Moyad Mark A
Department of Urology, University of Michigan Medical Center, Ann Arbor, MI, USA.
Curr Urol Rep. 2023 Nov;24(11):515-525. doi: 10.1007/s11934-023-01180-7. Epub 2023 Sep 2.
The history of multiple weight loss medications has been a concerning paradox based on an increased cardiovascular risk despite significant reductions in adipose tissue and weight. A new class of weight loss medications could change this past narrative based on early preliminary results of cardiovascular risk (not events-still need to be determined) and weight reduction in non-diabetics that acutely competes with results achieved with bariatric surgery. The purpose of this review is to provide a comprehensive summary of the advantages and disadvantages of these newer medications, and how they could impact urology.
Weight loss of - 15 to - 20% compared to baseline has become plausible in the short-term and preliminary guidance to reduce acute and chronic adverse events are receiving attention. However, the cost, access, conflicts of interest, supply chain, life-long adherence issues, and the long-term diverse implications on mental and physical health when exposed to this class of medications (GLP-1 agonists) are unknown. The profound caloric reductions should also result in baseline or ongoing nutritional deficiency testing, and general and specific dietary recommendations, which could theoretically mimic some bariatric surgery pre- and post-surgical protocols but has yet to be studied. Regardless, the potential impact of these medicines within a variety of medical specialties needs clinical research. Current and future lifestyle interventions, dietary patterns, and medicines in the weight loss category need to be held to a paradigm whereby cardiovascular health should improve with significant weight loss without a negative impact on mental health. In urology, the ability to impact cancer risk, ED, FSD, incontinence, infertility, nephrolithiasis, and multiple other endpoints are plausible (based on bariatric surgery data) but need preliminary clinical research. Other medicines with a similar or even larger potential impact are in clinical trials, and thus, a concise overview for clinicians and researchers was needed for objective guidance. Currently, comprehensive lifestyle changes utilized with and without these medications continue to garner positive mental, physical, and legacy effects, which suggest that they are as necessary as ever in the treatment of the numerous conditions impacted by unhealthy weight gain.
多种减肥药物的历史呈现出一个令人担忧的悖论，即尽管脂肪组织和体重显著减少，但心血管风险却有所增加。基于心血管风险（尚未确定事件，仍有待观察）的早期初步结果以及非糖尿病患者体重减轻的情况，一类新型减肥药物可能会改变过去的这种说法，其效果与减肥手术相当。本综述的目的是全面总结这些新型药物的优缺点，以及它们对泌尿外科的影响。
与基线相比，短期内体重减轻15%至20%已成为可能，减少急性和慢性不良事件的初步指导受到关注。然而，这类药物（胰高血糖素样肽-1激动剂）的成本、可及性、利益冲突、供应链、终身依从性问题以及对身心健康的长期多方面影响尚不清楚。热量的大幅减少还应进行基线或持续的营养缺乏检测，并给出一般和具体的饮食建议，理论上这可能类似于一些减肥手术的术前和术后方案，但尚未得到研究。无论如何，这些药物在各种医学专科中的潜在影响需要临床研究。当前和未来的生活方式干预、饮食模式以及减肥类药物需要遵循这样一种模式，即显著的体重减轻应能改善心血管健康，而不对心理健康产生负面影响。在泌尿外科领域，基于减肥手术数据，这类药物对癌症风险、勃起功能障碍、女性性功能障碍、尿失禁、不孕症、肾结石以及其他多个终点产生影响是有可能的，但需要初步临床研究。其他具有类似甚至更大潜在影响的药物正在进行临床试验，因此，需要为临床医生和研究人员提供简要概述以给予客观指导。目前，无论是否使用这些药物，全面的生活方式改变都继续产生积极的心理、身体和长期影响，这表明在治疗因不健康体重增加而受影响的众多疾病时，它们一如既往地必要。
