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 - 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 - Fode, Mikkel

AU - Jensen, Christian Fuglesang S.

AU - Sonksen, Jens

AU - the Global Andrology Forum

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

U2 - 10.5534/wjmh.220048

DO - 10.5534/wjmh.220048

M3 - Journal article

C2 - 35791302

AN - SCOPUS:85134651253

VL - 40

JO - World Journal of Men?s Health

JF - World Journal of Men?s Health

SN - 2287-4208

M1 - wjmh.220048

ER -