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

Rupin Shah, Ashok Agarwal, Parviz Kavoussi, Amarnath Rambhatla, Ramadan Saleh, Rossella Cannarella, Ahmed M Harraz, Florence Boitrelle, Shinnosuke Kuroda, Taha Abo-Almagd Abdel-Meguid Hamoda, Armand Zini, Edmund Ko, Gokhan Calik, Tuncay Toprak, Hussein Kandil, Mustafa Emre Bakırcıoğlu, Neel Parekh, Giorgio Ivan Russo, Nicholas Tadros, Ates KadiogluMohamed Arafa, Eric Chung, Osvaldo Rajmil, Fotios Dimitriadis, Vineet Malhotra, Gianmaria Salvio, Ralf Henkel, Tan V Le, Emrullah Sogutdelen, Sarah Vij, Abdullah Alarbid, Ahmet Gudeloglu, Akira Tsujimura, Aldo E Calogero, Amr El Meliegy, Andrea Crafa, Arif Kalkanli, Aykut Baser, Berk Hazir, Carlo Giulioni, Chak-Lam Cho, Christopher C K Ho, Ciro Salzano, Daniel Suslik Zylbersztejn, Dung Mai Ba Tien, Edoardo Pescatori, Edson Borges, Ege Can Serefoglu, Mikkel Fode, Christian Fuglesang S Jensen, Global Andrology Forum


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.

TidsskriftWorld Journal of Men?s Health
Udgave nummer1
Sider (fra-til)164-197
Antal sider34
StatusUdgivet - jan. 2023


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