TY - JOUR
T1 - Consensus and Diversity in the Management of Varicocele for Male Infertility
T2 - Results of a Global Practice Survey and Comparison with Guidelines and Recommendations
AU - the Global Andrology Forum
AU - Shah, Rupin
AU - Agarwal, Ashok
AU - Kavoussi, Parviz
AU - Rambhatla, Amarnath
AU - Saleh, Ramadan
AU - Cannarella, Rossella
AU - Harraz, Ahmed M.
AU - Boitrelle, Florence
AU - Kuroda, Shinnosuke
AU - Hamoda, Taha Abo Almagd Abdel Meguid
AU - Zini, Armand
AU - Ko, Edmund
AU - Calik, Gokhan
AU - Toprak, Tuncay
AU - Kandil, Hussein
AU - Gül, Murat
AU - Bakırcıoğlu, Mustafa Emre
AU - Parekh, Neel
AU - Russo, Giorgio Ivan
AU - Tadros, Nicholas
AU - Kadioglu, Ates
AU - Arafa, Mohamed
AU - Chung, Eric
AU - Rajmil, Osvaldo
AU - Dimitriadis, Fotios
AU - Malhotra, Vineet
AU - Salvio, Gianmaria
AU - Henkel, Ralf
AU - Le, Tan V.
AU - Sogutdelen, Emrullah
AU - Vij, Sarah
AU - Alarbid, Abdullah
AU - Gudeloglu, Ahmet
AU - Tsujimura, Akira
AU - Calogero, Aldo E.
AU - El Meliegy, Amr
AU - Crafa, Andrea
AU - Kalkanli, Arif
AU - Baser, Aykut
AU - Hazir, Berk
AU - Giulioni, Carlo
AU - Cho, Chak Lam
AU - Ho, Christopher C.K.
AU - Salzano, Ciro
AU - Zylbersztejn, Daniel Suslik
AU - Tien, Dung Mai Ba
AU - Pescatori, Edoardo
AU - Borges, Edson
AU - Serefoglu, Ege Can
AU - Alsuhaibani, Shaheed
N1 - Publisher Copyright:
Copyright, © 2022 Korean Society for Sexual Medicine and Andrology
PY - 2022
Y1 - 2022
N2 - Purpose: 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. Materials and Methods: 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. Results: 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. Conclusions: 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.
AB - Purpose: 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. Materials and Methods: 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. Results: 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. Conclusions: 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.
KW - Consensus
KW - Disease management
KW - Male infertility
KW - Survey
KW - Varicocele
UR - https://www.scopus.com/pages/publications/85134651253
U2 - 10.5534/wjmh.220048
DO - 10.5534/wjmh.220048
M3 - Article
AN - SCOPUS:85134651253
SN - 2287-4208
VL - 41
JO - World Journal of Men's Health
JF - World Journal of Men's Health
IS - 1
M1 - wjmh.220048
ER -