Common Urologic Diseases in Older Men and Their Treatment: How They Impact Fertility
February 2017
in “
Fertility and Sterility
”
ejaculatory dysfunction erectile dysfunction benign prostatic hyperplasia alpha blockers 5α-reductase inhibitors post-finasteride syndrome semen parameters aspermia oligospermia radical prostatectomy radiation therapy hormone ablation therapy intravesical therapy Bacille Calmette-Guérin inguinal hernia repair exogenous testosterone vasal obstruction BPH 5ARIs BCG
TLDR Urologic diseases and treatments in older men can negatively affect fertility, and doctors should talk to patients about this.
The 2017 document reviews how common urologic diseases and their treatments can affect fertility in older men. It notes that diseases like ejaculatory dysfunction and erectile dysfunction become more prevalent with age and can impact fertility. Treatments for benign prostatic hyperplasia (BPH), such as alpha blockers and 5α-reductase inhibitors (5ARIs), can adversely affect ejaculation and sperm parameters. Specifically, 5ARIs may lead to reversible negative effects on semen parameters and contribute to "post-finasteride syndrome." Surgical treatments for BPH, prostate cancer (PCa), and bladder cancer can significantly impair fertility, with many resulting in aspermia or oligospermia. The document advises that fertility preservation should be discussed before treatments like radical prostatectomy, radiation therapy, hormone ablation therapy, and intravesical therapy with Bacille Calmette-Guérin (BCG). Additionally, inguinal hernia repair and the use of exogenous testosterone can also threaten fertility by causing vasal obstruction and suppressing hormones necessary for sperm production, respectively. The document concludes that clinicians should discuss the potential impacts on fertility with older male patients undergoing treatment for urologic conditions.
