Metabolic and urological outcomes following sleeve gastrectomy: a prospective surgical cohort study

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To evaluate the incidence of urolithiasis and associated alterations in 24-hour urinary biochemistry in patients undergoing sleeve gastrectomy (SG). This prospective single-center study included patients undergoing sleeve gastrectomy between January 2020 and June 2023. Ultrasonography and a 24-hour urine collection were performed one week preoperatively. Postoperative ultrasonography was conducted every 6 months through 24 months, with repeat 24-hour urine analysis at 24 months. Urinary volume, pH, calcium, oxalate, citrate, uric acid, sodium, potassium, and magnesium were measured. All ultrasonographic evaluations were performed by a single radiologist, and all surgical procedures were conducted by a single experienced surgeon. Of 94 analyzed patients, 12 (12.8%) developed urolithiasis over a median 18-month follow-up. Postoperatively, mean urine volume decreased (2248 to 1518 mL) and mean uric acid declined (623 to 541 mg), whereas mean calcium (170 to 242 mg) and mean urinary pH (5.5 to 5.9) increased (all p < 0.001). Significant postoperative reductions were also observed in systolic and diastolic blood pressure, serum glucose, triglycerides, and LDL cholesterol, whereas HDL cholesterol significantly increased (all p < 0.05). Oxalate and citrate were unchanged overall. Among stone formers, calcium and citrate increased, while volume and magnesium decreased. SG was associated with lower urine volume and uric acid and higher calcium and pH, alongside a 12.8% urolithiasis rate. These shifts underscore the lithogenic potential of SG despite its non-malabsorptive nature and support structured metabolic follow-up after surgery.

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