To evaluate the association between established glucagon-like peptide-1 receptor agonist (GLP-1RA) use and postoperative outcomes in obese patients undergoing robotic urologic surgery. Single-center retrospective cohort study of 361 adults with BMI ≥ 35 undergoing robotic-assisted radical prostatectomy, partial nephrectomy, or radical nephrectomy from 2017 to 2024. Established GLP-1RA exposure required ≥ 3 months of documented use before and after surgery. Propensity score was used for 2:1 nearest-neighbor matching (36 GLP-1RA users, 59 controls). The primary outcome was any complication (Clavien-Dindo classification); secondary outcomes included major complications (Clavien-Dindo ≥ III), comprehensive complication index (CCI), estimated blood loss (EBL), length of stay (LOS), peak pain score, and emergency department (ED) utilization at 90 days and 1 year. Covariate balance was achieved (mean absolute SMD 0.036; maximum 0.074). GLP-1RA use was not associated with any complication (OR 2.39, 95% CI 0.63-9.10), major complications (OR 3.70, 95% CI 0.45-30.32), or CCI (mean difference 1.29, p = 0.64). EBL was reduced but nonsignificant (mean difference - 81.32 mL, 95% CI -165.85 to 3.22, p = 0.06); LOS was shorter but nonsignificant (mean difference - 0.78 days, p = 0.11). Peak pain scores and ED utilization did not differ. Established GLP-1RA use was not associated with increased postoperative complications, morbidity, or ED utilization in obese patients undergoing robotic urologic surgery. While power constraints preclude conclusions of equivalence, these findings provide the first urologic-specific perioperative safety data and support individualized rather than reflexive GLP-1RA discontinuation in this growing surgical population.
