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 TadrosAtes 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, the Global Andrology Forum

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

17 Citations (Scopus)
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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.

Original languageEnglish
Article numberwjmh.220048
Pages (from-to)164-197
Number of pages34
JournalWorld Journal of Men's Health
Volume41
Issue number1
DOIs
Publication statusPublished - Jan 2023

Bibliographical note

Version archived for private and non-commercial use with the permission of the author/s and according to publisher conditions. For further rights please contact the publisher.

Keywords

  • Consensus
  • Disease management
  • Male infertility
  • Survey
  • Varicocele

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