OBJECTIVE: To investigate the relationship between level of sperm DNA damage, seminal oxidative status, and shock-wave lithotripsy (SWL) for distal ureteral stones.
DESIGN: Prospective study with control.
SETTING: Academic research institute.
PATIENT(S): Men who had undergone SWL for distal and upper ureter stones.
INTERVENTION(S): Level of sperm DNA damage and seminal oxidative status assessed through the examination of semen on the day before and 3 days, and 3 months after SWL.
MAIN OUTCOME MEASURE(S): DNA damage score and oxidative stress in semen parameters.
RESULT(S): Sperm DNA damage score and semen total oxidant status (TOS) levels increased, but semen total antioxidant status (TAS) levels, sperm concentration, and motility decreased immediately after SWL. However, there were no statistically significant correlations between the DNA damage scores and the increased TAS and TOS levels in the study group. All of the changes returned completely to initial level during three months after SWL.
CONCLUSION(S): SWL may affect fertility in men. Therefore, we suggest other treatment modalities, such as ureteroscopy, for young men with distal ureteral stones to prevent the development of male infertility.
Copyright © 2011 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.
Fertil Steril. 2011 Nov;96(5):1087-90. doi: 10.1016/j.fertnstert.2011.08.003. Epub 2011 Aug 25
PMID: 21871622 [PubMed - in process]
This study shows increased sperm DNA damage score and semen total oxidant status (TOS) levels and decreased sperm concentration and motility 3 days after SWL for lower ureteral stones compared to controls treated for upper ureteral stones in an otherwise healthy population of young men. This information is important and the authors conclude: “Therefore, we suggest other treatment modalities, such as ureteroscopy, for young men with distal ureteral stones to prevent the development of male infertility. Therefore, alternative techniques, such as ureteroscopy, should be taken into account when treating young male patients who have borderline sperm parameters.”
The conclusions are difficult to follow: This would mean that a sperm analysis is necessary in all young? / fertile patients planned for SWL of distal ureteral stones.
The study was not performed on patients with borderline sperm parameters, it did not show a “development of male infertility” in the patient group and the values were normal after three months. In addition a study showing the effects of ureteroscopy in a similar patient group is lacking.