Dataset Information

Consensus and Diversity in the Management of Varicocele for Male Infertility: Results of a Global Practice Survey and Comparison with Guidelines and Recommendations.

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.

SUBMITTER: Shah R

PROVIDER: S-EPMC9826919 | biostudies-literature | 2023 Jan

REPOSITORIES: biostudies-literature

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Publications

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 R Agarwal Ashok A Kavoussi Parviz P Rambhatla Amarnath A Saleh Ramadan R Cannarella Rossella R Harraz Ahmed M AM Boitrelle Florence F Kuroda Shinnosuke S Hamoda Taha Abo-Almagd Abdel-Meguid TAA Zini Armand A Ko Edmund E Calik Gokhan G Toprak Tuncay T Kandil Hussein H Gül Murat M Bakırcıoğlu Mustafa Emre ME Parekh Neel N Russo Giorgio Ivan GI Tadros Nicholas N Kadioglu Ates A Arafa Mohamed M Chung Eric E Rajmil Osvaldo O Dimitriadis Fotios F Malhotra Vineet V Salvio Gianmaria G Henkel Ralf R Le Tan V TV Sogutdelen Emrullah E Vij Sarah S Alarbid Abdullah A Gudeloglu Ahmet A Tsujimura Akira A Calogero Aldo E AE El Meliegy Amr A Crafa Andrea A Kalkanli Arif A Baser Aykut A Hazir Berk B Giulioni Carlo C Cho Chak-Lam CL Ho Christopher C K CCK Salzano Ciro C Zylbersztejn Daniel Suslik DS Tien Dung Mai Ba DMB Pescatori Edoardo E Borges Edson E Serefoglu Ege Can EC Saïs-Hamza Emine E Huyghe Eric E Ceyhan Erman E Caroppo Ettore E Castiglioni Fabrizio F Bahar Fahmi F Gokalp Fatih F Lombardo Francesco F Gadda Franco F Duarsa Gede Wirya Kusuma GWK Pinggera Germar-Michael GM Busetto Gian Maria GM Balercia Giancarlo G Cito Gianmartin G Blecher Gideon G Franco Giorgio G Liguori Giovanni G Elbardisi Haitham H Keskin Hakan H Lin Haocheng H Taniguchi Hisanori H Park Hyun Jun HJ Ziouziou Imad I de la Rosette Jean J Hotaling Jim J Ramsay Jonathan J Molina Juan Manuel Corral JMC Lo Ka Lun KL Bocu Kadir K Khalafalla Kareim K Bowa Kasonde K Okada Keisuke K Nagao Koichi K Chiba Koji K Hakim Lukman L Makarounis Konstantinos K Hehemann Marah M Rodriguez Peña Marcelo M Falcone Marco M Bendayan Marion M Martinez Marlon M Timpano Massimiliano M Altan Mesut M Fode Mikkel M Al-Marhoon Mohamed S MS Sadighi Gilani Mohammad Ali MA Soebadi Mohammad Ayodhia MA Gherabi Nazim N Sofikitis Nikolaos N Kahraman Oğuzhan O Birowo Ponco P Kothari Priyank P Sindhwani Puneet P Javed Qaisar Q Ambar Rafael F RF Kosgi Raghavender R Ghayda Ramy Abou RA Adriansjah Ricky R Condorelli Rosita Angela RA La Vignera Sandro S Micic Sava S Kim Shannon Hee Kyung SHK Fukuhara Shinichiro S Ahn Sun Tae ST Mostafa Taymour T Ong Teng Aik TA Takeshima Teppei T Amano Toshiyasu T Barrett Trenton T Arslan Umut U Karthikeyan Vilvapathy Senguttuvan VS Atmoko Widi W Yumura Yasushi Y Yuan Yiming Y Kato Yuki Y Jezek Davor D Cheng Bryan Kwun-Chung BK Hatzichristodoulou Georgios G Dy Jun J Castañé Eduard Ruiz ER El-Sakka Ahmed I AI Nguyen Quang Q Sarikaya Selcuk S Boeri Luca L Tan Ronny R Moussa Mohamad A MA El-Assmy Ahmed A Alali Hamed H Alhathal Naif N Osman Yasser Y Perovic Dragoljub D Sajadi Hesamoddin H Akhavizadegan Hamed H Vučinić Miroslav M Kattan Said S Kattan Mohamed S MS Mogharabian Nasser N Phuoc Nguyen Ho Vinh NHV Ngoo Kay Seong KS Alkandari Mohammad H MH Alsuhaibani Shaheed S Sokolakis Ioannis I Babaei Mehdi M King Mak Siu MS Diemer Thorsten T Gava Marcelo M MM Henrique Raphael R Silva Rodrigo Spinola E RSE Paul Gustavo Marquesine GM Mierzwa Tiago Cesar TC Glina Sidney S Siddiqi Kashif K Wu Han H Wurzacher Jana J Farkouh Ala'a A Son Hwancheol H Minhas Suks S Lee Joe J Magsanoc Nikko N Capogrosso Paolo P Albano German Jose GJ Lewis Sheena E M SEM Jayasena Channa N CN Alvarez Juan G JG Teo Colin C Smith Ryan P RP Chua Jo Ben M JBM Jensen Christian Fuglesang S CFS Parekattil Sijo S Finelli Renata R Durairajanayagam Damayanthi D Karna Keshab Kumar KK Ahmed Abdelkareem A Evenson Don D Umemoto Yukihiro Y Puigvert Ana A Çeker Gökhan G Colpi Giovanni M GM

The world journal of men's health 20220613 1

<h4>Purpose</h4>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.<h4>Materials and methods</h4>Sixty practicing urologists/andrologists from 23 countries contributed 3 ...[more]

PMID: 35791302

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Project description:PurposeSperm DNA fragmentation (SDF) has been associated with male infertility and poor outcomes of assisted reproductive technology (ART). The purpose of this study was to investigate global practices related to the management of elevated SDF in infertile men, summarize the relevant professional society recommendations, and provide expert recommendations for managing this condition.Materials and methodsAn online global survey on clinical practices related to SDF was disseminated to reproductive clinicians, according to the CHERRIES checklist criteria. Management protocols for various conditions associated with SDF were captured and compared to the relevant recommendations in professional society guidelines and the appropriate available evidence. Expert recommendations and consensus on the management of infertile men with elevated SDF were then formulated and adapted using the Delphi method.ResultsA total of 436 experts from 55 different countries submitted responses. As an initial approach, 79.1% of reproductive experts recommend lifestyle modifications for infertile men with elevated SDF, and 76.9% prescribe empiric antioxidants. Regarding antioxidant duration, 39.3% recommend 4-6 months and 38.1% recommend 3 months. For men with unexplained or idiopathic infertility, and couples experiencing recurrent miscarriages associated with elevated SDF, most respondents refer to ART 6 months after failure of conservative and empiric medical management. Infertile men with clinical varicocele, normal conventional semen parameters, and elevated SDF are offered varicocele repair immediately after diagnosis by 31.4%, and after failure of antioxidants and conservative measures by 40.9%. Sperm selection techniques and testicular sperm extraction are also management options for couples undergoing ART. For most questions, heterogenous practices were demonstrated.ConclusionsThis paper presents the results of a large global survey on the management of infertile men with elevated SDF and reveals a lack of consensus among clinicians. Furthermore, it demonstrates the scarcity of professional society guidelines in this regard and attempts to highlight the relevant evidence. Expert recommendations are proposed to help guide clinicians.

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Project description:Background: Varicocele (VC) is a relatively common and treatable cause of male infertility. Mailuoshutong pill (MLST), a traditional Chinese patent medicine, is widely used for treating varicose vein disease, but the underlying mechanism of MLST on varicocele-associated male infertility is unclear. Objective: To reveal the phytochemical characterisation and multitarget mechanism of MLST on varicocele-associated male infertility. Methods: The components in MLST were determined using UHPLC-MS/MS. Through network analysis, we constructed the "Drug-Components-Targets-Disease" network and predicted the potential biological functions and signaling pathways of MLST. Finally, the therapeutic effects and potential mechanisms of MLST were discovered by pharmacological experiments. Results: By network analysis, the "Drug-Components-Targets-Disease" network was constructed, 62 components such as apigenin, limonin, kaempferol, and obacunoic acid may be the main active components of MLST for varicocele-associated male infertility, 28 targets such as VEGFA, PIK3CA, AKT1, and MTOR are considered as hub targets, signaling pathways such as HIF-1, Estrogen, PI3K/Akt, and mTOR may be key pathways for MLST against varicocele-associated male infertility. Through pharmacological experiments, we found that MLST ameliorated VC-induced testicular atrophy. Further histomorphology showed that MLST reduced VC-induced damage to testicular spermatogonia and seminiferous tubule, while MLST reduced ROS and MDA levels and increased antioxidant enzymes (GSH, GSH-Px, SOD, and CAT) levels. TUNEL staining and immunofluorescence showed that MLST reduced VC-induced apoptosis in testicular tissue, decreased BAX, and increased BCL2. Western blot results showed that MLST decreased the phosphorylation of PI3K, AKT, and mTOR proteins, and decreased the expression of HIF1α. Conclusion: The phytochemical characterisation and multitarget mechanism of MLST on varicocele-associated male infertility were discovered using network analysis and pharmacological experiments. We verified that MLST can inhibit the activation of the PI3K/Akt/mTOR signaling pathway, reduce the expression of HIF1α, and further attenuate VC-induced oxidative stress and apoptosis in the testis. These findings provide evidence for the therapeutic role of MLST in varicocele-associated male infertility.

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Dataset Information

Consensus and Diversity in the Management of Varicocele for Male Infertility: Results of a Global Practice Survey and Comparison with Guidelines and Recommendations.

Purpose

Materials and methods

Results

Conclusions

Publications

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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