No / In 2013, the World Health Organization referred to tobacco smoking as an epidemic and a great threat to human health. Despite the obvious exposures from first- and secondhand smoking contributing to illnesses, an increased cancer risk, and death, there is a hidden risk to the next generation(s) from transgenerational mutations. In human populations, paternal preconceptional germ cell damage leading to genomic instability in offspring has always been difficult to evaluate as preconceptional and gestational exposures usually cannot be analyzed independently. Clear indications have been found that the effect of pre- and periconceptional paternal smoking may have been transmitted to the offspring via the spermatozoal genome and epigenome. Hence, cigarette smoke has to be considered a human germ cell mutagen due to its potential of inducing transgenerational DNA alterations in the unexposed F1 offspring of smoking-exposed fathers. For cohort studies, the practice of almost exclusively employing mother–childbirth pairs for the evaluation of lifestyle factors, such as smoking, while excluding the fathers’ contribution has to be reconsidered. Evidence now strongly points to the necessity of including the fathers in order not to miss paternal transgenerational damage in the offspring. This applies for genetic, epigenetic, and other transmissible effects.

Urogenital disorders, including cryptorchidism, hypospadias, and reduced semen quality, represent significant congenital and developmental challenges in male reproductive health. While maternal smoking during pregnancy is a well-established risk factor, emerging evidence indicates that paternal smoking may also have adverse effects on male offspring’s reproductive development. This systematic review assessed the impact of paternal cigarette smoke exposure before and during pregnancy on the incidence of various urogenital disorders. By synthesizing data from five critical studies, we found that paternal smoking was associated with a 3.8-fold increased risk of cryptorchidism and hypospadias, a 1.26-fold reduction in semen quality, and potential epigenetic changes in sperm that could elevate the risk of future reproductive health issues, including testicular cancer. These findings suggested that paternal smoking may lead to DNA damage, hormonal disruptions, and oxidative stress, which negatively affect male reproductive outcomes. Highlighting the importance of paternal smoking cessation during the preconception and prenatal periods, this review provided evidence to inform public health strategies aimed at reducing the incidence of male urogenital disorders. The insights gathered from this review support the need for targeted interventions and educational programs to minimize prenatal exposure to cigarette smoke, with the potential to improve reproductive health outcomes in future generations.