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; Murat Gül; 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; Emine Saïs-Hamza; Eric Huyghe; Erman Ceyhan; Ettore Caroppo; Fabrizio Castiglioni; Fahmi Bahar; Fatih Gokalp; Francesco Lombardo; Franco Gadda; Gede Wirya Kusuma Duarsa; Germar-Michael Pinggera; Gian Maria Busetto; Giancarlo Balercia; Gianmartin Cito; Gideon Blecher; Giorgio Franco; Giovanni Liguori; Haitham Elbardisi; Hakan Keskin; Haocheng Lin; Hisanori Taniguchi; Hyun Jun Park; Imad Ziouziou; Jean de la Rosette; Jim Hotaling; Jonathan Ramsay; Juan Manuel Corral Molina; Ka Lun Lo; Kadir Bocu; Kareim Khalafalla; Kasonde Bowa; Keisuke Okada; Koichi Nagao; Koji Chiba; Lukman Hakim; Konstantinos Makarounis; Marah Hehemann; Marcelo Rodriguez Peña; Marco Falcone; Marion Bendayan; Marlon Martinez; Massimiliano Timpano; Mesut Altan; Mikkel Fode; Mohamed S Al-Marhoon; Mohammad Ali Sadighi Gilani; Mohammad Ayodhia Soebadi; Nazim Gherabi; Nikolaos Sofikitis; Oğuzhan Kahraman; Ponco Birowo; Priyank Kothari; Puneet Sindhwani; Qaisar Javed; Rafael F Ambar; Raghavender Kosgi; Ramy Abou Ghayda; Ricky Adriansjah; Rosita Angela Condorelli; Sandro La Vignera; Sava Micic; Shannon Hee Kyung Kim; Shinichiro Fukuhara; Sun Tae Ahn; Taymour Mostafa; Teng Aik Ong; Teppei Takeshima; Toshiyasu Amano; Trenton Barrett; Umut Arslan; Vilvapathy Senguttuvan Karthikeyan; Widi Atmoko; Yasushi Yumura; Yiming Yuan; Yuki Kato; Davor Jezek; Bryan Kwun-Chung Cheng; Georgios Hatzichristodoulou; Jun Dy; Eduard Ruiz Castañé; Ahmed I El-Sakka; Quang Nguyen; Selcuk Sarikaya; Luca Boeri; Ronny Tan; Mohamad A Moussa; Ahmed El-Assmy; Hamed Alali; Naif Alhathal; Yasser Osman; Dragoljub Perovic; Hesamoddin Sajadi; Hamed Akhavizadegan; Miroslav Vučinić; Said Kattan; Mohamed S Kattan; Nasser Mogharabian; Nguyen Ho Vinh Phuoc; Kay Seong Ngoo; Mohammad H Alkandari; Shaheed Alsuhaibani; Ioannis Sokolakis; Mehdi Babaei; Mak Siu King; Thorsten Diemer; Marcelo M Gava; Raphael Henrique; Rodrigo Spinola E Silva; Gustavo Marquesine Paul; Tiago Cesar Mierzwa; Sidney Glina; Kashif Siddiqi; Han Wu; Jana Wurzacher; Ala'a Farkouh; Hwancheol Son; Suks Minhas; Joe Lee; Nikko Magsanoc; Paolo Capogrosso; German Jose Albano; Sheena E M Lewis; Channa N Jayasena; Juan G Alvarez; Colin Teo; Ryan P Smith; Jo Ben M Chua; Christian Fuglesang S Jensen; Sijo Parekattil; Renata Finelli; Damayanthi Durairajanayagam; Keshab Kumar Karna; Abdelkareem Ahmed; Don Evenson; Yukihiro Umemoto; Ana Puigvert; Gökhan Çeker; Giovanni M Colpi; Global Andrology Forum

doi:10.5534/wjmh.220048

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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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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, …

The world journal of men's health, Vol.41(1), pp.164-197

01/01/2023

DOI: https://doi.org/10.5534/wjmh.220048

PMID: 35791302

Abstract

Varicocele

Survey

Disease management

Male infertility

Consensus

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. 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. 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. 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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Title: Consensus and Diversity in the Management of Varicocele for Male Infertility: Results of a Global Practice Survey and Comparison with Guidelines and Recommendations
Creators - without role: Rupin Shah - Lilavati Hospital & Research Centre
Ashok Agarwal - Cleveland Clinic
Parviz Kavoussi - Texas Fertility Center
Amarnath Rambhatla - Henry Ford Health System
Ramadan Saleh - Sohag University
Rossella Cannarella - University of Catania
Ahmed M Harraz - Mansoura University
Florence Boitrelle - Centre Hospitalier Intercommunal de Poissy
Shinnosuke Kuroda - Cleveland Clinic
Taha Abo-Almagd Abdel-Meguid Hamoda - Minia University
Armand Zini - McGill University
Edmund Ko - Loma Linda University
Gokhan Calik - Istanbul Medipol University
Tuncay Toprak - Fatih Sultan Mehmet Eğitim Ve Araştırma Hastanesi
Hussein Kandil - IVI Middle East Fertility Clinic
Murat Gül - Selçuk University
Mustafa Emre Bakırcıoğlu - SENSART Clinic, Istanbul, Turkey
Neel Parekh - Cleveland Clinic
Giorgio Ivan Russo - University of Catania
Nicholas Tadros - Southern Illinois University School of Medicine
Ates Kadioglu - Istanbul University
Mohamed Arafa - Cleveland Clinic
Eric Chung - Princess Alexandra Hospital
Osvaldo Rajmil - Puigvert Foundation
Fotios Dimitriadis - Aristotle University of Thessaloniki
Vineet Malhotra - SCM Clinic and Hospital, New Delhi, India.
Gianmaria Salvio - Marche Polytechnic University
Ralf Henkel - Imperial College London
Tan V Le - Pham Ngoc Thach University of Medicine
Emrullah Sogutdelen - Bolu Abant İzzet Baysal University
Sarah Vij - Cleveland Clinic
Abdullah Alarbid - Farwaniya Hospital
Ahmet Gudeloglu - Hacettepe University
Akira Tsujimura - Juntendo University Urayasu Hospital
Aldo E Calogero - University of Catania
Amr El Meliegy - Cairo University
Andrea Crafa - University of Catania
Arif Kalkanli - Taksim German Hospital
Aykut Baser - Bandırma Onyedi Eylül University
Berk Hazir - Lund University
Carlo Giulioni - Marche Polytechnic University
Chak-Lam Cho - Chinese University of Hong Kong
Christopher C K Ho - Universiti Teknologi MARA
Ciro Salzano - Ospedale San Giovanni Bosco
Daniel Suslik Zylbersztejn - Hospital Israelita Albert Einstein
Dung Mai Ba Tien - Department of Andrology, Binh Dan Hospital, Ho Chi Minh City, Vietnam
Edoardo Pescatori - GynePro Medical
Edson Borges - Fertility Medical Group
Ege Can Serefoglu - Biruni University
Emine Saïs-Hamza - Centre Hospitalier Intercommunal de Poissy
Eric Huyghe - Université de Toulouse
Erman Ceyhan - Başkent University
Ettore Caroppo - Asl Bari, PTA "F Jaia", Reproductive and IVF unit, Andrology Outpatients Clinic, Asl Bari, Conversano (Ba), Italy.
Fabrizio Castiglioni - Ospedale San Carlo
Fahmi Bahar - Sriwijaya University
Fatih Gokalp - Mustafa Kemal University
Francesco Lombardo - Laboratory of Seminology-Sperm Bank "Loredana Gandini", Department of Experimental Medicine, University of Rome "Sapienza", Rome, Italy.
Franco Gadda - Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico
Gede Wirya Kusuma Duarsa - Udayana University
Germar-Michael Pinggera - Innsbruck Medical University
Gian Maria Busetto - Ospedali Riuniti di Foggia
Giancarlo Balercia - Marche Polytechnic University
Gianmartin Cito - University of Florence
Gideon Blecher - Monash University
Giorgio Franco - Policlinico Umberto I
Giovanni Liguori - University of Trieste
Haitham Elbardisi - Hamad Medical Corporation
Hakan Keskin - Hacettepe University
Haocheng Lin - Peking University Third Hospital
Hisanori Taniguchi - Kansai Medical University
Hyun Jun Park - Pusan National University Hospital
Imad Ziouziou - Université Ibn Zohr
Jean de la Rosette - Department of urology, Faculty of Medicine, Istanbul Medipol Mega University Hospital, Istanbul, Turkey
Jim Hotaling - University of Utah
Jonathan Ramsay - Hammersmith Hospital
Juan Manuel Corral Molina - Servicio de Urología, Hospital Clínico de Barcelona, Barcelona, Spain
Ka Lun Lo - Chinese University of Hong Kong
Kadir Bocu - Sivas State Hospital
Kareim Khalafalla - Hamad Medical Corporation
Kasonde Bowa - University of Lusaka
Keisuke Okada - Kobe University
Koichi Nagao - Toho University
Koji Chiba - Kobe University
Lukman Hakim - Airlangga University
Konstantinos Makarounis - Department of Urology and Andrology, Locus Medicus, Athens, Greece.
Marah Hehemann - University of Washington
Marcelo Rodriguez Peña - University of Buenos Aires
Marco Falcone - Fondazione Ricerca Molinette
Marion Bendayan - Centre Hospitalier Intercommunal de Poissy
Marlon Martinez - University of Santo Tomas Hospital
Massimiliano Timpano - Fondazione Ricerca Molinette
Mesut Altan - Hacettepe University
Mikkel Fode - Gentofte Hospital
Mohamed S Al-Marhoon - Sultan Qaboos University
Mohammad Ali Sadighi Gilani - Royan Institute
Mohammad Ayodhia Soebadi - Faculty
Nazim Gherabi - Andrology Committee of the Algerian Association of Urology, Algiers, Algeria.
Nikolaos Sofikitis - University of Ioannina
Oğuzhan Kahraman - Başkent University
Ponco Birowo - Rumah Sakit Umum Pusat Nasional Dr. Cipto Mangunkusumo
Priyank Kothari - B.Y.L Nair Ch Hospital, Mumbai, India
Puneet Sindhwani - University of Toledo
Qaisar Javed - Department of Urology, Al - Ahlia Hospital Abu Dhabi UAE, Abu Dhabi, UAE
Rafael F Ambar - Andrology Group at Ideia Fertil Institute of Human Reproduction, Santo André, Brazil
Raghavender Kosgi - Department of Urology and Andrology, AIG Hospitals, Hyderabad, Telangana, India
Ramy Abou Ghayda - Case Western Reserve University
Ricky Adriansjah - Faculty
Rosita Angela Condorelli - University of Catania
Sandro La Vignera - University of Catania
Sava Micic - Department of Andrology, Uromedica Polyclinic, Belgrade, Serbia
Shannon Hee Kyung Kim - University of Sydney
Shinichiro Fukuhara - Osaka University
Sun Tae Ahn - Department of Urology, Korea University College of Medicine, Seoul, Korea
Taymour Mostafa - Cairo University
Teng Aik Ong - Department of Surgery, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
Teppei Takeshima - Yokohama City University Medical Center
Toshiyasu Amano - Nagano Red Cross Hospital
Trenton Barrett - Perth Urology Clinic, Perth, WA, Australia
Umut Arslan - Department of Urology, Fatih Sultan Mehmet Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
Vilvapathy Senguttuvan Karthikeyan - Andrology Unit, Department of Urology, Apollo Hospitals, Greams Road, Chennai, India
Widi Atmoko - Department of Urology and Andrology, AIG Hospitals, Hyderabad, Telangana, India
Yasushi Yumura - Yokohama City University Medical Center
Yiming Yuan - Peking University First Hospital
Yuki Kato - Kanazawa University
Davor Jezek - University of Zagreb
Bryan Kwun-Chung Cheng - United Christian Hospital
Georgios Hatzichristodoulou - Martha-Maria Hospital
Jun Dy - Stone and Prostate Treatment Services/Pelvic Floor Center and Anorectal Diseases, St. Luke's Medical Center, Quezon City, Metro Manila, Philippines
Eduard Ruiz Castañé - Department of Andrology, Fundació Puigvert, Universitat Autònoma de Barcelona, Barcelona, Spain
Ahmed I El-Sakka - Suez Canal University
Quang Nguyen - Vietnam National University, Hanoi
Selcuk Sarikaya - Ankara
Luca Boeri - Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico
Ronny Tan - Mount Elizabeth Hospital
Mohamad A Moussa - Department of Urology, Al Zahraa Hospital, UMC, Lebanon
Ahmed El-Assmy - Mansoura University
Hamed Alali - King Fahad Specialist Hospital
Naif Alhathal - King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
Yasser Osman - Mansoura University
Dragoljub Perovic - University of Montenegro
Hesamoddin Sajadi - B.Y.L Nair Ch Hospital, Mumbai, India
Hamed Akhavizadegan - Tehran University of Medical Sciences
Miroslav Vučinić - Department of Urology, Užice General Hospital, Zlatibor, Serbia
Said Kattan - King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
Mohamed S Kattan - King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
Nasser Mogharabian - Shahroud University of Medical Sciences
Nguyen Ho Vinh Phuoc - Department of Andrology, Binh Dan Hospital, Ho Chi Minh City, Vietnam
Kay Seong Ngoo - Urology Unit, Department of Surgery, Hospital Angkatan Tentera Tuanku Mizan, Kuala Lumpur, Malaysia
Mohammad H Alkandari - Kuwait University
Shaheed Alsuhaibani - Imam Abdulrahman Bin Faisal University
Ioannis Sokolakis - Martha-Maria Hospital
Mehdi Babaei - Tehran University of Medical Sciences
Mak Siu King - Chinese University of Hong Kong
Thorsten Diemer - University of Giessen
Marcelo M Gava - Andrology Group at Ideia Fertil Institute of Human Reproduction, Santo André, Brazil
Raphael Henrique - CASA
Rodrigo Spinola E Silva - Andrology Group at Ideia Fertil Institute of Human Reproduction, Santo André, Brazil
Gustavo Marquesine Paul - Universidade Federal do Paraná
Tiago Cesar Mierzwa - Androlab, Fertility Clinic, Curitiba, Brazil
Sidney Glina - Department of Urology, Centro Universitario em Saude do ABC, Santo André, Brazil
Kashif Siddiqi - Cleveland Clinic
Han Wu - Department of Andrology, PKU 3rd Hospital Reproductive Medicine Center, Beijing, China
Jana Wurzacher - University Hospital Innsbruck
Ala'a Farkouh - Cleveland Clinic
Hwancheol Son - Boramae Medical Center
Suks Minhas - Imperial College London
Joe Lee - Department of Urology, National University Hospital, Singapore
Nikko Magsanoc - Department of Surgery, University of the Philippines College of Medicine, Manila, Philippines
Paolo Capogrosso - University of Insubria
German Jose Albano - University of Santo Tomas Hospital
Sheena E M Lewis - Northern (Arctic) Federal University
Channa N Jayasena - Department of Andrology, Hammersmith & St. Mary's Hospitals, London, UK
Juan G Alvarez - Department of Andrology, Centro ANDROGEN, La Coruña, Spain
Colin Teo - Gleneagles Hospital
Ryan P Smith - University of Virginia
Jo Ben M Chua - East Avenue Medical Center
Christian Fuglesang S Jensen - Copenhagen University Hospital
Sijo Parekattil - Avant Concierge Urology & University of Central Florida, Winter Garden, FL, USA
Renata Finelli - Cleveland Clinic
Damayanthi Durairajanayagam - Universiti Teknologi MARA
Keshab Kumar Karna - Cleveland Clinic
Abdelkareem Ahmed - Department of Urology, Sabah Al Ahmad Urology Center, Kuwait City, Kuwait
Don Evenson - SCSA Diagnostics, Brookings, SD, USA
Yukihiro Umemoto - Department of Nephro-Urology, Nagoya City West Medical Center, Nagoya, Japan
Ana Puigvert - Urological and Human Reproduction Unit, Quiron Hospital, Barcelona, Spain
Gökhan Çeker - Bülent Ecevit University
Giovanni M Colpi - Next Fertility Procrea, Lugano, Switzerland
Global Andrology Forum
Publication Details: The world journal of men's health, Vol.41(1), pp.164-197
Identifiers: 9916101508331
Academic Unit: Imam Abdulrahman Bin Faisal University; King Abdulaziz University
Language: English
Resource Type: Journal article