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 Kadioglu; Mohamed 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

doi:10.5534/wjmh.220048

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

Urinvejssygdomme

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.

Originalsprog	Engelsk
Artikelnummer	wjmh.220048
Tidsskrift	World Journal of Men?s Health
Vol/bind	41
Udgave nummer	1
Sider (fra-til)	164-197
Antal sider	34
ISSN	2287-4208
DOI	https://doi.org/10.5534/wjmh.220048
Status	Udgivet - jan. 2023

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10.5534/wjmh.220048Licens: CC BY-NC

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Shah, R., Agarwal, A., Kavoussi, P., Rambhatla, A., Saleh, R., Cannarella, R., Harraz, A. M., Boitrelle, F., Kuroda, S., Hamoda, T. A.-A. A.-M., Zini, A., Ko, E., Calik, G., Toprak, T., Kandil, H., Bakırcıoğlu, M. E., Parekh, N., Russo, G. I., Tadros, N., ... Global Andrology Forum (2023). Consensus and Diversity in the Management of Varicocele for Male Infertility: Results of a Global Practice Survey and Comparison with Guidelines and Recommendations. World Journal of Men?s Health, 41(1), 164-197. Artikel wjmh.220048. https://doi.org/10.5534/wjmh.220048

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 et al.
I: World Journal of Men?s Health, Bind 41, Nr. 1, wjmh.220048, 01.2023, s. 164-197.

Publikation: Bidrag til tidsskrift › Tidsskriftartikel › Forskning › peer review

Shah, R, Agarwal, A, Kavoussi, P, Rambhatla, A, Saleh, R, Cannarella, R, Harraz, AM, Boitrelle, F, Kuroda, S, Hamoda, TA-AA-M, Zini, A, Ko, E, Calik, G, Toprak, T, Kandil, H, Bakırcıoğlu, ME, Parekh, N, Russo, GI, Tadros, N, Kadioglu, A, Arafa, M, Chung, E, Rajmil, O, Dimitriadis, F, Malhotra, V, Salvio, G, Henkel, R, Le, TV, Sogutdelen, E, Vij, S, Alarbid, A, Gudeloglu, A, Tsujimura, A, Calogero, AE, El Meliegy, A, Crafa, A, Kalkanli, A, Baser, A, Hazir, B, Giulioni, C, Cho, C-L, Ho, CCK, Salzano, C, Zylbersztejn, DS, Tien, DMB, Pescatori, E, Borges, E, Serefoglu, EC, Fode, M , Jensen, CFS & Global Andrology Forum 2023, 'Consensus and Diversity in the Management of Varicocele for Male Infertility: Results of a Global Practice Survey and Comparison with Guidelines and Recommendations', World Journal of Men?s Health, bind 41, nr. 1, wjmh.220048, s. 164-197. https://doi.org/10.5534/wjmh.220048

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

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.",

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

note = "Copyright {\textcopyright} 2023 Korean Society for Sexual Medicine and Andrology.",

year = "2023",

month = jan,

doi = "10.5534/wjmh.220048",

language = "English",

volume = "41",

pages = "164--197",

journal = "World Journal of Men?s Health",

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publisher = "Korean Society for Sexual Medicine and Andrology",

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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 - 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 - 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 - Fode, Mikkel

AU - Jensen, Christian Fuglesang S

AU - Global Andrology Forum

PY - 2023/1

Y1 - 2023/1

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.

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U2 - 10.5534/wjmh.220048

DO - 10.5534/wjmh.220048

M3 - Journal article

C2 - 35791302

SN - 2287-4208

VL - 41

SP - 164

EP - 197

JO - World Journal of Men?s Health

JF - World Journal of Men?s Health

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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

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