection. The International Consultation on Incontinence Questionnaire–Urinary Incontinence Short Form (ICIQ-UI SF) score decreased from 16.7 ± 2.8 to 12.3 ± 2.6 at 2 weeks (p < 0.001). Mean post-void residual volume rose from 16 to 79 mL (p < 0.001); 30.9% had at least 100 mL, none exceeded 200 mL and none required catheterization. The interval to re-injection was under 6 months in 24.7%, 6–12 months in 37.1% and over 12 months in 38.1%. Limitations include the retrospective design, outcome data restricted to continuers and an early outcome assessment. AboBoNT-A appears effective in patients who continue treatment, but most patients discontinue, and cost is a modifiable barrier.

The artificial urinary sphincter (AUS) imposed itself as the most effective treatment for urinary incontinence after surgery of the prostate. Along with the technological development and improvement of the device over time, more indications have emerged, most of which are not yet considered mainstream but provide an alternative in the armamentarium of the modern urologist. The artificial urinary sphincter was first introduced in 1974 and has undergone significant evolution since then, with several manufacturers currently active in this market. This treatment is effective and safe, although some potential complications may still occur and need to be understood and accepted by the patient. Considering that there is no other therapeutic option comparable in terms of efficacy, the artificial urinary sphincter deserves its place as the gold standard treatment for post-prostatectomy incontinence in males. We conclude that the AUS brought significant improvement in the health-related quality of life for most men with incontinence after prostatic surgery; however, there is still a need for further development of the device, as the complication rate remains high, despite a noticeable improvement over the decades.

Background/Objectives: Obesity and type 2 diabetes mellitus (T2DM) are associated with impaired male reproductive function. We assessed changes in semen quality and reproductive hormones during 12 months of glucagon-like peptide-1 receptor agonist (GLP-1 RA) therapy. Methods: In this prospective, single-center cohort study, 161 men with obesity and/or T2DM initiated semaglutide or liraglutide. Semen parameters, reproductive hormones, and metabolic indices were assessed at baseline and 12 months. Paired comparisons were performed in 108 completers (54 receiving each agent), with Holm adjustment for five principal semen endpoints. Total progressive motile sperm count (TPMSC) was evaluated post hoc. Baseline characteristics of completers and non-completers were compared. Results: Body mass index decreased from 37.5 to 31.3 kg/m² and HbA1c from 6.49% to 5.64%. Sperm concentration increased from 62.9 to 86.7 × 10⁶/mL, progressive motility from 22.8% to 38.4%, and normal morphology from 3.14% to 4.46% (all p < 0.001). Total sperm number increased but did not remain statistically significant after Holm correction (adjusted p = 0.062). Exploratory TPMSC increased from 42.4 to 80.9 × 10⁶/ejaculate (p < 0.001). Total testosterone increased from 5.91 to 7.74 nmol/L, whereas estradiol decreased from 36.5 to 28.4 pg/mL (both p < 0.001). Fifty-three participants (32.9%) did not complete follow-up; non-completers were older and more frequently had T2DM. Conclusions: Twelve months of GLP-1 RA therapy coincided with improved semen laboratory parameters, higher total testosterone, and improved metabolic status. The uncontrolled design and selective attrition preclude causal inference or conclusions about fertility outcomes.