Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) have evolved rapidly from an antidiabetic drug class into one of the most influential pharmacological groups in internal medicine. The approved agents - semaglutide, liraglutide and the dual GIP/GLP-1 agonist tirzepatide - achieve weight reductions of up to 22% of body weight. The close pathophysiological link between obesity, metabolic syndrome and urological-andrological disease creates direct clinical relevance for urology.This narrative review summarises a systematic PubMed search (2020-2026) covering erectile dysfunction, hypogonadism, male fertility, nephroprotection, prostate cancer, lower urinary tract symptoms and perioperative considerations in the context of GLP-1 RA therapy.GLP-1 RAs show clinically relevant effects in several urological domains: increase in total testosterone and improvement in erectile function in men with obesity-related hypogonadism, nephroprotection with reduction of albuminuria and slowing of eGFR decline, signals of reduced prostate cancer risk in epidemiological studies, and indirect benefit for stress incontinence and overactive bladder via weight loss. At the same time, clinically relevant warning signals exist: a 4.5-fold increased risk of new-onset erectile dysfunction in non-diabetic obese men on semaglutide, novel urological adverse effects in case reports, perioperative aspiration risk through delayed gastric emptying, and a near-complete absence of data in women.GLP-1 RAs represent both a therapeutic opportunity and a clinical challenge for urologists. Systematic andrological and nephrological monitoring as well as proactive patient education on urogenital and perioperative implications is recommended. Prospective controlled trials with urological endpoints are needed.
