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KMID : 1037120230410010164
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The World Journal of Men′s Health
2023 Volume.41 No. 1 p.164 ~ p.197
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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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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
Gul Murat
Bakırcıoglu Mustafa Emre
Parekh Neel
Russo Giorgio Ivan
Tadros Nicholas
Kadioglu Ates
Arafa Mohamed
Chung Eric
Rajmil Osvaldo
Dimitriadis Fotios
Malhotra Vineet
Salvio Gianmaria
Henkel Ralf
Le Tan V
Sogutdelen Emrullah
Vij Sarah C.
Alarbid Abdullah
Gudeloglu Ahmet
Tsujimura Akira
Calogero Aldo Eugenio
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 Jr.
Serefoglu Ege Can
Hamza Emine Sais
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
Bowa Kasonde
Okada Keisuke
Nagao Koichi
Chiba Koji
Hakim Lukman
Makarounis Konstantinos
Hehemann Marah
Timpano Massimiliano
Altan Mesut
Fode Mikkel
Marhoon Mohamed S Al
Gilani Mohammad Ali Sadighi
Soebadi Mohammad Ayodhia
Gherabi Nazim
Sofikitis Nikolaos
Kahraman Oguzhan
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 Yukio
Jezek Davor
Cheng Bryan Kwun Chung
Hatzichristodoulou Georgios
Dy Jun S.
Castane Eduard Ruiz
Sakka Ahmed I E
Nguyen Quang
Sarikaya Selcuk
Boeri Luca
Tan Ronny
Moussa Mohamad A
Assmy Ahmed El
Alali Hamed
Alhathal Naif
Osman Yasser
Perovic Dragoljub
Sajadi Hesamoddin
Akhavizadegan Hamed
Vucinic Miroslav
Kattan Said
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
Paul Gustavo Marquesine
Mierzwa Tiago Cesar
Glina Sidney
Siddiqi Kashif
Wu Han
Wurzacher Jana
Farkouh Ala’a
Son Hwan-Cheol
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 J.
Finelli Renata
Durairajanayagam Damayanthi
Karna Keshab Kumar
Ahmed Abdelkareem
Evenson Don
Umemoto Yukihiro
Puigvert Ana
ceker Gokhan
Forum Giovanni M Colpi
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Abstract
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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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KEYWORD
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Consensus, Disease management, Male infertility, Survey, Varicocele.
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