Medicinal Leech Therapy in Urology: A PRISMA-Compliant Systematic Review

To systematically review cases of medicinal leech therapy, otherwise known as hirudotherapy or leeching, in the context of urology.

A systematic review of cases in MEDLINE / PubMed was performed in accordance with PRISMA guidelines.

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.

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.