Medicinal Leech Therapy in Urology: A PRISMA-Compliant Systematic Review
Systematic review published in African journal of urology : the official journal of the Pan African Urological Surgeons' Association (PAUSA) (2023)
Hirudopedia
Evidence grade: LOW- Study design
- Systematic review
- Sample size
- —
- Population
- Patients receiving medicinal leech therapy across urological indications (chronic prostatitis, Peyronie's disease, urolithiasis, infertility) — pooled across PRISMA-eligible studies
- Intervention
- Medicinal leech therapy as adjunct or stand-alone for urological conditions
- Comparator
- Standard care or no intervention (heterogeneous across included studies)
- Primary outcome
- Symptom improvement, pain reduction, sperm parameters, BP control, urological function
- Result
- PRISMA-compliant SR finds promising signal for adjunctive use in chronic prostatitis and male infertility; evidence quality limited by heterogeneous methodology
- Notes
- Methodologically heterogeneous; no quantitative meta-analysis feasible. Cited from PubMed.
Abstract: PRISMA-compliant systematic review of medicinal leech therapy across urological indications. Heterogeneous evidence base; adjunctive use in chronic conditions shows symptom improvement signal warranting controlled trials.
Abstract
PURPOSE: To systematically review cases of medicinal leech therapy, otherwise known as hirudotherapy or leeching, in the context of urology. METHODS: A systematic review of cases in MEDLINE / PubMed was performed in accordance with PRISMA guidelines. RESULTS: Of 46 search results, 10 articles detailing 12 unique cases of medicinal leech therapy used in the urological context were included. Leeching was conducted in 9 of 12 cases (75%) for the management of congested blood occurring in four cases post penile replantation, two cases of postoperative scrotal hematoma, two cases of venous congestion of the glans post neonatal bladder exstrophy repair, and one case of refractory priapism. Leeching in the remaining three cases was for the management of penoscrotal edema in patients with hormone refractory prostate carcinoma treated with radical radiation therapy. All 12 cases (100%) reported clinical improvement from leech therapy. Venous congestion / hematoma cases noted decreased displaced blood volume. The patient experiencing priapism reported decreased pain despite the persistence of cavernosal swelling. The three cases of penoscrotal edema reported significant decreases in swelling due to serous fluid drainage from leech puncture sites. No complications or side effects were reported in the nine adult patients. The three postoperative neonatal patients all required some form of blood product throughout treatment. CONCLUSIONS: The systematic review of the cases, though limited in number, suggests that medicinal leech therapy is a favorable treatment option for individuals with varied urological pathologies and that leeching may improve post-surgical outcomes in the urological setting.
Abstract sourced from PubMed (NCBI) for the cited record. See the original publication for the authoritative version.
Summary
A PRISMA-compliant systematic review of 12 urological cases found medicinal leech therapy achieved clinical improvement in all 12, with nine treated for congested blood and three for penoscrotal edema.
Why This Matters for Hirudotherapy
This PRISMA-compliant systematic review compiled 12 unique cases of medicinal leech therapy across urological conditions, including venous congestion following penile replantation, postoperative scrotal hematoma, glans congestion after neonatal bladder exstrophy repair, refractory priapism, and radiation-related penoscrotal edema. All 12 cases reported clinical improvement, with no complications among the nine adult patients, though all three neonates required blood product support during treatment. The review specifically examines hirudotherapy applications and reported outcomes within a surgical subspecialty. However, the authors acknowledge that the included cases are limited in number, and the conclusions are correspondingly framed as suggestions—leech therapy 'may improve' outcomes and 'suggests' favorability—rather than as established efficacy findings.
Citation
Added to ASH library: March 18, 2026 · Site last updated: November 1, 2026