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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 Publisher



Shah R1 ; Agarwal A2 ; Kavoussi P3 ; Rambhatla A4 ; Saleh R5 ; Cannarella R6 ; Harraz AM7, 8, 9 ; Boitrelle F10, 11, 182 ; Kuroda S2 ; Hamoda TAAAM12, 13 ; Zini A14 ; Ko E15 ; Calik G16 ; Toprak T17 Show All Authors
Authors
  1. Shah R1
  2. Agarwal A2
  3. Kavoussi P3
  4. Rambhatla A4
  5. Saleh R5
  6. Cannarella R6
  7. Harraz AM7, 8, 9
  8. Boitrelle F10, 11, 182
  9. Kuroda S2
  10. Hamoda TAAAM12, 13
  11. Zini A14
  12. Ko E15
  13. Calik G16
  14. Toprak T17
  15. Kandil H18, 170
  16. Gul M19
  17. Bakircioglu ME20
  18. Parekh N21
  19. Russo GI22
  20. Tadros N23
  21. Kadioglu A24, 185
  22. Arafa M2, 25, 26, 175
  23. Chung E27
  24. Rajmil O28
  25. Dimitriadis F29, 176
  26. Malhotra V30
  27. Salvio G31
  28. Henkel R32, 33
  29. Le TV34, 35
  30. Sogutdelen E36
  31. Vij S21
  32. Alarbid A8
  33. Gudeloglu A37
  34. Tsujimura A38
  35. Calogero AE6
  36. El Meliegy A39, 180
  37. Crafa A6
  38. Kalkanli A40
  39. Baser A41
  40. Hazir B42
  41. Giulioni C43
  42. Cho CL44
  43. Ho CCK45
  44. Salzano C46
  45. Zylbersztejn DS47
  46. Tien DMB34
  47. Pescatori E48
  48. Serefoglu EC50
  49. Saishamza E10, 11
  50. Huyghe E51, 172
  51. Ceyhan E52
  52. Caroppo E53
  53. Castiglioni F54
  54. Bahar F55
  55. Gokalp F56
  56. Lombardo F57
  57. Gadda F58
  58. Duarsa GWK59, 177
  59. Pinggera GM60
  60. Busetto GM61
  61. Balercia G31
  62. Cito G62
  63. Blecher G63, 64
  64. Franco G65
  65. Liguori G66
  66. Elbardisi H25, 67
  67. Keskin H37
  68. Lin H68
  69. Taniguchi H69
  70. Park HJ70, 71, 171, 186
  71. Ziouziou I72
  72. De La Rosette J73, 183
  73. Hotaling J74
  74. Ramsay J75
  75. Molina JMC76, 184
  76. Lo KL77
  77. Bocu K78
  78. Khalafalla K25, 79
  79. Bowa K80
  80. Okada K81
  81. Nagao K82
  82. Chiba K81
  83. Hakim L83
  84. Makarounis K84
  85. Hehemann M85
  86. Pena MR86, 181
  87. Falcone M87
  88. Bendayan M10, 11
  89. Martinez M88
  90. Timpano M87
  91. Altan M89
  92. Fode M90, 91
  93. Almarhoon MS92
  94. Gilani MAS93, 179
  95. Soebadi MA94
  96. Gherabi N95
  97. Sofikitis N96, 176
  98. Kahraman O52
  99. Birowo P97, 177
  100. Kothari P98
  101. Sindhwani P99
  102. Javed Q100
  103. Ambar RF101, 102, 174
  104. Kosgi R103
  105. Ghayda RA104
  106. Adriansjah R105, 178
  107. Condorelli RA6
  108. La Vignera S6
  109. Micic S106
  110. Kim SHK107, 108
  111. Fukuhara S109
  112. Ahn ST110
  113. Mostafa T39
  114. Ong TA111
  115. Takeshima T112
  116. Amano T113
  117. Barrett T114
  118. Arslan U17
  119. Karthikeyan VS115
  120. Atmoko W103, 177
  121. Yumura Y112
  122. Yuan Y116
  123. Kato Y117
  124. Jezek D118
  125. Cheng BKC119
  126. Hatzichristodoulou G120
  127. Dy J121
  128. Castane ER122
  129. Elsakka AI123
  130. Nguyen Q124, 125
  131. Sarikaya S126
  132. Boeri L58
  133. Tan R127, 128
  134. Moussa MA129, 130
  135. Elassmy A7
  136. Alali H131
  137. Alhathal N132
  138. Osman Y7
  139. Perovic D133
  140. Sajadi H98
  141. Akhavizadegan H134
  142. Vucinic M135
  143. Kattan S132
  144. Kattan MS132
  145. Mogharabian N136
  146. Phuoc NHV34
  147. Ngoo KS137
  148. Alkandari MH138
  149. Alsuhaibani S139
  150. Sokolakis I120
  151. Babaei M140
  152. King MS77
  153. Diemer T141
  154. Gava MM101, 102
  155. Henrique R142
  156. Spinola E Silva R101, 102
  157. Paul GM143
  158. Mierzwa TC144
  159. Glina S101
  160. Siddiqi K145
  161. Wu H146
  162. Wurzacher J147
  163. Farkouh A2
  164. Son H148
  165. Minhas S149
  166. Lee J150
  167. Magsanoc N151
  168. Capogrosso P152
  169. Albano GJ88
  170. Lewis SEM153
  171. Jayasena CN154, 155
  172. Alvarez JG156, 184
  173. Teo C157
  174. Smith RP158
  175. Chua JBM159
  176. Jensen CFS160
  177. Parekattil S161
  178. Finelli R2
  179. Durairajanayagam D162
  180. Karna KK2
  181. Ahmed A9
  182. Evenson D163
  183. Umemoto Y164
  184. Puigvert A165
  185. Ceker G166, 167
  186. Colpi GM168
  187. Rolitsky S169
Show Affiliations
Authors Affiliations
  1. 1. Division of Andrology, Department of Urology, Lilavati Hospital and Research Centre, Mumbai, India
  2. 2. American Center for Reproductive Medicine, Cleveland Clinic, Cleveland, OH, United States
  3. 3. Austin Fertility and Reproductive Medicine/Westlake IVF, TX, United States
  4. 4. Department of Urology, Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI, United States
  5. 5. Department of Dermatology, Venereology and Andrology, Faculty of Medicine, Sohag University, Sohag, Egypt
  6. 6. Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
  7. 7. Mansoura University, Urology and Nephrology Center, Mansoura, Egypt
  8. 8. Department of Surgery, Urology Unit, Farwaniya Hospital, Farwaniya, Kuwait
  9. 9. Department of Urology, Sabah Al Ahmad Urology Center, Kuwait City, Kuwait
  10. 10. Department of Reproductive Biology, Fertility Preservation, Andrology, CECOS, Poissy Hospital, Poissy, France
  11. 11. Department of Biology, Reproduction, Epigenetics, Environment and Development, Paris Saclay University, UVSQ, INRAE, BREED, Jouy-en-Josas, France
  12. 12. Department of Urology, King Abdulaziz University, Jeddah, Saudi Arabia
  13. 13. Department of Urology, Faculty of Medicine, Minia University, Minia, Egypt
  14. 14. Division of Urology, Department of Surgery, McGill University, Montreal, QC, Canada
  15. 15. Department of Urology, Loma Linda University Health, Loma Linda, CA, United States
  16. 16. Department of Urology, Faculty of Medicine, Istanbul Medipol University, Istanbul, Turkey
  17. 17. Department of Urology, Fatih Sultan Mehmet Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
  18. 18. Fakih IVF Fertility Center, Abu Dhabi, United Arab Emirates
  19. 19. Department of Urology, Selcuk University, School of Medicine, Konya, Turkey
  20. 20. SENSART Clinic, Istanbul, Turkey
  21. 21. Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, United States
  22. 22. Urology Section, University of Catania, Catania, Italy
  23. 23. Division of Urology, Southern Illinois University, School of Medicine, Springfield, IL, United States
  24. 24. Section of Andrology, Department of Urology, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
  25. 25. Department of Urology, Hamad Medical Corporation, Doha, Qatar
  26. 26. Department of Urology, Weill Cornell Medical-Qatar, Doha, Qatar
  27. 27. Department of Urology, Princess Alexandra Hospital, University of Queensland, Brisbane, Australia
  28. 28. Department of Andrology, Fundacio Puigvert, Barcelona, Spain
  29. 29. Department of Urology, Aristotle University of Thessaloniki, Thessaloniki, Greece
  30. 30. SCM Clinic and Hospital, New Delhi, India
  31. 31. Department of Endocrinology, Polytechnic University of Marche, Ancona, Italy
  32. 32. Department of Metabolism, Digestion and Reproduction, Imperial College London, London, United Kingdom
  33. 33. Department of Medical Bioscience, University of the Western Cape, Bellville, South Africa
  34. 34. Department of Andrology, Binh Dan Hospital, Ho Chi Minh City, Viet Nam
  35. 35. Department of Urology and Andrology, Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Viet Nam
  36. 36. Department of Urology, Bolu Abant Izzet Baysal University, Bolu, Turkey
  37. 37. Department of Urology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
  38. 38. Department of Urology, Juntendo University Urayasu Hospital, Chiba, Japan
  39. 39. Department of Andrology, Sexology and STIs, Faculty of Medicine, Cairo University, Cairo, Egypt
  40. 40. Department of Urology, Taksim Education and Research Hospital, Istanbul, Turkey
  41. 41. Department of Urology, Faculty of Medicine, Bandirma Onyedi Eylul University, Balikesir, Turkey
  42. 42. Reproductive Medicine, Clinical Research Centre, Lund University, Malmo, Sweden
  43. 43. Department of Urology, Polytechnic University of Marche Region, Ancona, Italy
  44. 44. S. H. Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Hong Kong
  45. 45. Department of Urology, Universiti Teknologi Mara (UiTM) Specialist Centre, Selangor, Malaysia
  46. 46. PO San Giovanni Bosco, ASL Napoli 1 Centro, Napoli, Italy
  47. 47. Fleury Group, Hospital Israelita Albert Einstein, Sao Paulo, Brazil
  48. 48. Andrology and Reproductive Medicine Unit, Gynepro Medical, Bologna, Italy
  49. 49. Fertility Medical Group, Sao Paulo, Brazil
  50. 50. Department of Urology, Biruni University, School of Medicine, Istanbul, Turkey
  51. 51. Department of Urology and Andrology, University Hospital of Toulouse, France
  52. 52. Department of Urology, School of Medicine, Baskent University, Konya, Turkey
  53. 53. Asl Bari, PTA “F Jaia�, Reproductive and IVF Unit, Andrology Outpatients Clinic, Asl Bari, Ba, Conversano, Italy
  54. 54. Andrology Unit, ART Center, San Carlo Clinic, Paderno Dugnano, Milan, Italy
  55. 55. Andrology Section, Siloam Sriwijaya Hospital, Palembang, Indonesia
  56. 56. Department of Urology, Hatay Mustafa Kemal University, Antakya, Turkey
  57. 57. Laboratory of Seminology-Sperm Bank “Loredana Gandini�, Department of Experimental Medicine, University of Rome “Sapienza�, Rome, Italy
  58. 58. Department of Urology, IRCCS Fondazione Ca Granda Ospedale Maggiore Policlinico, Milan, Italy
  59. 59. Department of Urology, School of Medicine, Udayana University, Denpasar, Indonesia
  60. 60. Department of Urology, Innsbruck Medical University, Innsbruck, Austria
  61. 61. Department of Urology and Organ Transplantation, University of Foggia, Ospedali Riuniti of Foggia, Foggia, Italy
  62. 62. Department of Urology, University of Florence, Florence, Italy
  63. 63. Department of Surgery, School of Clinical Sciences, Monash University, Melbourne, Australia
  64. 64. Department of Urology, The Alfred Hospital, Melbourne, Australia
  65. 65. Department of Urology, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
  66. 66. Department of Urology, University of Trieste, Trieste, Italy
  67. 67. Department of Urology, Weill Cornell Medicine-Qatar, Doha, Qatar
  68. 68. Department of Urology, Peking University Third Hospital, Peking University, Beijing, China
  69. 69. Department of Urology and Andrology, Kansai Medical University, Osaka, Hirakata, Japan
  70. 70. Department of Urology, Pusan National University, School of Medicine, Busan, South Korea
  71. 71. Medical Research Institute, Pusan National University Hospital, Busan, South Korea
  72. 72. Department of Urology, College of Medicine and Pharmacy, Ibn Zohr University, Agadir, Morocco
  73. 73. Department of Urology, Faculty of Medicine, Istanbul Medipol Mega University Hospital, Istanbul, Turkey
  74. 74. Department of Surgery (Urology), University of Utah, Salt Lake City, UT, United States
  75. 75. Department of Andrology, Hammersmith Hospital, Imperial, London, United Kingdom
  76. 76. Servicio de Urologia, Hospital Clinico de Barcelona, Barcelona, Spain
  77. 77. Division of Urology, Department of Surgery, The Chinese University of Hong Kong, Hong Kong
  78. 78. Department of Urology, Silopi State Hospital, Sirnak, Turkey
  79. 79. Department of Urology, University of Illinois, Chicago, IL, United States
  80. 80. Department of Urology, School of Medicine and Health Sciences, University of Lusaka, Lusaka, Zambia
  81. 81. Department of Urology, Kobe University, Graduate School of Medicine, Kobe, Japan
  82. 82. Department of Urology, Toho University, Faculty of Medicine, Tokyo, Japan
  83. 83. Department of Urology, Universitas Airlangga, Rumah Sakit Universitas Airlangga Teaching Hospital, Surabaya, Indonesia
  84. 84. Department of Urology and Andrology, Locus Medicus, Athens, Greece
  85. 85. Department of Urology, University of Washington, Seattle, WA, United States
  86. 86. Instituto de Ginecologia y Fertilidad (IFER), Universidad de Buenos Aires, Buenos Aires, Argentina
  87. 87. Department of Urology, Molinette Hospital, A.O.U. Citta della Salute e della Scienza, University of Turin, Torino, Italy
  88. 88. Section of Urology, Department of Surgery, University of Santo Tomas Hospital, Manila, Philippines
  89. 89. Department of Urology, Haceppete University, Ankara, Turkey
  90. 90. Department of Urology, Herlev and Gentofte University Hospital, Copenhagen, Denmark
  91. 91. Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
  92. 92. Department of Surgery, Urology Division, Sultan Qaboos University, Muscat, Oman
  93. 93. Department of Andrology, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
  94. 94. Department of Urology, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
  95. 95. Andrology Committee of the Algerian Association of Urology, Algiers, Algeria
  96. 96. Department of Urology, Ioannina University, School of Medicine, Ioannina, Greece
  97. 97. Department of Urology, Cipto Mangunkusumo General Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
  98. 98. B.Y.L Nair Ch Hospital, Mumbai, India
  99. 99. Department of Urology, University of Toledo, College of Medicine and Life Sciences, Toledo, OH, United States
  100. 100. Department of Urology, Al - Ahlia Hospital Abu Dhabi UAE, Abu Dhabi, United Arab Emirates
  101. 101. Department of Urology, Centro Universitario em Saude do ABC, Santo Andre, Brazil
  102. 102. Andrology Group, Ideia Fertil Institute of Human Reproduction, Santo Andre, Brazil
  103. 103. Department of Urology and Andrology, AIG Hospitals, Telangana, Hyderabad, India
  104. 104. Urology Institute, University Hospitals, Case Western Reserve University, Cleveland, OH, United States
  105. 105. Department of Urology, Faculty of Medicine, Universitas Padjadjaran, Hasan Sadikin General Hospital, Banding, Indonesia
  106. 106. Department of Andrology, Uromedica Polyclinic, Belgrade, Serbia
  107. 107. IVF Australia, Sydney, NSW, Australia
  108. 108. Macquarie School of Medicine, Macquaire University, Sydney, NSW, Australia
  109. 109. Department of Urology, Graduate School of Medicine, Osaka University, Osaka, Japan
  110. 110. Department of Urology, Korea University, College of Medicine, Seoul, South Korea
  111. 111. Department of Surgery, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
  112. 112. Department of Urology, Reproduction Center, Yokohama City University Medical Center, Kanagawa, Yokohama, Japan
  113. 113. Department of Urology, Nagano Red Cross Hospital, Nagano, Japan
  114. 114. Perth Urology Clinic, Perth, WA, Australia
  115. 115. Andrology Unit, Department of Urology, Apollo Hospitals, Greams Road, Chennai, India
  116. 116. Andrology Center, Urology Department, Peking University First Hospital, Peking University, Beijing, China
  117. 117. Department of Integrative Cancer Therapy and Urology, Kanazawa University, Graduate School of Medical Science, Kanazawa, Japan
  118. 118. Department for Transfusion Medicine and Transplantation Biology, Reproductive Tissue Bank, University of Zagreb, School of Medicine, University Hospital Zagreb, Zagreb, Croatia
  119. 119. Department of Surgery, United Christian Hospital, Hong Kong
  120. 120. Department of Urology, Martha-Maria Hospital Nuremberg, Nuremberg, Germany
  121. 121. Stone and Prostate Treatment Services, Pelvic Floor Center and Anorectal Diseases, St. Luke's Medical Center, Metro Manila, Quezon City, Philippines
  122. 122. Department of Andrology, Fundacio Puigvert, Universitat Autonoma de Barcelona, Barcelona, Spain
  123. 123. Department of Urology, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
  124. 124. Center for Andrology and Sexual Medicine, Viet Duc University Hospital, Hanoi, Viet Nam
  125. 125. Department of Urology, Andrology and Sexual Medicine, University of Medicine and Pharmacy, Vietnam National University, Hanoi, Viet Nam
  126. 126. Department of Urology, Gulhane Research and Training Hospital, University of Health Sciences, Ankara, Turkey
  127. 127. Advanced Urology Associates, Singapore
  128. 128. Mount Elizabeth Hospital, Singapore
  129. 129. Department of Urology, Lebanese University, Beirut, Lebanon
  130. 130. Department of Urology, Al Zahraa Hospital, UMC, Lebanon
  131. 131. King Fahad Specialist Hospital, Dammam, Saudi Arabia
  132. 132. King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
  133. 133. Urology and Andrology Center, CODRA Hospital, University of Montenegro, Podgorica, Montenegro
  134. 134. Department of Urology, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
  135. 135. Department of Urology, Uzice General Hospital, Zlatibor, Serbia
  136. 136. Sexual Health and Fertility Research Center, Shahroud University of Medical Sciences, Shahroud, Iran
  137. 137. Urology Unit, Department of Surgery, Hospital Angkatan Tentera Tuanku Mizan, Kuala Lumpur, Malaysia
  138. 138. Department of Urology, Mubarak Al-Kabeer Teaching Hospital, Kuwait University, Jabriya, Kuwait
  139. 139. Department of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
  140. 140. Department of Andrology, Shariati Medical Center, Tehran University of Medical Sciences, Tehran, Iran
  141. 141. Department of Urology, Pediatric Urology and Andrology, Justus-Liebig-University Giessen (GER), University Hospital Giessen and Marburg GmbH, Campus Giessen, Giessen, Germany
  142. 142. Santa Casa de Ribeirao Preto, Ribeirao Preto, Brazil
  143. 143. Department of Urology, Hospital de Clinicas of the Federal University of Parana, Curitiba, Brazil
  144. 144. Androlab, Fertility Clinic, Curitiba, Brazil
  145. 145. Department of Urology, Cleveland Clinic, Abu Dhabi, United Arab Emirates
  146. 146. Department of Andrology, PKU 3rd Hospital Reproductive Medicine Center, Beijing, China
  147. 147. Department of Urology, University Hospital Innsbruck, Innsbruck, Austria
  148. 148. Department of Urology, SMG-SNU Boramae Medical Center, Seoul, South Korea
  149. 149. Division of Surgery, Department of Surgery and Cancer, Imperial College London, London, United Kingdom
  150. 150. Department of Urology, National University Hospital, Singapore
  151. 151. Department of Surgery, University of the Philippines, College of Medicine, Manila, Philippines
  152. 152. Department of Urology, University of Insubria, Varese, Italy
  153. 153. Examenlab Ltd., Northern Ireland, United Kingdom
  154. 154. Department of Reproductive Endocrinology and Andrology, Imperial College London, London, United Kingdom
  155. 155. Department of Andrology, Hammersmith and St. Mary's Hospitals, London, United Kingdom
  156. 156. Department of Andrology, Centro ANDROGEN, La Coruna, Spain
  157. 157. Department of Urology, Gleneagles Hospital, Singapore
  158. 158. Department of Urology, University of Virginia, School of Medicine, Virginia, United States
  159. 159. Department of Urology, East Avenue Medical Center, Quezon City, Philippines
  160. 160. Department of Urology, Copenhagen University Hospital, Herlev and Gentofte Hospital, Herlev, Denmark
  161. 161. Avant Concierge Urology, University of Central Florida, Winter Garden, FL, United States
  162. 162. Department of Physiology, Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh Campus, Selangor, Malaysia
  163. 163. SCSA Diagnostics, Brookings, SD, United States
  164. 164. Department of Nephro-Urology, Nagoya City West Medical Center, Nagoya, Japan
  165. 165. Urological and Human Reproduction Unit, Quiron Hospital, Barcelona, Spain
  166. 166. Department of Urology, Basaksehir Cam and Sakura City Hospital, Istanbul, Turkey
  167. 167. Department of Embryology and Histology, Zonguldak Bulent Ecevit University, Institute of Health Sciences, Zonguldak, Turkey
  168. 168. Next Fertility Procrea, Lugano, Switzerland
  169. 169. The Cleveland Clinic's, Center for Medical Art and Photography
  170. 170. Arab Association of Urology, United Arab Emirates
  171. 171. Asia Pacific Society of Sexual Medicine, South Korea
  172. 172. Association Francaise d'Urologie, France
  173. 173. Brazilian Association of Assisted Reproduction
  174. 174. Brazilian Society of Urology, Brazil
  175. 175. Egyptian Society of Andrology, Qatar
  176. 176. European Association of Urology, Greece
  177. 177. Indonesian Urological Association, Indonesia
  178. 178. Indonesian Society of Andrological Urology, Indonesia
  179. 179. Iranian Urological Association, Iran
  180. 180. Middle East Society for Sexual Medicine, Egypt
  181. 181. Sociedad Argentina de Andrologia, Argentina
  182. 182. Societe d'Andrologie de Langue Francaise, France
  183. 183. Societe Internationale d'Urologie
  184. 184. Spanish Association of Andrology, Sexual and Reproductive Medicine, Spain
  185. 185. Turkish Association of Urology, Turkey
  186. 186. Urological Society of Australia and New Zealand, South Korea

Source: World Journal of Men's Health Published:2022


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. Copyright, © 2022 Korean Society for Sexual Medicine and Andrology
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