Urological Congenitalism, Reconstruction and Neuro-Urological Male Patients: Reproductive Health and Fertility Challenges and Their Contemporary Management

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Abstract
Male patients with congenital urogenital anomalies and neuro-urological conditions represent a unique and underrecognized population at risk for infertility and sexual dysfunction. This chapter aims to review the embryological and developmental basis of these conditions and to clarify their direct effects on spermatogenesis, hormonal regulation, and sperm transport. We provide a detailed discussion of common anomalies—including bladder exstrophy, prune belly syndrome, cryptorchidism, and spinal dysraphism—as well as acquired neuro-urological disorders, such as multiple sclerosis, spinal cord injury, and cerebrovascular accident, highlighting their impact on reproductive health and quality of life. Key findings demonstrate that both congenital and neurogenic conditions disrupt male fertility through structural anomalies, impaired testicular development, endocrine dysfunction, and ejaculatory disorders. Contemporary management strategies—ranging from early orchiopexy, reconstructive and substitution phalloplasty, penile prostheses, and urinary tract reconstruction, to assisted reproductive technologies (ART) and sperm retrieval—can mitigate these challenges. Multidisciplinary care, involving functional and reproductive urology, endocrinology, neurology, and psychology, is shown to optimize fertility outcomes. Additionally, models of transitional urology illustrate how proactive fertility counseling and early intervention improve long-term reproductive prospects. In conclusion, congenitalism and neuro-urological disease exert profound effects on male reproductive health that extend beyond childhood survival into adulthood and family planning. Advances in surgical reconstruction, ART, and multidisciplinary care are improving outcomes; yet, long-term follow-up and fertility-preservation strategies remain critical. Future directions—including stem-cell therapy, neuromodulation, and AI-supported management—offer promise in addressing the unmet needs of this vulnerable population.

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