Semen quality after extracorporeal shockwave lithotripsy for the management of lower ureteric stones: a review of the literature

Abstract

language on semen analysis after lithotripsy. KEYWORDS extracorporeal shockwave lithotripsy, ESWL, distal ureteric calculi, semenWhat's known on the subject? and What does the study add? ESWL is effective in treating distal ureteric stones. However, the effect of lithotripsy on semen parameters and the testis has not been reviewed.This review reports that lithotripsy to distal ureteric stones causes a transient oligoasthenozoospermia for up to three months after lithotripsy. We have highlighted this important after-effect to be discussed while counselling men with a procreative intent before lithotripsy.Extracorporeal Shockwave Lithotripsy has long been an important tool in the urologists' armamentarium for the treatment of distal ureteric stones. Several studies have been conducted on the morbidity and adverse effects of ESWL on human tissues but the effect of lithotripsy on semen and testes remains inconclusive. Impact on semen analysis and testes is important because the seminal vesicles and testes are exposed to the shock waves due to their anatomical proximity to the distal ureter. This article has reviewed all the published literature in English

Impact of extracorporeal shockwave therapy for erectile dysfunction and Peyronie's disease on reproductive and hormonal testicular function

“…This study reported the negative effect of high‐energy shock waves delivered by a lithotripter on human semen in vitro 28 . Since then, several clinical studies have evaluated the structure and testicular function of patients undergoing ESWL for distal ureteral stones (particularly close to the male reproductive organs), producing limited and contradictory evidence 26 . A recent meta‐analysis by Radfar et al.…”

“…[4][5][6] ESWT is generally described as a safe andrological procedure characterized by mild and transient side effects. 4,5,7 However, the still limited knowledge of the biological effects of shock waves, 2,3 the description of testicular damage following ESWL, 25,26 and espe-cially some recent pre-clinical studies showing the negative impact of low-intensity ESWT (Li-ESWT) on testicular function 8,27 have raised several concerns about the possible testicular effects of ESWT in ED or PD setting because of tissue contiguity between penis and testes.…”

“…However, these sperm parameters recovered 3 months after ESWL 25 . Despite this noteworthy background, it is essential to underline that energy settings, protocols, and sites of application of ESWL for distal ureteral stones and ESWT for ED and PD differ substantially 4,5,26 ; therefore, it was not possible to extend the conclusions of the ESWL studies to patients undergoing shock waves for andrological purposes. Currently, only a few articles are available on the impact of Li‐ESWT on the testis, all being pre‐clinical studies on rat models 8,27,29,30 .…”

“…28 Since then, several clinical studies have evaluated the structure and testicular function of patients undergoing ESWL for distal ureteral stones (particularly close to the male reproductive organs), producing limited and contradictory evidence. 26 A recent meta-analysis by Radfar et al found a significant worsening in sperm concentration and motility and a significant increase in hematospermia rate after ESWL for lower ureteral calculi. However, these sperm parameters recovered 3 months after ESWL.…”

“…However, these sperm parameters recovered 3 months after ESWL. 25 PD differ substantially 4,5,26 ; therefore, it was not possible to extend the conclusions of the ESWL studies to patients undergoing shock waves for andrological purposes. Currently, only a few articles are available on the impact of Li-ESWT on the testis, all being pre-clinical studies on rat models.…”