title: What is the impact of extracorporeal shock wave lithotripsy on semen parameters? A systematic review and meta-analysis.
abstract: BACKGROUND
  Extracorporeal shock wave lithotripsy (ESWL) is an important tool for the management of urolithiasis. The effects of shockwaves on tissues are established. The aim of this meta-analysis is to evaluate the microscopic semen characteristics of young men before and after ESWL treatment for lower ureteral calculi.
  
  
  METHODS
  Literature searches were performed following the Cochrane guidelines. We conducted a systematic review and meta-analysis that included six trials that investigated the effects of ESWL on semen parameters, including sperm concentration, motility, and hematospermia. Meta-analyses were performed using fixed and random-effects models with tests for publication bias and heterogeneity.
  
  
  RESULTS
  Significant worsening was detected in sperm concentration and motility after ESWL between case and control groups (mean difference -17.23, 95% confidence interval -22.53 to -11.93, p&lt;0.00001, mean difference -10.82, 95% confidence interval -18.56 to -3.07, p = 0.006). Rate of microscopic and macroscopic hematospermia was significantly higher after ESWL between case and control groups [risk ratio (RR) 40.00, 95% confidence interval 10.11-158.30, p&lt;0.00001, RR 14.33, 95% confidence interval 2.82-72.90, p = 0.001]. All parameters recovered after 3 months.
  
  
  CONCLUSIONS
  This study showed sperm concentration, motility, and rate of hematospermia (microscopic and macroscopic) were affected by ESWL that was used for the treatment of lower ureteral stone. Long-term studies with a focus on male fertility (i.e., pregnancy rates) after ESWL are warranted.
authors.affiliation: Urology and Nephrology Research Center, Shahid Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran - Iran.
authors.forename: Mohammad H
authors.initials: MH
authors.lastname: Radfar
authors.affiliation: Urology and Nephrology Research Center, Shahid Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran - Iran.
authors.forename: Nasser
authors.initials: N
authors.lastname: Simforoosh
authors.affiliation: Urology and Nephrology Research Center, Shahid Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran - Iran.
authors.forename: Mehdi
authors.initials: M
authors.lastname: Sotoudeh
authors.affiliation: Urology and Nephrology Research Center, Shahid Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran - Iran.
authors.forename: Mehdi H
authors.initials: MH
authors.lastname: Ramezani
authors.affiliation: Urology and Nephrology Research Center, Shahid Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran - Iran.
authors.forename: Mohammad J
authors.initials: MJ
authors.lastname: Mollakoochakian
authors.affiliation: Urology and Nephrology Research Center, Shahid Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran - Iran.
authors.forename: Maryam
authors.initials: M
authors.lastname: Nikravesh
authors.affiliation: Urology and Nephrology Research Center, Shahid Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran - Iran.|Research Committee, Shahid Beheshti University of Medical Sciences, Tehran - Iran.
authors.forename: Hamidreza
authors.initials: H
authors.lastname: Shemshaki
mesh_terms: D006801:Humans; D008096:Lithotripsy; D008297:Male; D012661:Semen; D055101:Semen Analysis