The vicious cycling: bicycling related urogenital disorders.
OBJECTIVE
Bicycle riding is one of the most popular means of transportation, recreation, fitness and sports among millions of people of all ages who ride on road and off road, using a variety of bicycle types. It is also a readily available form of aerobic non-impact exercise with established cardiovascular beneficial effects. Bicycles are also a common source of significant injuries. This review focuses upon the specific bicycling related overuse injuries affecting the genitourinary tract.


METHODS
MEDLINE search of the literature on bicycling and genitourinary disorders was performed using multiple subject headings and additional keywords. The search yielded overall 62 pertinent articles. We focused primarily on the most prevalent related disorders such as pudendal nerve entrapment, erectile dysfunction and infertility. The potential effect of bicycling on serum PSA level was also discussed in depth in view of its recognized clinical importance. Infrequent disorders, which were reported sporadically, were still addressed, despite their rarity, for the comprehensiveness of this review.


RESULTS
The reported incidence of bicycling related urogenital symptoms varies considerably. The most common bicycling associated urogenital problems are nerve entrapment syndromes presenting as genitalia numbness, which is reported in 50-91% of the cyclists, followed by erectile dysfunction reported in 13-24%. Other less common symptoms include priapism, penile thrombosis, infertility, hematuria, torsion of spermatic cord, prostatitis, perineal nodular induration and elevated serum PSA, which are reported only sporadically.


CONCLUSIONS
Urologists should be aware that bicycling is a potential and not an infrequent cause of a variety of urological and andrological disorders caused by overuse injuries affecting the genitourinary system.
Leibovitch
Ilan
I
Department of Urology, Meir Medical Center, Affiliated to Sackler School of Medicine, Tel Aviv University, 59 Tchernichovski st., Kfar Saba, Israel. leibovitchi@clalit.org.il
Mor
Yoram
Y
D001642:Bicycling / Q000293:injuries*; D007172:Erectile Dysfunction / Q000209:etiology / Q000503:physiopathology; D005260:Female; D052776:Female Urogenital Diseases / Q000175:diagnosis / Q000209:etiology* / Q000378:metabolism / Q000503:physiopathology*; D012739:Gonadal Steroid Hormones / Q000378:metabolism; D006417:Hematuria / Q000209:etiology / Q000503:physiopathology; D006801:Humans; D007248:Infertility, Male / Q000209:etiology / Q000503:physiopathology; D008297:Male; D052801:Male Urogenital Diseases; D009408:Nerve Compression Syndromes / Q000209:etiology / Q000503:physiopathology; D010413:Penis / Q000098:blood supply; D011317:Priapism / Q000209:etiology / Q000503:physiopathology; D017430:Prostate-Specific Antigen / Q000097:blood; D012039:Regional Blood Flow; D012307:Risk Factors; D012611:Scrotum / Q000000981:diagnostic imaging; D017695:Soft Tissue Injuries / Q000209:etiology / Q000503:physiopathology; D013086:Spermatic Cord Torsion / Q000209:etiology / Q000503:physiopathology; D013736:Testicular Neoplasms / Q000209:etiology; D014463:Ultrasonography
D012739:Gonadal Steroid Hormones; D017430:Prostate-Specific Antigen