精索静脉曲张男性不育症管理中的共识与差异：一项全球实践调查结果及与指南和建议的比较
Consensus and Diversity in the Management of Varicocele for Male Infertility: Results of a Global Practice Survey and Comparison with Guidelines and Recommendations.
作者信息
Shah Rupin, Agarwal Ashok, Kavoussi Parviz, Rambhatla Amarnath, Saleh Ramadan, Cannarella Rossella, Harraz Ahmed M, Boitrelle Florence, Kuroda Shinnosuke, Hamoda Taha Abo-Almagd Abdel-Meguid, Zini Armand, Ko Edmund, Calik Gokhan, Toprak Tuncay, Kandil Hussein, Gül Murat, Bakırcıoğlu Mustafa Emre, Parekh Neel, Russo Giorgio Ivan, Tadros Nicholas, Kadioglu Ates, Arafa Mohamed, Chung Eric, Rajmil Osvaldo, Dimitriadis Fotios, Malhotra Vineet, Salvio Gianmaria, Henkel Ralf, Le Tan V, Sogutdelen Emrullah, Vij Sarah, Alarbid Abdullah, Gudeloglu Ahmet, Tsujimura Akira, Calogero Aldo E, El Meliegy Amr, Crafa Andrea, Kalkanli Arif, Baser Aykut, Hazir Berk, Giulioni Carlo, Cho Chak-Lam, Ho Christopher C K, Salzano Ciro, Zylbersztejn Daniel Suslik, Tien Dung Mai Ba, Pescatori Edoardo, Borges Edson, Serefoglu Ege Can, Saïs-Hamza Emine, Huyghe Eric, Ceyhan Erman, Caroppo Ettore, Castiglioni Fabrizio, Bahar Fahmi, Gokalp Fatih, Lombardo Francesco, Gadda Franco, Duarsa Gede Wirya Kusuma, Pinggera Germar-Michael, Busetto Gian Maria, Balercia Giancarlo, Cito Gianmartin, Blecher Gideon, Franco Giorgio, Liguori Giovanni, Elbardisi Haitham, Keskin Hakan, Lin Haocheng, Taniguchi Hisanori, Park Hyun Jun, Ziouziou Imad, de la Rosette Jean, Hotaling Jim, Ramsay Jonathan, Molina Juan Manuel Corral, Lo Ka Lun, Bocu Kadir, Khalafalla Kareim, Bowa Kasonde, Okada Keisuke, Nagao Koichi, Chiba Koji, Hakim Lukman, Makarounis Konstantinos, Hehemann Marah, Rodriguez Peña Marcelo, Falcone Marco, Bendayan Marion, Martinez Marlon, Timpano Massimiliano, Altan Mesut, Fode Mikkel, Al-Marhoon Mohamed S, Sadighi Gilani Mohammad Ali, Soebadi Mohammad Ayodhia, Gherabi Nazim, Sofikitis Nikolaos, Kahraman Oğuzhan, Birowo Ponco, Kothari Priyank, Sindhwani Puneet, Javed Qaisar, Ambar Rafael F, Kosgi Raghavender, Ghayda Ramy Abou, Adriansjah Ricky, Condorelli Rosita Angela, La Vignera Sandro, Micic Sava, Kim Shannon Hee Kyung, Fukuhara Shinichiro, Ahn Sun Tae, Mostafa Taymour, Ong Teng Aik, Takeshima Teppei, Amano Toshiyasu, Barrett Trenton, Arslan Umut, Karthikeyan Vilvapathy Senguttuvan, Atmoko Widi, Yumura Yasushi, Yuan Yiming, Kato Yuki, Jezek Davor, Cheng Bryan Kwun-Chung, Hatzichristodoulou Georgios, Dy Jun, Castañé Eduard Ruiz, El-Sakka Ahmed I, Nguyen Quang, Sarikaya Selcuk, Boeri Luca, Tan Ronny, Moussa Mohamad A, El-Assmy Ahmed, Alali Hamed, Alhathal Naif, Osman Yasser, Perovic Dragoljub, Sajadi Hesamoddin, Akhavizadegan Hamed, Vučinić Miroslav, Kattan Said, Kattan Mohamed S, Mogharabian Nasser, Phuoc Nguyen Ho Vinh, Ngoo Kay Seong, Alkandari Mohammad H, Alsuhaibani Shaheed, Sokolakis Ioannis, Babaei Mehdi, King Mak Siu, Diemer Thorsten, Gava Marcelo M, Henrique Raphael, Silva Rodrigo Spinola E, Paul Gustavo Marquesine, Mierzwa Tiago Cesar, Glina Sidney, Siddiqi Kashif, Wu Han, Wurzacher Jana, Farkouh Ala'a, Son Hwancheol, Minhas Suks, Lee Joe, Magsanoc Nikko, Capogrosso Paolo, Albano German Jose, Lewis Sheena E M, Jayasena Channa N, Alvarez Juan G, Teo Colin, Smith Ryan P, Chua Jo Ben M, Jensen Christian Fuglesang S, Parekattil Sijo, Finelli Renata, Durairajanayagam Damayanthi, Karna Keshab Kumar, Ahmed Abdelkareem, Evenson Don, Umemoto Yukihiro, Puigvert Ana, Çeker Gökhan, Colpi Giovanni M
机构信息
Division of Andrology, Department of Urology, Lilavati Hospital and Research Centre, Mumbai, India.
American Center for Reproductive Medicine, Cleveland Clinic, Cleveland, OH, USA.
出版信息
World J Mens Health. 2023 Jan;41(1):164-197. doi: 10.5534/wjmh.220048. Epub 2022 Jun 13.
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.
目的
精索静脉曲张是不育男性中的常见问题。精索静脉曲张修复术（VR）常用于改善精液参数及提高受孕几率。然而，关于精索静脉曲张的诊断、VR的适应症及其疗效，目前尚无共识。本研究旨在探讨男性不育背景下精索静脉曲张管理的全球实践模式。
材料与方法
来自23个国家的60名执业泌尿科医生/男科学医生提供了382个与精索静脉曲张管理相关的多项选择题。这些题目被浓缩成一份在线问卷，并通过直接邀请分发给参与男性不育管理的临床医生。分析结果以了解实践模式中的分歧与共识，并与国际专业学会（美国泌尿外科学会[AUA]、美国生殖医学学会[ASRM]和欧洲泌尿外科学会[EAU]）的最新指南以及近期系统评价和荟萃分析得出的证据进行比较。此外，基于该领域16位专家的共识，对每个主题提供了专家意见。
结果
来自59个国家的574名临床医生回答了问卷。大多数受访者为泌尿科医生/泌尿男科学医生。在精索静脉曲张的诊断、修复适应症、技术选择、亚临床精索静脉曲张的管理以及VR在无精子症中的作用等各个方面，均存在广泛的意见分歧。相当一部分回答与AUA、ASRM和EAU的建议不一致。还发现了大量尚无指南可循的临床情况。
结论
本研究是迄今为止针对男性不育精索静脉曲张临床管理开展的最大规模全球调查。研究表明：1）精索静脉曲张管理方法存在广泛分歧；2）专业学会的临床实践指南存在较大差距；3）需要对不育男性精索静脉曲张管理的多个方面进行进一步研究。
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