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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.
Consensus and Diversity in the Management of Varicocele for Male Infertility: Results of a Global Practice Survey and Comparison with Guidelines and Recommendations
Shah R.;Agarwal A.;Kavoussi P.;Rambhatla A.;Saleh R.;Cannarella R.;Harraz A. M.;Boitrelle F.;Kuroda S.;Hamoda T. A. -A. A. -M.;Zini A.;Ko E.;Calik G.;Toprak T.;Kandil H.;Gul M.;Bakircioglu M. E.;Parekh N.;Russo G. I.;Tadros N.;Kadioglu A.;Arafa M.;Chung E.;Rajmil O.;Dimitriadis F.;Malhotra V.;Salvio G.;Henkel R.;Le T. V.;Sogutdelen E.;Vij S.;Alarbid A.;Gudeloglu A.;Tsujimura A.;Calogero A. E.;El Meliegy A.;Crafa A.;Kalkanli A.;Baser A.;Hazir B.;Giulioni C.;Cho C. -L.;Ho C. C. K.;Salzano C.;Zylbersztejn D. S.;Tien D. M. B.;Pescatori E.;Borges E.;Serefoglu E. C.;Sais-Hamza E.;Huyghe E.;Ceyhan E.;Caroppo E.;Castiglioni F.;Bahar F.;Gokalp F.;Lombardo F.;Gadda F.;Duarsa G. W. K.;Pinggera G. -M.;Busetto G. M.;Balercia G.;Cito G.;Blecher G.;Franco G.;Liguori G.;Elbardisi H.;Keskin H.;Lin H.;Taniguchi H.;Park H. J.;Ziouziou I.;de la Rosette J.;Hotaling J.;Ramsay J.;Molina J. M. C.;Lo K. L.;Bocu K.;Khalafalla K.;Bowa K.;Okada K.;Nagao K.;Chiba K.;Hakim L.;Makarounis K.;Hehemann M.;Pena M. R.;Falcone M.;Bendayan M.;Martinez M.;Timpano M.;Altan M.;Fode M.;Al-Marhoon M. S.;Gilani M. A. S.;Soebadi M. A.;Gherabi N.;Sofikitis N.;Kahraman O.;Birowo P.;Kothari P.;Sindhwani P.;Javed Q.;Ambar R. F.;Kosgi R.;Ghayda R. A.;Adriansjah R.;Condorelli R. A.;La Vignera S.;Micic S.;Kim S. H. K.;Fukuhara S.;Ahn S. T.;Mostafa T.;Ong T. A.;Takeshima T.;Amano T.;Barrett T.;Arslan U.;Karthikeyan V. S.;Atmoko W.;Yumura Y.;Yuan Y.;Kato Y.;Jezek D.;Cheng B. K. -C.;Hatzichristodoulou G.;Dy J.;Castane E. R.;El-Sakka A. I.;Nguyen Q.;Sarikaya S.;Boeri L.;Tan R.;Moussa M. A.;El-Assmy A.;Alali H.;Alhathal N.;Osman Y.;Perovic D.;Sajadi H.;Akhavizadegan H.;Vucinic M.;Kattan S.;Kattan M. S.;Mogharabian N.;Phuoc N. H. V.;Ngoo K. S.;Alkandari M. H.;Alsuhaibani S.;Sokolakis I.;Babaei M.;King M. S.;Diemer T.;Gava M. M.;Henrique R.;Spinola e Silva R.;Paul G. M.;Mierzwa T. C.;Glina S.;Siddiqi K.;Wu H.;Wurzacher J.;Farkouh A.;Son H.;Minhas S.;Lee J.;Magsanoc N.;Capogrosso P.;Albano G. J.;Lewis S. E. M.;Jayasena C. N.;Alvarez J. G.;Teo C.;Smith R. P.;Chua J. B. M.;Jensen C. F. S.;Parekattil S.;Finelli R.;Durairajanayagam D.;Karna K. K.;Ahmed A.;Evenson D.;Umemoto Y.;Puigvert A.;Ceker G.;Colpi G. M.;Rolitsky S.;Bouzouita A.;Shokeir A.;Asci A.;Bouker A.;Adamyan A.;Avoyan A. E.;Palani A.;Aghamajidi A.;Eze B.;Noegroho B. S.;Purnomo B.;Erkan B. K.;Zilaitiene B.;Kulaksiz D.;Kafetzis D.;Lee D. S.;Stember D.;Evgeni E.;Alhajeri F.;Finocchi F.;Colombo F.;Tsangaris G.;Sallam H. N.;Acosta H.;Rosas I. M.;Kirkman-Brown J.;Shin J. I.;Sonksen J.;Dong J.;Marmar J.;Moreno-Sepulveda J.;Seo J. T.;Aydos K.;Kesari K. K.;Trost L.;Jenkins L.;Rocco L.;Darbandi M.;Simopoulou M.;Alves M.;Sabbaghian M.;Tavalaee M.;Razi M.;Duran M. B.;Nago M.;Elkhouly M.;Khalili M.;Nasr-Esfahani M. H.;Kamath M. S.;Ugur M. R.;Park N. C.;Cruz N.;Garrido N.;Sodeifi N.;Al Khalidi N.;Shoshany O.;Satyagraha P.;Drakopoulos P.;Vogiatzi P.;Dolati P.;Das P.;Chiu P. K. -F.;Tsioulou P. A.;Patel P.;Singh R.;Kaiyal R. S.;Santos F.;Dada R.;Brodjonegoro S.;Banihani S. A.;Schon S.;Darbandi S.;Gunes S.;Homa S.;Mutambirwa S.;Roychoudhury S.;Diaz S. I. L.;Gopalakrishnan S.;Krawetz S.;Jindal S.;Avidor-Reiss T.;Lin T. Y.;Kumar V.;Ibrahim W.;Kerkeni W.;Woo W.;Morimoto Y.;Cheng Y. -S.
2022-01-01
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.
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11383/2194127
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simulazione ASN
Il report seguente simula gli indicatori relativi alla propria produzione scientifica in relazione alle soglie ASN 2023-2025 del proprio SC/SSD. Si ricorda che il superamento dei valori soglia (almeno 2 su 3) è requisito necessario ma non sufficiente al conseguimento dell'abilitazione. La simulazione si basa sui dati IRIS e sugli indicatori bibliometrici alla data indicata e non tiene conto di eventuali periodi di congedo obbligatorio, che in sede di domanda ASN danno diritto a incrementi percentuali dei valori. La simulazione può differire dall'esito di un’eventuale domanda ASN sia per errori di catalogazione e/o dati mancanti in IRIS, sia per la variabilità dei dati bibliometrici nel tempo. Si consideri che Anvur calcola i valori degli indicatori all'ultima data utile per la presentazione delle domande.
La presente simulazione è stata realizzata sulla base delle specifiche raccolte sul tavolo ER del Focus Group IRIS coordinato dall’Università di Modena e Reggio Emilia e delle regole riportate nel DM 589/2018 e allegata Tabella A. Cineca, l’Università di Modena e Reggio Emilia e il Focus Group IRIS non si assumono alcuna responsabilità in merito all’uso che il diretto interessato o terzi faranno della simulazione. Si specifica inoltre che la simulazione contiene calcoli effettuati con dati e algoritmi di pubblico dominio e deve quindi essere considerata come un mero ausilio al calcolo svolgibile manualmente o con strumenti equivalenti.
