Consensus and diversity in the management of varicocele for male infertility: results of a global practice survey and comparison with guidelines and recommendations

Shah, Rupin and Agarwal, Ashok and Kavoussi, Parviz and Rambhatla, Amarnath and Saleh, Ramadan and Cannarella, Rossella and Harraz, Ahmed M. and Boitrelle, Florence and Kuroda, Shinnosuke and Hamoda, Taha Abo-Almagd Abdel-Meguid and Zini, Armand and Ko, Edmund and Calik, Gokhan and Toprak, Tuncay and Kandil, Hussein and Gul, Murat and Parekh, Neel and Russo, Giorgio Ivan and Tadros, Nicholas and Kadioglu, Ates and Arafa, Mohamed and Chung, Eric and Rajmil, Osvaldo and Dimitriadis, Fotios and Malhotra, Vineet and Salvio, Gianmaria and Henkel, Ralf and Le, Tan and Sogutdelen, Emrullah and Vij, Sarah and Alarbid, Abdullah and Gudeloglu, Ahmet and Tsujimura, Akira and Calogero, Aldo E. and El Meliegy, Amr and Crafa, Andrea and Kalkanli, Arif and Baser, Aykut and Hazir, Berk and Giulioni, Carlo and Cho, Chak-Lam and Ho, Christopher C. K. and Salzano, Ciro and Zylbersztejn, Daniel Suslik and Tien, Dung Mai Ba and Pescatori, Edoardo and Borges, Edson and Serefoglu, Ege Can and Sais-Hamza, Emine and Huyghe, Eric and Ceyhan, Erman and Caroppo, Ettore and Castiglioni, Fabrizio and Bahar, Fahmi and Gokalp, Fatih and Lombardo, Francesco and Gadda, Franco and Duarsa, Gede Wirya Kusuma and Pinggera, Germar-Michael and Busetto, Gian Maria and Balercia, Giancarlo and Cito, Gianmartin and Blecher, Gideon and Franco, Giorgio and Liguori, Giovanni and Elbardisi, Haitham and Keskin, Hakan and Lin, Haocheng and Taniguchi, Hisanori and Park, Hyun Jun and Ziouziou, Imad and de la Rosette, Jean and Hotaling, Jim and Ramsay, Jonathan and Corral Molina, Juan Manuel and Lo, Ka Lun and Bocu, Kadir and Khalafalla, Kareim and Bowa, Kasonde and Okada, Keisuke and Nagao, Koichi and Chiba, Koji and Hakim, Lukman and Makarounis, Konstantinos and Hehemann, Marah and Pena, Marcelo Rodriguez and Falcone, Marco and Bendayan, Marion and Martinez, Marlon and Timpano, Massimiliano and Altan, Mesut and Fode, Mikkel and Al-Marhoon, Mohamed S. and Gilani, Mohammad Ali Sadighi and Soebadi, Mohammad Ayodhia and Gherabi, Nazim and Sofikitis, Nikolaos and Kahraman, Oguzhan and Birowo, Ponco and Kothari, Priyank and Sindhwani, Puneet and Javed, Qaisar and Ambar, Rafael F. and Kosgi, Raghavender and Abou Ghayda, Ramy and Adriansjah, Ricky and Condorelli, Rosita Angela and La Vignera, Sandro and Micic, Sava and Kim, Shannon Hee Kyung and Fukuhara, Shinichiro and Ahn, Sun Tae and Mostafa, Taymour and Ong, Teng Aik and Takeshima, Teppei and Amano, Toshiyasu and Barrett, Trenton and Arslan, Umut and Karthikeyan, Vilvapathy Senguttuvan and Atmoko, Widi and Yumura, Yasushi and Yuan, Yiming and Kato, Yuki and Jezek, Davor and Cheng, Bryan Kwun-Chung and Hatzichristodoulou, Georgios and Dy, Jun and Ruiz Castane, Eduard and El-Sakka, Ahmed and Bakircioglu, Mustafa Emre and Nguyen, Quang and Sarikaya, Selcuk and Boeri, Luca and Tan, Ronny and Moussa, Mohamad A. and El-Assmy, Ahmed and Alali, Hamed and Alhathal, Naif and Osman, Yasser and Perovic, Dragoljub and Sajadi, Hesamoddin and Akhavizadegan, Hamed and Vucinic, Miroslav and Kattan, Said and Kattan, Mohamed S. and Mogharabian, Nasser and Phuoc, Nguyen Ho Vinh and Ngoo, Kay Seong and Alkandari, Mohammad H. and Alsuhaibani, Shaheed and Sokolakis, Ioannis and Babaei, Mehdi and King, Mak Siu and Diemer, Thorsten and Gava, Marcelo M. and Henrique, Raphael and Silva, Rodrigo Spinola E. and Paul, Gustavo Marquesine and Mierzwa, Tiago Cesar and Glina, Sidney and Siddiqi, Kashif and Wu, Han and Wurzacher, Jana and Farkouh, Ala'a and Son, Hwancheol and Minhas, Suks and Lee, Joe and Magsanoc, Nikko and Capogrosso, Paolo and Jose Albano, German and Lewis, Sheena E. M. and Jayasena, Channa N. and Alvarez, Juan G. and Teo, Colin and Smith, Ryan P. and Chua, Jo Ben M. and Jensen, Christian Fuglesang S. and Parekattil, Sijo and Finelli, Renata and Durairajanayagam, Damayanthi and Karna, Keshab Kumar and Ahmed, Abdelkareem and Evenson, Don and Umemoto, Yukihiro and Puigvert, Ana and Ceker, Gokhan and Colpi, Giovanni M. and Forum, Global Andrology (2023) Consensus and diversity in the management of varicocele for male infertility: results of a global practice survey and comparison with guidelines and recommendations. WORLD JOURNAL OF MEN'S HEALTH, 41 (1). pp. 164-197. ISSN 2287-4208, DOI

Full text not available from this repository.


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.

Item Type: Article
Funders: American Center for Reproductive Medicine, Cleveland Clinic (Project Number: IF100066).
Uncontrolled Keywords: Consensus; Disease management; Male infertility; Survey; Varicocele
Subjects: R Medicine > RA Public aspects of medicine > RA0421 Public health. Hygiene. Preventive Medicine
Depositing User: Ms Zaharah Ramly
Date Deposited: 22 Nov 2023 04:29
Last Modified: 22 Nov 2023 04:29

Actions (login required)

View Item View Item