1. 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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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, Çalık, Gökhan, Toprak, Tuncay, Kandil, Hussein, Gül, Murat, Bakırcıoğlu, Mustafa Emre, Parekh, Neel, Russo, Giorgio Ivan, Tadros, Nicholas, Kadıoğlu, Ateş, Arafa, Mohamed, Chung, Eric, Rajmil, Osvaldo, Dimitriadis, Fotios, Malhotra, Vineet, Salvio, Gianmaria, Henkel, Ralf, Le, Tan V., Sogutdelen, Emrullah, Vij, Sarah, Alarbid, Abdullah, Güdeloğlu, Ahmet, Tsujimura, Akira, Calogero, Aldo E., El Meliegy, Amr, Crafa, Andrea, Kalkanlı, Arif, Baser, Aykut, Hazır, Berk, Giulioni, Carlo, Cho, Chak-Lam, Ho, Christopher C.K., Salzano, Ciro, Zylbersztejn, Daniel Suslik, Tien, Dung Mai Ba, Pescatori, Edoardo, Borges, Edson, Saïs-Hamza, Eminej, Huyghe, Eric, Ceyhan, Erman, Caroppo, Ettore, Castiglioni, Fabrizio, Bahar, Fahmi, Gökalp, 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, de la Rosette, Jean J. M. C. H., Hotaling, Jim, Ramsay, Jonathan, Molina, Juan Manuel Corral, Lo, Ka Lun, Böcü, 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, La Vignera, Sandro, 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, Sarıkaya, Selçuk, 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, Spinola e Silva, Rodrigo, 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, Colpi, Giovanni M., Rolitsky, Sarah, Bouzouita, Abderrazak, Shokeir, Ahmed, Aşçı, Ahmet, Bouker, Amin, Adamyan, Aram, Avoyan, Armen E., Palani, Ayad, Aghamajidi, Azin, Eze, Balantine, Noegroho, Bambang Sasongko, Purnomo, Basuki, Erkan, Bircan Kolbaşı, Zilaitiene, Birute, Kulaksız, Deniz, Kafetzis, Dimitrios, Lee, Dong Sup, Stember, Doron, Evgeni, Evangelini, Alhajeri, Faisal, Finocchi, Federica, Colombo, Fulvio, Tsangaris, George, Sallam, Hassan N., Acosta, Herik, Rosas, Israel Maldonado, Kirkman-Brown, Jackson, Shin, Jae Il, Sonksen, Jens, Dong, Jie, Marmar, Joel, Moreno-Sepulveda, Jose, Seo, Ju Tae, Aydos, Kaan, Kesari, Kavindra Kumar, Trost, Landon, Jenkins, Lawrence, Rocco, Lucia, Darbandi, Mahsa, Simopoulou, Mara, Alves, Marco, Sabbaghian, Marjan, Tavalaee, Marziyeh, Razi, Mazdak, Duran, Mesut Berkan, Nago, Mitsuru, Elkhouly, Mohamed, Khalili, Mohamed, Nasr-Esfahani, Mohammad Hossein, Kamath, Mohan S., Uğur, Muhammet Raşit, Park, Nam Cheol, Cruz, Natalio, Garrido, Nicolas, Sodeifi, Niloofar, Al Khalidi, Noora, Shoshany, Ohad, Satyagraha, Paksi, Drakopoulos, Panagiotos, Vogiatzi, Paraskevi, Dolati, Parisa, Das, Partha, Chiu, Peter Ka-Fung, Tsioulou, Petroula A., Patel, Premal, Singh, Rajender, Kaiyal, Raneen Sawaid, Santos, Ferreira, Dada, Rima, Brodjonegoro, Sakti, Banihani, Saleem Ali, Schon, Samantha, Darbandi, Sara, Güneş, Sezgin, Homa, Sheryl, Mutambirwa, Shingai, Roychoudhury, Shubhadeep, Diaz, Sofia Ines Leonardi, Gopalakrishnan, Sreelatha, Krawetz, Stephen, Jindal, Sunil, Avidor-Reiss, Tomer, Lin, Tsung Yen, Kumar, Vijay, Ibrahim, Wael, Kerkeni, Walid, Woo, Wongi, Morimoto, Yoshiharu, Cheng, Yu-Sheng, 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, Nichola, Kadioglu, Ate, Arafa, Mohamed, Chung, Eric, Rajmil, Osvaldo, Dimitriadis, Fotio, 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, Sas-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, Konstantino, 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, Nikolao, 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, Georgio, 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, Ioanni, 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, Suk, 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, 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., Gul, M., Bakircioglu, M. E., Parekh, N., Russo, G. I., Tadros, N., Kadioglu, A., Arafa, M., Chung, E., Rajmil, O., Dimitriadis, F., Malhotra, V., Salvio, G., Henkel, R., Le, T. V., Sogutdelen, E., Vij, S., Alarbid, A., Gudeloglu, A., Tsujimura, A., Calogero, A. E., El Meliegy, A., Crafa, A., Kalkanli, A., Baser, A., Hazir, B., Giulioni, C., Cho, C. -L., Ho, C. C. K., Salzano, C., Zylbersztejn, D. S., Tien, D. M. B., Pescatori, E., Borges, E., Serefoglu, E. C., Sais-Hamza, E., Huyghe, E., Ceyhan, E., Caroppo, E., Castiglioni, F., Bahar, F., Gokalp, F., Lombardo, F., Gadda, F., Duarsa, G. W. K., Pinggera, G. -M., Busetto, G. M., Balercia, G., Cito, G., Blecher, G., Franco, G., Liguori, G., Elbardisi, H., Keskin, H., Lin, H., Taniguchi, H., Park, H. J., Ziouziou, I., de la Rosette, J., Hotaling, J., Ramsay, J., Molina, J. M. C., Lo, K. L., Bocu, K., Khalafalla, K., Bowa, K., Okada, K., Nagao, K., Chiba, K., Hakim, L., Makarounis, K., Hehemann, M., Pena, M. R., Falcone, M., Bendayan, M., Martinez, M., Timpano, M., Altan, M., Fode, M., Al-Marhoon, M. S., Gilani, M. A. S., Soebadi, M. A., Gherabi, N., Sofikitis, N., Kahraman, O., Birowo, P., Kothari, P., Sindhwani, P., Javed, Q., Ambar, R. F., Kosgi, R., Ghayda, R. A., Adriansjah, R., Condorelli, R. A., La Vignera, S., Micic, S., Kim, S. H. K., Fukuhara, S., Ahn, S. T., Mostafa, T., Ong, T. A., Takeshima, T., Amano, T., Barrett, T., Arslan, U., Karthikeyan, V. S., Atmoko, W., Yumura, Y., Yuan, Y., Kato, Y., Jezek, D., Cheng, B. K. -C., Hatzichristodoulou, G., Dy, J., Castane, E. R., El-Sakka, A. I., Nguyen, Q., Sarikaya, S., Boeri, L., Tan, R., Moussa, M. A., El-Assmy, A., Alali, H., Alhathal, N., Osman, Y., Perovic, D., Sajadi, H., Akhavizadegan, H., Vucinic, M., Kattan, S., Kattan, M. S., Mogharabian, N., Phuoc, N. H. V., Ngoo, K. S., Alkandari, M. H., Alsuhaibani, S., Sokolakis, I., Babaei, M., King, M. S., Diemer, T., Gava, M. M., Henrique, R., Spinola e Silva, R., Paul, G. M., Mierzwa, T. C., Glina, S., Siddiqi, K., Wu, H., Wurzacher, J., Farkouh, A., Son, H., Minhas, S., Lee, J., Magsanoc, N., Capogrosso, P., Albano, G. J., Lewis, S. E. M., Jayasena, C. N., Alvarez, J. G., Teo, C., Smith, R. P., Chua, J. B. M., Jensen, C. F. S., Parekattil, S., Finelli, R., Durairajanayagam, D., Karna, K. K., Ahmed, A., Evenson, D., Umemoto, Y., Puigvert, A., Ceker, G., Colpi, G. M., Rolitsky, S., Bouzouita, A., Shokeir, A., Asci, A., Bouker, A., Adamyan, A., Avoyan, A. E., Palani, A., Aghamajidi, A., Eze, B., Noegroho, B. S., Purnomo, B., Erkan, B. K., Zilaitiene, B., Kulaksiz, D., Kafetzis, D., Lee, D. S., Stember, D., Evgeni, E., Alhajeri, F., Finocchi, F., Colombo, F., Tsangaris, G., Sallam, H. N., Acosta, H., Rosas, I. M., Kirkman-Brown, J., Shin, J. I., Sonksen, J., Dong, J., Marmar, J., Moreno-Sepulveda, J., Seo, J. T., Aydos, K., Kesari, K. K., Trost, L., Jenkins, L., Rocco, L., Darbandi, M., Simopoulou, M., Alves, M., Sabbaghian, M., Tavalaee, M., Razi, M., Duran, M. B., Nago, M., Elkhouly, M., Khalili, M., Nasr-Esfahani, M. H., Kamath, M. S., Ugur, M. R., Park, N. C., Cruz, N., Garrido, N., Sodeifi, N., Al Khalidi, N., Shoshany, O., Satyagraha, P., Drakopoulos, P., Vogiatzi, P., Dolati, P., Das, P., Chiu, P. K. -F., Tsioulou, P. A., Patel, P., Singh, R., Kaiyal, R. S., Santos, F., Dada, R., Brodjonegoro, S., Banihani, S. A., Schon, S., Darbandi, S., Gunes, S., Homa, S., Mutambirwa, S., Roychoudhury, S., Diaz, S. I. L., Gopalakrishnan, S., Krawetz, S., Jindal, S., Avidor-Reiss, T., Lin, T. Y., Kumar, V., Ibrahim, W., Kerkeni, W., Woo, W., Morimoto, Y., Cheng, Y. -S., and Tıp Fakültesi
- Subjects
Aging ,Consensus ,Urology ,INGUINAL VARICOCELECTOMY ,Disease management ,Male infertility ,Survey ,Varicocele ,Consensu ,Global Andrology Forum ,Endocrinology & Metabolism ,NONOBSTRUCTIVE AZOOSPERMIA ,ASSISTED REPRODUCTIVE TECHNOLOGY ,Male Infertility ,Pharmacology (medical) ,Andrology ,IMPAIRED SEMEN QUALITY ,EUROPEAN ASSOCIATION ,Science & Technology ,UROLOGY GUIDELINES ,Health Policy ,Public Health, Environmental and Occupational Health ,Disease Management ,Urology & Nephrology ,SUBCLINICAL VARICOCELE ,Psychiatry and Mental health ,Health Care Sciences & Services ,MICROSURGICAL SUBINGUINAL VARICOCELECTOMY ,Reproductive Medicine ,SPERM MORPHOLOGY ,UNTREATED VARICOCELE ,Life Sciences & Biomedicine - 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 As- sociation [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 re- sponses were at odds with the recommendations of AUA, ASRM, and EAU. A large number of clinical situations were identi- fied where no guidelines are available. Conclusions: This study is the largest global survey performed to date on the clinical management of varicocele for male in- fertility. It demonstrates: 1) a wide disagreement in the approach to varicocele management, 2) large gaps in the clinical prac- tice guidelines from professional societies, and 3) the need for further studies on several aspects of varicocele management in infertile men.
- Published
- 2022