Male Infertility: A Comprehensive Review of Urological Causes and Contemporary Management
Biagio Barone, Ugo Amicuzi, Simone Tammaro, Michelangelo Olivetta, Marco Stizzo, Michele Musone, Luigi Napolitano, Luigi De Luca, Pasquale Reccia, Federico Capone, Arturo Lecce, Giovanni Pagano, Silvestro Imperatore, Stefano Chianese, Salvatore Papi, Giampiero Della Rosa, Fabrizio Dinacci, Mariano Coppola, Antonio Madonna, Marco Grillo, Dante Dino Di Domenico, Francesco Del Giudice, Vincenzo Caputo, Dario Del Biondo, Roberto Falabella, Felice Crocetto
Abstract
Male infertility is a prevalent global health issue, with urological disorders representing some of the most common and correctable causes. Key conditions such as varicocele, obstructive azoospermia, erectile dysfunction and Peyronie's disease impair fertility through distinct pathophysiological mechanisms, including disrupted spermatogenesis, reproductive tract obstruction and failed sperm delivery. The effective management of these conditions hinges on a systematic diagnostic evaluation, which integrates clinical history, physical examination, semen analysis and specialized imaging. Modern management follows a logical progression, beginning with foundational lifestyle modifications, advancing to targeted medical or surgical interventions, and culminating, when necessary, in assisted reproductive technologies. Treatment strategies are therefore highly targeted, ranging from medical management and surgical correction-such as varicocelectomy or microsurgical reconstruction-to sperm retrieval techniques. Furthermore, evidence-based lifestyle modifications and a multidisciplinary clinical approach are fundamental to optimizing reproductive outcomes for affected couples. A comprehensive understanding of these urological etiologies is therefore essential for guiding appropriate intervention and improving the prospects of achieving pregnancy.