Consensus and Diversity in the Management of Varicocele for Male Infertility: Results of a Global Practice Survey and Comparison with Guidelines and Recommendations.
Consensus
Disease management
Male infertility
Survey
Varicocele
Journal
The world journal of men's health
ISSN: 2287-4208
Titre abrégé: World J Mens Health
Pays: Korea (South)
ID NLM: 101596899
Informations de publication
Date de publication:
01 2023
01 2023
Historique:
received:
08
03
2022
revised:
15
03
2022
accepted:
20
03
2022
pubmed:
7
7
2022
medline:
7
7
2022
entrez:
6
7
2022
Statut:
ppublish
Résumé
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.
Identifiants
pubmed: 35791302
pii: 40.e48
doi: 10.5534/wjmh.220048
pmc: PMC9826919
doi:
Types de publication
Journal Article
Langues
eng
Pagination
164-197Informations de copyright
Copyright © 2023 Korean Society for Sexual Medicine and Andrology.
Déclaration de conflit d'intérêts
The authors have nothing to disclose.
Références
J Urol. 1999 Jan;161(1):117-21
pubmed: 10037382
Urology. 2007 Feb;69(2):352-5
pubmed: 17320677
Andrologia. 2021 Feb;53(1):e13885
pubmed: 33118219
World J Urol. 2011 Oct;29(5):645-50
pubmed: 21607575
Urology. 2015 Apr;85(4):826-30
pubmed: 25817105
Hum Reprod Update. 1998 Jan-Feb;4(1):73-82
pubmed: 9622414
Andrologia. 2020 Mar;52(2):e13500
pubmed: 31840291
Reprod Sci. 2021 Mar;28(3):909-919
pubmed: 32909188
Urology. 2015 Dec;86(6):1123-8
pubmed: 26341572
Andrologia. 2018 Nov;50(9):e13078
pubmed: 30024042
Asian J Androl. 2016 Mar-Apr;18(2):179-81
pubmed: 26763551
Andrology. 2019 Mar;7(2):193-198
pubmed: 30618196
Hum Fertil (Camb). 2022 Feb;25(1):135-141
pubmed: 31916507
Hum Reprod. 2006 Apr;21(4):986-93
pubmed: 16361286
J Urol. 2012 Jan;187(1):222-6
pubmed: 22100001
Urology. 2015 Jul;86(1):48-51
pubmed: 26142582
Can Urol Assoc J. 2012 Aug;6(4):266-8
pubmed: 23093537
Urology. 2014 May;83(5):1071-4
pubmed: 24674115
J Androl. 2009 Jan-Feb;30(1):33-40
pubmed: 18772487
BJU Int. 2012 Nov;110(10):1536-42
pubmed: 22642226
Asian J Androl. 2016 Mar-Apr;18(2):246-53
pubmed: 26680033
Fertil Steril. 1980 Jan;33(1):88-90
pubmed: 7351263
Indian J Med Sci. 2007 Sep;61(9):505-10
pubmed: 17785886
J Urol. 2009 Oct;182(4):1500-5
pubmed: 19683732
Asian J Androl. 2016 Mar-Apr;18(2):254-8
pubmed: 26510504
Int J Androl. 2011 Jun;34(3):236-41
pubmed: 20579135
Urol Ann. 2021 Jul-Sep;13(3):268-271
pubmed: 34421263
J Urol. 2005 Feb;173(2):482-4
pubmed: 15643221
Andrologia. 2021 Feb;53(1):e13576
pubmed: 32271477
J Urol. 1995 Jan;153(1):82-4
pubmed: 7966798
Andrologia. 2021 Jul;53(6):e14059
pubmed: 33763931
Urology. 2008 Mar;71(3):485-9
pubmed: 18342193
Arab J Urol. 2021 Feb 14;19(2):186-190
pubmed: 34104495
Singapore Med J. 2014 Jun;55(6):305-9
pubmed: 25017405
J Urol. 2008 Nov;180(5):2129-32
pubmed: 18804226
Urology. 2006 Dec;68(6):1323-6
pubmed: 17169654
Fertil Steril. 2001 May;75(5):1013-6
pubmed: 11334918
J Urol. 2021 Jan;205(1):36-43
pubmed: 33295257
Arab J Urol. 2017 Dec 14;16(1):157-170
pubmed: 29713547
Eur Urol. 2021 Sep;80(3):333-357
pubmed: 34183196
Curr Urol Rep. 2019 Jun 15;20(8):43
pubmed: 31203470
Urol Int. 2008;80(2):172-6
pubmed: 18362488
Eur Urol. 2011 Oct;60(4):796-808
pubmed: 21733620
Fertil Steril. 2010 Apr;93(6):1907-10
pubmed: 19249033
Biol Rev Camb Philos Soc. 2021 Aug;96(4):1284-1300
pubmed: 33644978
Scand J Urol. 2014 Dec;48(6):494-8
pubmed: 25001949
Andrologia. 2020 Dec;52(11):e13875
pubmed: 33118228
Fertil Steril. 2021 Sep;116(3):696-712
pubmed: 33985792
Cochrane Database Syst Rev. 2021 Apr 23;4:CD000479
pubmed: 33890288
Scand J Urol Nephrol. 2000 Apr;34(2):119-22
pubmed: 10903073
Andrologia. 2018 Feb 20;:
pubmed: 29460294
Fertil Steril. 2016 Nov;106(6):1338-1343
pubmed: 27526630
J Urol. 2012 Jan;187(1):227-31
pubmed: 22100000
Int J Urol. 2007 Aug;14(8):729-32
pubmed: 17681064
J Assist Reprod Genet. 2015 Apr;32(4):615-23
pubmed: 25711835
Urology. 2009 Jun;73(6):1236-40
pubmed: 19371942
Can Urol Assoc J. 2019 Mar;13(3):E66-E69
pubmed: 30169150
World J Mens Health. 2022 Oct;40(4):627-635
pubmed: 35118836
Asian J Androl. 2016 Mar-Apr;18(2):229-33
pubmed: 26806078
J Urol. 2020 Jan;203(1):48-56
pubmed: 31042452
Int Urol Nephrol. 2018 Feb;50(2):205-210
pubmed: 29210007
Cureus. 2020 Apr 20;12(4):e7744
pubmed: 32455063
World J Mens Health. 2021 Apr;39(2):302-314
pubmed: 30799564
Adv Biomed Res. 2014 Jan 09;3:17
pubmed: 24592367
Fertil Steril. 1992 Jan;57(1):174-7
pubmed: 1730313
Eur Urol. 2021 Nov;80(5):603-620
pubmed: 34511305
Andrology. 2019 Jan;7(1):62-68
pubmed: 30354030
J Urol. 2010 Jun;183(6):2309-15
pubmed: 20400156
Fertil Steril. 2003 Dec;80(6):1431-6
pubmed: 14667879
Korean J Urol. 2013 Oct;54(10):703-9
pubmed: 24175046
J Urol. 2018 Mar;199(3):812-822
pubmed: 29129781
Fertil Steril. 1992 Jun;57(6):1289-93
pubmed: 1601152
BJU Int. 2006 Jan;97(1):142-5
pubmed: 16336345
Fertil Steril. 2011 Feb;95(2):487
pubmed: 21183178
J Urol. 2011 Feb;185(2):620-5
pubmed: 21168880
J Urol. 1992 Dec;148(6):1808-11
pubmed: 1433614
Andrologia. 2019 Dec;51(11):e13462
pubmed: 31646672
Fertil Steril. 2010 May 1;93(7):2396-9
pubmed: 19268931
World J Mens Health. 2022 Oct;40(4):636-652
pubmed: 35118839
Urol Clin North Am. 2014 Feb;41(1):97-113
pubmed: 24286770
Urol J. 2015 Sep 04;12(4):2261-6
pubmed: 26341769
Tani Girisim Radyol. 2004 Jun;10(2):144-6
pubmed: 15236130
Gynecol Obstet Fertil Senol. 2017 Apr;45(4):238-248
pubmed: 28697346
Int Braz J Urol. 2021 Mar-Apr;47(2):275-283
pubmed: 33146981
Asian J Androl. 2016 Mar-Apr;18(2):217-21
pubmed: 26732108
Asian J Androl. 2015 Nov-Dec;17(6):1012-6
pubmed: 25677136
Eur Urol. 2016 Dec;70(6):1019-1029
pubmed: 27423503
Asian J Androl. 2013 Jan;15(1):56-60
pubmed: 23147467
Hum Reprod. 1998 Aug;13(8):2147-50
pubmed: 9756286
Asian J Androl. 2022 Jan-Feb;24(1):85-89
pubmed: 34003172
Asian J Androl. 2015 Jan-Feb;17(1):74-80
pubmed: 25248652
Antioxidants (Basel). 2021 Jul 01;10(7):
pubmed: 34356300
Syst Biol Reprod Med. 2019 Dec;65(6):430-436
pubmed: 31434522
Urol Int. 1998 Aug;60(4):220-3
pubmed: 9701734
Arch Ital Urol Androl. 2020 Oct 02;92(3):
pubmed: 33016058
ISRN Urol. 2013 Oct 21;2013:698351
pubmed: 24236235
Eur Radiol. 2020 Jan;30(1):11-25
pubmed: 31332561
Genet Med. 2020 Dec;22(12):1956-1966
pubmed: 32741963
J Urol. 2021 Jan;205(1):44-51
pubmed: 33295258
Fertil Steril. 2014 Jul;102(1):68-74
pubmed: 24825425
Andrologia. 2015 May;47(4):412-6
pubmed: 24698207
Urology. 2010 Jan;75(1):83-6
pubmed: 19913887