Consensus and Diversity in the Management of Varicocele for Male Infertility: Results of a Global Practice Survey and Comparison with Guidelines and Recommendations.
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Consensus and Diversity in the Management of Varicocele for Male Infertility: Results of a Global Practice Survey and Comparison with Guidelines and Recommendations.

Shah, Rupin;Agarwal, Ashok;Kavoussi, Parviz;Rambhatla, Amarnath;Saleh, Ramadan;Cannarella, Rossella;Harraz, Ahmed M;Boitrelle, Florence;Kuroda, Shinnosuke;Hamoda, Taha Abo-Almagd Abdel-Meguid;Zini, Armand;Ko, Edmund;Calik, Gokhan;Toprak, Tuncay;Kandil, Hussein;Gül, Murat;Bakırcıoğlu, Mustafa Emre;Parekh, Neel;Russo, Giorgio Ivan;Tadros, Nicholas;Kadioglu, Ates;Arafa, Mohamed;Chung, Eric;Rajmil, Osvaldo;Dimitriadis, Fotios;Malhotra, Vineet;Salvio, Gianmaria;Henkel, Ralf;Le, Tan V;Sogutdelen, Emrullah;Vij, Sarah;Alarbid, Abdullah;Gudeloglu, Ahmet;Tsujimura, Akira;Calogero, Aldo E;Meliegy, Amr El;Crafa, Andrea;Kalkanli, Arif;Baser, Aykut;Hazir, Berk;Giulioni, Carlo;Cho, Chak-Lam;Ho, Christopher C K;Salzano, Ciro;Zylbersztejn, Daniel Suslik;Tien, Dung Mai Ba;Pescatori, Edoardo;Borges, Edson;Serefoglu, Ege Can;Saïs-Hamza, Emine;Huyghe, Eric;Ceyhan, Erman;Caroppo, Ettore;Castiglioni, Fabrizio;Bahar, Fahmi;Gokalp, Fatih;Lombardo, Francesco;Gadda, Franco;Duarsa, Gede Wirya Kusuma;Pinggera, Germar-Michael;Busetto, Gian Maria;Balercia, Giancarlo;Cito, Gianmartin;Blecher, Gideon;Franco, Giorgio;Liguori, Giovanni;Elbardisi, Haitham;Keskin, Hakan;Lin, Haocheng;Taniguchi, Hisanori;Park, Hyun Jun;Ziouziou, Imad;Rosette, Jean de la;Hotaling, Jim;Ramsay, Jonathan;Molina, Juan Manuel Corral;Lo, Ka Lun;Bocu, Kadir;Khalafalla, Kareim;Bowa, Kasonde;Okada, Keisuke;Nagao, Koichi;Chiba, Koji;Hakim, Lukman;Makarounis, Konstantinos;Hehemann, Marah;Peña, Marcelo Rodriguez;Falcone, Marco;Bendayan, Marion;Martinez, Marlon;Timpano, Massimiliano;Altan, Mesut;Fode, Mikkel;Al-Marhoon, Mohamed S;Gilani, Mohammad Ali Sadighi;Soebadi, Mohammad Ayodhia;Gherabi, Nazim;Sofikitis, Nikolaos;Kahraman, Oğuzhan;Birowo, Ponco;Kothari, Priyank;Sindhwani, Puneet;Javed, Qaisar;Ambar, Rafael F;Kosgi, Raghavender;Ghayda, Ramy Abou;Adriansjah, Ricky;Condorelli, Rosita Angela;Vignera, Sandro La;Micic, Sava;Kim, Shannon Hee Kyung;Fukuhara, Shinichiro;Ahn, Sun Tae;Mostafa, Taymour;Ong, Teng Aik;Takeshima, Teppei;Amano, Toshiyasu;Barrett, Trenton;Arslan, Umut;Karthikeyan, Vilvapathy Senguttuvan;Atmoko, Widi;Yumura, Yasushi;Yuan, Yiming;Kato, Yuki;Jezek, Davor;Cheng, Bryan Kwun-Chung;Hatzichristodoulou, Georgios;Dy, Jun;Castañé, Eduard Ruiz;El-Sakka, Ahmed I;Nguyen, Quang;Sarikaya, Selcuk;Boeri, Luca;Tan, Ronny;Moussa, Mohamad A;El-Assmy, Ahmed;Alali, Hamed;Alhathal, Naif;Osman, Yasser;Perovic, Dragoljub;Sajadi, Hesamoddin;Akhavizadegan, Hamed;Vučinić, Miroslav;Kattan, Said;Kattan, Mohamed S;Mogharabian, Nasser;Phuoc, Nguyen Ho Vinh;Ngoo, Kay Seong;Alkandari, Mohammad H;Alsuhaibani, Shaheed;Sokolakis, Ioannis;Babaei, Mehdi;King, Mak Siu;Diemer, Thorsten;Gava, Marcelo M;Henrique, Raphael;Silva, Rodrigo Spinola E;Paul, Gustavo Marquesine;Mierzwa, Tiago Cesar;Glina, Sidney;Siddiqi, Kashif;Wu, Han;Wurzacher, Jana;Farkouh, Ala'a;Son, Hwancheol;Minhas, Suks;Lee, Joe;Magsanoc, Nikko;Capogrosso, Paolo;Albano, German Jose;Lewis, Sheena E M;Jayasena, Channa N;Alvarez, Juan G;Teo, Colin;Smith, Ryan P;Chua, Jo Ben M;Jensen, Christian Fuglesang S;Parekattil, Sijo;Finelli, Renata;Durairajanayagam, Damayanthi;Karna, Keshab Kumar;Ahmed, Abdelkareem;Evenson, Don;Umemoto, Yukihiro;Puigvert, Ana;Çeker, Gökhan;Forum, Giovanni M Colpi;, ;
The world journal of men's health 2022
141
shah2022consensusthe

Abstract

Varicocele is a common problem among infertile men. Varicocele repair (VR) is frequently performed to improve semen parameters and the chances of pregnancy. However, there is a lack of consensus about the diagnosis, indications for VR and its outcomes. The aim of this study was to explore global practice patterns on the management of varicocele in the context of male infertility.Sixty practicing urologists/andrologists from 23 countries contributed 382 multiple-choice-questions pertaining to varicocele management. These were condensed into an online questionnaire that was forwarded to clinicians involved in male infertility management through direct invitation. The results were analyzed for disagreement and agreement in practice patterns and, compared with the latest guidelines of international professional societies (American Urological Association [AUA], American Society for Reproductive Medicine [ASRM], and European Association of Urology [EAU]), and with evidence emerging from recent systematic reviews and meta-analyses. Additionally, an expert opinion on each topic was provided based on the consensus of 16 experts in the field.The questionnaire was answered by 574 clinicians from 59 countries. The majority of respondents were urologists/uro-andrologists. A wide diversity of opinion was seen in every aspect of varicocele diagnosis, indications for repair, choice of technique, management of sub-clinical varicocele and the role of VR in azoospermia. A significant proportion of the responses were at odds with the recommendations of AUA, ASRM, and EAU. A large number of clinical situations were identified where no guidelines are available.This study is the largest global survey performed to date on the clinical management of varicocele for male infertility. It demonstrates: 1) a wide disagreement in the approach to varicocele management, 2) large gaps in the clinical practice guidelines from professional societies, and 3) the need for further studies on several aspects of varicocele management in infertile men.

Keywords

survey male infertility consensus disease management varicocele

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DOI:
10.5534/wjmh.220048

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