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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 Publisher



Shah R1 ; Agarwal A2 ; Kavoussi P3 ; Rambhatla A4 ; Saleh R5 ; Cannarella R6 ; Harraz AM7, 8, 9 ; Boitrelle F10, 11, 182 ; Kuroda S2 ; Hamoda TAAAM12, 13 ; Zini A14 ; Ko E15 ; Calik G16 ; Toprak T17 Show All Authors
Authors
  1. Shah R1
  2. Agarwal A2
  3. Kavoussi P3
  4. Rambhatla A4
  5. Saleh R5
  6. Cannarella R6
  7. Harraz AM7, 8, 9
  8. Boitrelle F10, 11, 182
  9. Kuroda S2
  10. Hamoda TAAAM12, 13
  11. Zini A14
  12. Ko E15
  13. Calik G16
  14. Toprak T17
  15. Kandil H18, 170
  16. Gul M19
  17. Bakircioglu ME20
  18. Parekh N21
  19. Russo GI22
  20. Tadros N23
  21. Kadioglu A24, 185
  22. Arafa M2, 25, 26, 175
  23. Chung E27
  24. Rajmil O28
  25. Dimitriadis F29, 176
  26. Malhotra V30
  27. Salvio G31
  28. Henkel R32, 33
  29. Le TV34, 35
  30. Sogutdelen E36
  31. Vij S21
  32. Alarbid A8
  33. Gudeloglu A37
  34. Tsujimura A38
  35. Calogero AE6
  36. El Meliegy A39, 180
  37. Crafa A6
  38. Kalkanli A40
  39. Baser A41
  40. Hazir B42
  41. Giulioni C43
  42. Cho CL44
  43. Ho CCK45
  44. Salzano C46
  45. Zylbersztejn DS47
  46. Tien DMB34
  47. Pescatori E48
  48. Serefoglu EC50
  49. Saishamza E10, 11
  50. Huyghe E51, 172
  51. Ceyhan E52
  52. Caroppo E53
  53. Castiglioni F54
  54. Bahar F55
  55. Gokalp F56
  56. Lombardo F57
  57. Gadda F58
  58. Duarsa GWK59, 177
  59. Pinggera GM60
  60. Busetto GM61
  61. Balercia G31
  62. Cito G62
  63. Blecher G63, 64
  64. Franco G65
  65. Liguori G66
  66. Elbardisi H25, 67
  67. Keskin H37
  68. Lin H68
  69. Taniguchi H69
  70. Park HJ70, 71, 171, 186
  71. Ziouziou I72
  72. De La Rosette J73, 183
  73. Hotaling J74
  74. Ramsay J75
  75. Molina JMC76, 184
  76. Lo KL77
  77. Bocu K78
  78. Khalafalla K25, 79
  79. Bowa K80
  80. Okada K81
  81. Nagao K82
  82. Chiba K81
  83. Hakim L83
  84. Makarounis K84
  85. Hehemann M85
  86. Pena MR86, 181
  87. Falcone M87
  88. Bendayan M10, 11
  89. Martinez M88
  90. Timpano M87
  91. Altan M89
  92. Fode M90, 91
  93. Almarhoon MS92
  94. Gilani MAS93, 179
  95. Soebadi MA94
  96. Gherabi N95
  97. Sofikitis N96, 176
  98. Kahraman O52
  99. Birowo P97, 177
  100. Kothari P98
  101. Sindhwani P99
  102. Javed Q100
  103. Ambar RF101, 102, 174
  104. Kosgi R103
  105. Ghayda RA104
  106. Adriansjah R105, 178
  107. Condorelli RA6
  108. La Vignera S6
  109. Micic S106
  110. Kim SHK107, 108
  111. Fukuhara S109
  112. Ahn ST110
  113. Mostafa T39
  114. Ong TA111
  115. Takeshima T112
  116. Amano T113
  117. Barrett T114
  118. Arslan U17
  119. Karthikeyan VS115
  120. Atmoko W103, 177
  121. Yumura Y112
  122. Yuan Y116
  123. Kato Y117
  124. Jezek D118
  125. Cheng BKC119
  126. Hatzichristodoulou G120
  127. Dy J121
  128. Castane ER122
  129. Elsakka AI123
  130. Nguyen Q124, 125
  131. Sarikaya S126
  132. Boeri L58
  133. Tan R127, 128
  134. Moussa MA129, 130
  135. Elassmy A7
  136. Alali H131
  137. Alhathal N132
  138. Osman Y7
  139. Perovic D133
  140. Sajadi H98
  141. Akhavizadegan H134
  142. Vucinic M135
  143. Kattan S132
  144. Kattan MS132
  145. Mogharabian N136
  146. Phuoc NHV34
  147. Ngoo KS137
  148. Alkandari MH138
  149. Alsuhaibani S139
  150. Sokolakis I120
  151. Babaei M140
  152. King MS77
  153. Diemer T141
  154. Gava MM101, 102
  155. Henrique R142
  156. Spinola E Silva R101, 102
  157. Paul GM143
  158. Mierzwa TC144
  159. Glina S101
  160. Siddiqi K145
  161. Wu H146
  162. Wurzacher J147
  163. Farkouh A2
  164. Son H148
  165. Minhas S149
  166. Lee J150
  167. Magsanoc N151
  168. Capogrosso P152
  169. Albano GJ88
  170. Lewis SEM153
  171. Jayasena CN154, 155
  172. Alvarez JG156, 184
  173. Teo C157
  174. Smith RP158
  175. Chua JBM159
  176. Jensen CFS160
  177. Parekattil S161
  178. Finelli R2
  179. Durairajanayagam D162
  180. Karna KK2
  181. Ahmed A9
  182. Evenson D163
  183. Umemoto Y164
  184. Puigvert A165
  185. Ceker G166, 167
  186. Colpi GM168
  187. Rolitsky S169

Source: World Journal of Men's Health Published:2022


Abstract

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. Copyright, © 2022 Korean Society for Sexual Medicine and Andrology
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