CoChat
Sign Up
Cited by 67Sperm and Testicular FunctionMale Reproductive Health StudiesReproductive Health and Technologies

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

Open access
Shah, Rupin, Agarwal, Ashok, Kavoussi, Parviz, Rambhatla, Amarnath, Saleh, Ramadan, Cannarella, Rossella, Harraz, Ahmed M., Boitrelle, Florence +180 more·2023·The World Journal of Men's Health
DOI 10.5534/wjmh.220048PMC PMC9826919
Open this paper in CoChat — free account

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.

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Integrity signals

Registry

Crossref · 10.5534/wjmh.220048

Cites

4 of 4 references verified0 citation errors · 0 not checkable

Statistics

Claims the paper makes

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • Several studies have evaluated the role of varicocelectomy and antioxidants in improving sperm morphology, particularly for immature sperm and those with head and tail defects based on Kruger's classification.

    “Several studies have evaluated the role of varicocelectomy and antioxidants in improving sperm morphology, particularly for immature sperm and those with head and tail defects based on Kruger’s classification (97-104).”

    From Isolated teratozoospermia: revisiting its relevance in male infertility: a narrative review (2024) · cites this paper as [103]

    The Discussion of isolated teratozoospermia (Results and Discussion, §4; page not provided) reports mixed findings on sperm morphology after varicocele repair and says improvement was most likely in immature spermatozoa and those with head abnormalities. It does not extend that finding to tail defects or identify Kruger’s classification. Its separate discussion of antioxidants concerns pregnancy rates, not improved sperm morphology. (LLM, conf=0.88)

    Experimental — accuracy not yet measured

  • In a global varicocele survey of 574 clinicians from 59 countries, 41.1% would routinely and 30.3% in special cases advise varicocele surgery for isolated teratozoospermia.

    “Despite the fact that the majority of respondents to a global varicocele survey (103), that included 574 clinicians from 59 countries, said they would routinely (41.1%) or in special cases (30.3%) advise varicocele surgery for isolated teratozoospermia, the benefits of varicocelectomy are not supported by strong data.”

    From Isolated teratozoospermia: revisiting its relevance in male infertility: a narrative review (2024) · cites this paper as [103]

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

The self-check needs the paper’s full text.

Cites

Flagged first, then by citations

Research works printed but not linked: 98

  1. [1]Su JS Farber NJ Vij SC Pathophysiology and treatment options of varicocele: an overview Andrologia 2021 53 e13576 32271477
  2. [2]Alsaikhan B Alrabeeah K Delouya G Zini A Epidemiology of varicocele Asian J Androl 2016 18 179 181 26763551 PMC4770482
  3. [3]Damsgaard J Joensen UN Carlsen E Erenpreiss J Blomberg Jensen M Matulevicius V Varicocele is associated with impaired semen quality and reproductive hormone levels: a study of 7035 healthy young men from six European countries Eur Urol 2016 70 1019 1029 27423503
  4. [4]World Health Organization The influence of varicocele on parameters of fertility in a large group of men presenting to infertility clinics Fertil Steril 1992 57 1289 1293 1601152
  5. [5]Baskaran S Agarwal A Leisegang K Pushparaj PN Panner Selvam MK Henkel R An in-depth bibliometric analysis and current perspective on male infertility research World J Mens Health 2021 39 302 314 30799564 PMC7994650
  6. [6]Agarwal A Finelli R Durairajanayagam D Leisegang K Henkel R Salvio G Comprehensive analysis of global research on human varicocele: a scientometric approach World J Mens Health 2022 10.5534/wjmh.210202 [Epub] PMC9482861 35118839 · DOI
  7. [7]Persad E O'Loughlin CA Kaur S Wagner G Matyas N Hassler-Di Fratta MR Surgical or radiological treatment for varicoceles in subfertile men Cochrane Database Syst Rev 2021 4 CD000479 33890288 PMC8408310
  8. [8]Salonia A Bettocchi C Boeri L Capogrosso P Carvalho J Cilesiz NC EAU Working Group on Male Sexual and Reproductive Health European Association of Urology guidelines on sexual and reproductive health-2021 update: male sexual dysfunction Eur Urol 2021 80 333 357 34183196
  9. [9]Minhas S Bettocchi C Boeri L Capogrosso P Carvalho J Cilesiz NC EAU Working Group on Male Sexual and Reproductive Health European Association of Urology guidelines on male sexual and reproductive health: 2021 update on male infertility Eur Urol 2021 80 603 620 34511305
  10. [12]Schlegel PN Sigman M Collura B De Jonge CJ Eisenberg ML Lamb DJ Diagnosis and treatment of infertility in men: AUA/ASRM guideline part II J Urol 2021 205 44 51 33295258
  11. [13]Freeman S Bertolotto M Richenberg J Belfield J Dogra V Huang DY members of the ESUR-SPIWG WG Ultrasound evaluation of varicoceles: guidelines and recommendations of the European Society of Urogenital Radiology Scrotal and Penile Imaging Working Group (ESUR-SPIWG) for detection, classification, and grading Eur Radiol 2020 30 11 25 31332561
  12. [14]Hoekstra T Witt MA The correlation of internal spermatic vein palpability with ultrasonographic diameter and reversal of venous flow J Urol 1995 153 82 84 7966798
  13. [15]Pilatz A Altinkilic B Kohler E Marconi M Weidner W Color Doppler ultrasound imaging in varicoceles: is the venous diameter sufficient for predicting clinical and subclinical varicocele? World J Urol 2011 29 645 650 21607575
  14. [16]Karami M Mazdak H Khanbabapour S Adibi A Nasr N Determination of the best position and site for color Doppler ultrasonographic evaluation of the testicular vein to define the clinical grades of varicocele ultrasonographically Adv Biomed Res 2014 3 17 24592367 PMC3928839
  15. [17]Cavallini G Scroppo FI Colpi GM The clinical usefulness of a novel grading system for varicocoeles using duplex Doppler ultrasound examination based on postsurgical modifications of seminal parameters Andrology 2019 7 62 68 30354030
  16. [19]Pyrgidis N Sokolakis I Palapelas V Tishukov M Mykoniatis I Symeonidis EN The effect of antioxidant supplementation on operated or non-operated varicocele-associated infertility: a systematic review and meta-analysis Antioxidants (Basel) 2021 10 106 34356300 PMC8301171
  17. [20]Giagulli VA Carbone MD Varicocele correction for infertility: which patients to treat? Int J Androl 2011 34 236 241 20579135
  18. [21]Nieschlag E Hertle L Fischedick A Abshagen K Behre HM Update on treatment of varicocele: counselling as effective as occlusion of the vena spermatica Hum Reprod 1998 13 2147 2150 9756286
  19. [22]Wang Q Yu Y Liu Y Wang L Outcome of varicocelectomy on different degrees of total motile sperm count: a systematic review and meta-analysis Syst Biol Reprod Med 2019 65 430 436 31434522
  20. [23]Boman JM Libman J Zini A Microsurgical varicocelectomy for isolated asthenospermia J Urol 2008 180 2129 2132 18804226
  21. [24]Cakiroglu B Sinanoglu O Gozukucuk R The effect of varicocelectomy on sperm parameters in subfertile men with clinical varicoceles who have asthenozoospermia or teratozoospermia with normal sperm density ISRN Urol 2013 2013 698351 24236235 PMC3818894
  22. [25]Okeke L Ikuerowo O Chiekwe I Etukakpan B Shittu O Olapade-Olaopa O Is varicocelectomy indicated in subfertile men with clinical varicoceles who have asthenospermia or teratospermia and normal sperm density? Int J Urol 2007 14 729 732 17681064
  23. [26]Coetzee K Kruge TF Lombard CJ Predictive value of normal sperm morphology: a structured literature review Hum Reprod Update 1998 4 73 82 9622414
  24. [27]Danis RB Samplaski MK Sperm morphology: history, challenges, and impact on natural and assisted fertility Curr Urol Rep 2019 20 43 31203470
  25. [30]Ilktac A Hamidli S Ersoz C Dogan B Akcay M Efficacy of varicocelectomy in primary infertile patients with isolated teratozoospermia. A retrospective analysis Andrologia 2020 52 e13875 33118228
  26. [31]Cakan M Bakirtas H Aldemir M Demirel F Altug U Results of varicocelectomy in patients with isolated teratozoospermia Urol Int 2008 80 172 176 18362488
  27. [33]Dumont A Barbotin AL Lefebvre-Khalil V Mitchell V Rigot JM Boitrelle F [Necrozoospermia: from etiologic diagnosis to therapeutic management] Gynecol Obstet Fertil Senol 2017 45 238 248 French 28697346
  28. [34]Ribas-Maynou J Yeste M Becerra-Tomas N Aston KI James ER Salas-Huetos A Clinical implications of sperm DNA damage in IVF and ICSI: updated systematic review and meta-analysis Biol Rev Camb Philos Soc 2021 96 1284 1300 33644978
  29. [35]Lara-Cerrillo S Gual-Frau J Benet J Abad C Prats J Amengual MJ Microsurgical varicocelectomy effect on sperm telomere length, DNA fragmentation and seminal parameters Hum Fertil (Camb) 2022 25 135 141 31916507
  30. [36]Lira Neto FT Roque M Esteves SC Effect of varicocelectomy on sperm deoxyribonucleic acid fragmentation rates in infertile men with clinical varicocele: a systematic review and meta-analysis Fertil Steril 2021 116 696 712 33985792
  31. [37]Qiu D Shi Q Pan L Efficacy of varicocelectomy for sperm DNA integrity improvement: a meta-analysis Andrologia 2021 53 e13885 33118219
  32. [38]Saleh RA Agarwal A Sharma RK Said TM Sikka SC Thomas AJ Jr Evaluation of nuclear DNA damage in spermatozoa from infertile men with varicocele Fertil Steril 2003 80 1431 1436 14667879
  33. [39]Smith R Kaune H Parodi D Madariaga M Rios R Morales I Increased sperm DNA damage in patients with varicocele: relationship with seminal oxidative stress Hum Reprod 2006 21 986 993 16361286
  34. [40]Ammar O Tekeya O Hannachi I Sallem A Haouas Z Mehdi M Increased sperm DNA fragmentation in infertile men with varicocele: relationship with apoptosis, seminal oxidative stress, and spermatic parameters Reprod Sci 2021 28 909 919 32909188
  35. [41]Jeremias JT Belardin LB Okada FK Antoniassi MP Fraietta R Bertolla RP Oxidative origin of sperm DNA fragmentation in the adult varicocele Int Braz J Urol 2021 47 275 283 33146981 PMC7857753
  36. [42]Fathi A Mohamed O Mahmoud O Alsagheer GA Reyad AM Abolyosr A The impact of varicocelectomy on sperm DNA fragmentation and pregnancy rate in subfertile men with normal semen parameters: a pilot study Arab J Urol 2021 19 186 190 34104495 PMC8158247
  37. [43]Esteves SC Roque M Agarwal A Outcome of assisted reproductive technology in men with treated and untreated varicocele: systematic review and meta-analysis Asian J Androl 2016 18 254 258 26510504 PMC4770495
  38. [44]Kirby EW Wiener LE Rajanahally S Crowell K Coward RM Undergoing varicocele repair before assisted reproduction improves pregnancy rate and live birth rate in azoospermic and oligospermic men with a varicocele: a systematic review and meta-analysis Fertil Steril 2016 106 1338 1343 27526630
  39. [45]Tan TY Lau SK Loh SF Tan HH Female ageing and reproductive outcome in assisted reproduction cycles Singapore Med J 2014 55 305 309 25017405 PMC4294057
  40. [46]Fırat F Erdemir F The effect of age on semen quality and spontaneous pregnancy rates in patients who treated with microsurgical inguinal varicocelectomy Cureus 2020 12 e7744 32455063 PMC7241228
  41. [47]Hsiao W Rosoff JS Pale JR Greenwood EA Goldstein M Older age is associated with similar improvements in semen parameters and testosterone after subinguinal microsurgical varicocelectomy J Urol 2011 185 620 625 21168880
  42. [48]Asafu-Adjei D Judge C Deibert CM Li G Stember D Stahl PJ Systematic review of the impact of varicocele grade on response to surgical management J Urol 2020 203 48 56 31042452
  43. [49]Birowo P Prasetyo DT Pujianto DA Atmoko W Rasyid N Sini IR Effect of varicocele repair on sperm retrieval rate and testicular histopathological patterns in men with nonobstructive azoospermia Asian J Androl 2022 24 85 89 34003172 PMC8788600
  44. [50]Cantoro U Catanzariti F Lacetera V Quaresima L Giovanni M Polito M Percentage change of FSH value: new variable to predict the seminal outcome after varicocelectomy Andrologia 2015 47 412 416 24698207
  45. [51]Zhou T Zhang W Chen Q Li L Cao H Xu CL Effect of varicocelectomy on testis volume and semen parameters in adolescents: a meta-analysis Asian J Androl 2015 17 1012 1016 25677136 PMC4814973
  46. [52]Culha M Mutlu N Acar O Baykal M Comparison of testicular volumes before and after varicocelectomy Urol Int 1998 60 220 223 9701734
  47. [53]Sakamoto H Saito K Ogawa Y Yoshida H Effects of varicocele repair in adults on ultrasonographically determined testicular volume and on semen profile Urology 2008 71 485 489 18342193
  48. [54]Almekaty K Zahran MH Zoeir A Minhas S Salem K The role of artery-preserving varicocelectomy in subfertile men with severe oligozoospermia: a randomized controlled study Andrology 2019 7 193 198 30618196
  49. [55]Majzoub A ElBardisi H Covarrubias S Mak N Agarwal A Henkel R Effect of microsurgical varicocelectomy on fertility outcome and treatment plans of patients with severe oligozoospermia: an original report and meta-analysis Andrologia 2021 53 e14059 33763931
  50. [56]Enatsu N Yamaguchi K Chiba K Miyake H Fujisawa M Clinical outcome of microsurgical varicocelectomy in infertile men with severe oligozoospermia Urology 2014 83 1071 1074 24674115
  51. [57]Dada R Kumar R Shamsi MB Sidhu T Mitra A Singh S Azoospermia factor deletions in varicocele cases with severe oligozoospermia Indian J Med Sci 2007 61 505 510 17785886
  52. [58]Samplaski MK Jarvi KA Prognostic factors for a favorable outcome after varicocele repair in adolescents and adults Asian J Androl 2016 18 217 221 26732108 PMC4770489
  53. [59]Samplaski MK Yu C Kattan MW Lo KC Grober ED Zini A Nomograms for predicting changes in semen parameters in infertile men after varicocele repair Fertil Steril 2014 102 68 74 24825425
  54. [60]Kamal KM Jarvi K Zini A Microsurgical varicocelectomy in the era of assisted reproductive technology: influence of initial semen quality on pregnancy rates Fertil Steril 2001 75 1013 1016 11334918
  55. [61]Ding H Tian J Du W Zhang L Wang H Wang Z Open non-microsurgical, laparoscopic or open microsurgical varicocelectomy for male infertility: a meta-analysis of randomized controlled trials BJU Int 2012 110 1536 1542 22642226
  56. [62]Lundy SD Sabanegh ES Jr Varicocele management for infertility and pain: a systematic review Arab J Urol 2017 16 157 170 29713547 PMC5922006
  57. [63]Cocuzza M Pagani R Coelho R Srougi M Hallak J The systematic use of intraoperative vascular Doppler ultrasound during microsurgical subinguinal varicocelectomy improves precise identification and preservation of testicular blood supply Fertil Steril 2010 93 2396 2399 19268931
  58. [64]Mehta A Goldstein M Microsurgical varicocelectomy: a review Asian J Androl 2013 15 56 60 23147467 PMC3739135
  59. [65]Wang J Xia SJ Liu ZH Tao L Ge JF Xu CM Inguinal and subinguinal micro-varicocelectomy, the optimal surgical management of varicocele: a meta-analysis Asian J Androl 2015 17 74 80 25248652 PMC4291882
  60. [66]Colpi GM Carmignani L Nerva F Piediferro G Castiglioni F Grugnetti C Surgical treatment of varicocele by a subinguinal approach combined with antegrade intraoperative sclerotherapy of venous vessels BJU Int 2006 97 142 145 16336345
  61. [67]Cassidy D Jarvi K Grober E Lo K Varicocele surgery or embolization: which is better? Can Urol Assoc J 2012 6 266 268 23093537 PMC3433543
  62. [68]Sayfan J Adam YG Soffer Y A new entity in varicocele subfertility: the "cremasteric reflux" Fertil Steril 1980 33 88 90 7351263
  63. [69]Goldstein M Gilbert BR Dicker AP Dwosh J Gnecco C Microsurgical inguinal varicocelectomy with delivery of the testis: an artery and lymphatic sparing technique J Urol 1992 148 1808 1811 1433614
  64. [70]Ramasamy R Schlegel PN Microsurgical inguinal varicocelectomy with and without testicular delivery Urology 2006 68 1323 1326 17169654
  65. [71]Hou Y Zhang Y Zhang Y Huo W Li H Comparison between microsurgical subinguinal varicocelectomy with and without testicular delivery for infertile men: is testicular delivery an unnecessary procedure Urol J 2015 12 2261 2266 26341769
  66. [72]Allameh F Hasanzadeh Haddad A Abedi A Ranjbar A Qashqai H Fadavi B Varicocelectomy with primary gubernaculum veins closure: a randomised clinical trial Andrologia 2018 10.1111/and.12991 [Epub] 29460294 · DOI
  67. [73]Ou N Zhu J Zhang W Liang Z Hu R Song Y Bilateral is superior to unilateral varicocelectomy in infertile men with bilateral varicocele: systematic review and meta-analysis Andrologia 2019 51 e13462 31646672
  68. [74]Niu Y Wang D Chen Y Pokhrel G Xu H Wang T Comparison of clinical outcome of bilateral and unilateral varicocelectomy in infertile males with left clinical and right subclinical varicocele: a meta-analysis of randomised controlled trials Andrologia 2018 50 e13078 30024042
  69. [75]Sun XL Wang JL Peng YP Gao QQ Song T Yu W Bilateral is superior to unilateral varicocelectomy in infertile males with left clinical and right subclinical varicocele: a prospective randomized controlled study Int Urol Nephrol 2018 50 205 210 29210007
  70. [76]Zheng YQ Gao X Li ZJ Yu YL Zhang ZG Li W Efficacy of bilateral and left varicocelectomy in infertile men with left clinical and right subclinical varicoceles: a comparative study Urology 2009 73 1236 1240 19371942
  71. [77]Chehval MJ Purcell MH Deterioration of semen parameters over time in men with untreated varicocele: evidence of progressive testicular damage Fertil Steril 1992 57 174 177 1730313
  72. [78]Addar AM Nazer A Almardawi A Al Hathal N Kattan S The yield of microscopic varicocelectomy in men with severe oligospermia Urol Ann 2021 13 268 271 34421263 PMC8343284
  73. [79]Chan PT Wright EJ Goldstein M Incidence and postoperative outcomes of accidental ligation of the testicular artery during microsurgical varicocelectomy J Urol 2005 173 482 484 15643221
  74. [80]Barazani Y Nagler HM Other work has highlighted the limitations of using histopathology to predict success after varicocelectomy Fertil Steril 2011 95 487 21183178
  75. [81]Lund L Roebuck DJ Lee KH Sørensen HT Yeung CK Clinical assessment after varicocelectomy Scand J Urol Nephrol 2000 34 119 122 10903073
  76. [82]Akcar Değirmenci N Turgut M Ozkan R [Recurrence rate after varicocelectomy in infertile men] Tani Girisim Radyol 2004 10 144 146 Turkish 15236130
  77. [83]Rotker K Sigman M Recurrent varicocele Asian J Androl 2016 18 229 233 26806078 PMC4770491
  78. [84]Cayan S Shavakhabov S Kadioğlu A Treatment of palpable varicocele in infertile men: a meta-analysis to define the best technique J Androl 2009 30 33 40 18772487
  79. [85]Franco G Iori F de Dominicis C Dal Forno S Mander A Laurenti C Challenging the role of cremasteric reflux in the pathogenesis of varicocele using a new venographic approach J Urol 1999 161 117 121 10037382
  80. [86]Kim KH Lee JY Kang DH Lee H Seo JT Cho KS Impact of surgical varicocele repair on pregnancy rate in subfertile men with clinical varicocele and impaired semen quality: a meta-analysis of randomized clinical trials Korean J Urol 2013 54 703 709 24175046 PMC3806996
  81. [87]Baazeem A Belzile E Ciampi A Dohle G Jarvi K Salonia A Varicocele and male factor infertility treatment: a new meta-analysis and review of the role of varicocele repair Eur Urol 2011 60 796 808 21733620
  82. [88]Fukuda T Miyake H Enatsu N Matsushita K Fujisawa M Assessment of time-dependent changes in semen parameters in infertile men after microsurgical varicocelectomy Urology 2015 86 48 51 26142582
  83. [89]Al Bakri A Lo K Grober E Cassidy D Cardoso JP Jarvi K Time for improvement in semen parameters after varicocelectomy J Urol 2012 187 227 231 22100000
  84. [90]Ghaed MA Makian SA Moradi A Maghsoudi R Gandomi-Mohammadabadi A Best time to wait for the improvement of the sperm parameter after varicocelectomy: 3 or 6 months Arch Ital Urol Androl 2020 92 10.4081/aiua.2020.3.259 33016058 · DOI · Paper page
  85. [91]Machen GL Johnson D Nissen MA Naber E Sandlow JI Time to improvement of semen parameters after microscopic varicocelectomy: when it occurs and its effects on fertility Andrologia 2020 52 e13500 31840291
  86. [92]Masterson TA Greer AB Ramasamy R Time to improvement in semen parameters after microsurgical varicocelectomy in men with severe oligospermia Can Urol Assoc J 2019 13 E66 E69 30169150 PMC6395104
  87. [93]Seo JT Kim KT Moon MH Kim WT The significance of microsurgical varicocelectomy in the treatment of subclinical varicocele Fertil Steril 2010 93 1907 1910 19249033
  88. [94]Cantoro U Polito M Muzzonigro G Reassessing the role of subclinical varicocele in infertile men with impaired semen quality: a prospective study Urology 2015 85 826 830 25817105
  89. [95]Elzanaty S Varicocele repair in non-obstructive azoospermic men: diagnostic value of testicular biopsy - a meta-analysis Scand J Urol 2014 48 494 498 25001949
  90. [96]Weedin JW Khera M Lipshultz LI Varicocele repair in patients with nonobstructive azoospermia: a meta-analysis J Urol 2010 183 2309 2315 20400156
  91. [97]Esteves SC Miyaoka R Roque M Agarwal A Outcome of varicocele repair in men with nonobstructive azoospermia: systematic review and meta-analysis Asian J Androl 2016 18 246 253 26680033 PMC4770494
  92. [98]Berookhim BM Schlegel PN Azoospermia due to spermatogenic failure Urol Clin North Am 2014 41 97 113 24286770
  93. [99]Abdel-Meguid TA Predictors of sperm recovery and azoospermia relapse in men with nonobstructive azoospermia after varicocele repair J Urol 2012 187 222 226 22100001
  94. [100]Lee JS Park HJ Seo JT What is the indication of varicocelectomy in men with nonobstructive azoospermia? Urology 2007 69 352 355 17320677
  95. [101]Sharma RK Gupta S Agarwal A Finelli R Kuroda S Saleh R Role of cytocentrifugation combined with nuclear fast picroindigocarmine staining in detecting cryptozoospermia in men diagnosed with azoospermia World J Mens Health 2022 10.5534/wjmh.210210 [Epub] PMC9482851 35118836 · DOI
  96. [102]Krausz C Riera-Escamilla A Moreno-Mendoza D Holleman K Cioppi F Algaba F Genetic dissection of spermatogenic arrest through exome analysis: clinical implications for the management of azoospermic men Genet Med 2020 22 1956 1966 32741963 PMC7710580
  97. [103]Inci K Hascicek M Kara O Dikmen AV Gurgan T Ergen A Sperm retrieval and intracytoplasmic sperm injection in men with nonobstructive azoospermia, and treated and untreated varicocele J Urol 2009 182 1500 1505 19683732
  98. [104]Haydardedeoglu B Turunc T Kilicdag EB Gul U Bagis T The effect of prior varicocelectomy in patients with nonobstructive azoospermia on intracytoplasmic sperm injection outcomes: a retrospective pilot study Urology 2010 75 83 86 19913887

Cited by

Sorted by citations

Authors
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., Gül, M., Bakırcıoğlu, 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., Meliegy, A. E., 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., Saïs-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., Peña, 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., Vignera, S. L., 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., Castañé, 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., Vučinić, 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., Silva, R. S. E., 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., Çeker, G., Colpi, G. M., & Forum, O. B. O. T. G. A.
Affiliations
  • Lilavati Hospital & Research Centre (IN)
  • Cleveland Clinic (US)
  • Texas Fertility Center (US)
  • Henry Ford Health (US)
  • Sohag University (EG)
  • University of Catania (IT)
  • Mansoura University (EG)
  • Université de Versailles Saint-Quentin-en-Yvelines (FR)
  • King Abdulaziz University (SA)
  • McGill University (CA)
  • Loma Linda University (US)
  • Department of Urology, Faculty of Medicine, Istanbul Medipol University, Istanbul, Turkey.
  • Sağlık Bilimleri Üniversitesi (TR)
  • Fakih IVF Fertility Center, Abu Dhabi, UAE.
  • Selçuk University (TR)
  • SENSART Clinic, Istanbul, Turkey.
  • SIU Medicine (US)
  • Section of Andrology, Department of Urology, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey.
  • The University of Queensland (AU)
  • Puigvert Foundation (ES)
  • Aristotle University of Thessaloniki (GR)
  • SCM Clinic and Hospital, New Delhi, India.
  • Marche Polytechnic University (IT)
  • Imperial College London (GB)
  • Pham Ngoc Thach University of Medicine (VN)
  • Department of Urology, Bolu Abant Izzet Baysal University, Bolu, Turkey.
  • Farwaniya Hospital (KW)
  • Department of Urology, Faculty of Medicine, Hacettepe University, Ankara, Turkey.
  • Juntendo University Urayasu Hospital (JP)
  • Cairo University (EG)
  • Department of Urology, Taksim Education and Research Hospital, Istanbul, Turkey.
  • Department of Urology, Faculty of Medicine, Bandırma Onyedi Eylül University, Balıkesir, Turkey.
  • Reproductive medicine, Clinical Research Centre, Lund University, Malmö, Sweden.
  • Chinese University of Hong Kong (HK)
  • Universiti Teknologi MARA System (MY)
  • PO San Giovanni Bosco, ASL Napoli 1 Centro, Napoli, Italy.
  • Hospital Israelita Albert Einstein (BR)
  • Bệnh viện Bình Dân (VN)
  • GynePro Medical (IT)
  • Fertility Medical Group (BR)
  • Department of Urology, Biruni University School of Medicine, Istanbul, Turkey.
  • Department of Reproductive Biology, Fertility Preservation, Andrology, CECOS, Poissy Hospital, Poissy, France.
  • Department of Urology and Andrology, University Hospital of Toulouse, France.
  • Başkent University (TR)
  • Asl Bari, PTA “F Jaia”, Reproductive and IVF unit, Andrology Outpatients Clinic, Asl Bari, Conversano (Ba), Italy.
  • Andrology Unit, ART Center - San Carlo Clinic, Paderno Dugnano, Milan, Italy.
  • Andrology Section, Siloam Sriwijaya Hospital, Palembang, Indonesia.
  • Department of Urology, Hatay Mustafa Kemal University, Antakya, Turkey.
  • Sapienza University of Rome (IT)
  • Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico (IT)
  • Udayana University (ID)
  • Innsbruck Medical University (AT)
  • University of Foggia (IT)
  • University of Florence (IT)
  • The Alfred Hospital (AU)
  • Policlinico Umberto I (IT)
  • University of Trieste (IT)
  • Weill Cornell Medical College in Qatar (QA)
  • Hacettepe University (TR)
  • Peking University (CN)
  • Kansai Medical University (JP)
  • Pusan National University Hospital (KR)
  • Université Ibn Zohr (MA)
  • Department of urology, Faculty of Medicine, Istanbul Medipol Mega University Hospital, Istanbul, Turkey.
  • University of Utah (US)
  • Hammersmith Hospital (GB)
  • Hospital Clínic de Barcelona (ES)
  • Department of Urology, Silopi State Hospital, Sirnak, Turkey.
  • University of Illinois Chicago (US)
  • University of Lusaka (ZM)
  • Kobe University (JP)
  • Department of Urology, Toho University Faculty of Medicine, Tokyo, Japan.
  • Universitas Airlangga (ID)
  • Department of Urology and Andrology, Locus Medicus, Athens, Greece.
  • University of Washington (US)
  • Instituto de Ginecología y Fertilidad (IFER), Universidad de Buenos Aires, Buenos Aires, Argentina.
  • Fondazione Ricerca Molinette (IT)
  • University of Santo Tomas Hospital (PH)
  • University of Copenhagen (DK)
  • Department of Surgery, Urology Division, Sultan Qaboos University, Muscat, Oman.
  • Royan Institute (IR)
  • Andrology Committee of the Algerian Association of Urology, Algiers, Algeria.
  • University of Ioannina (GR)
  • University of Indonesia (ID)
  • Topiwala National Medical College & BYL Nair Charitable Hospital (IN)
  • University of Toledo (US)
  • Department of Urology, Al - Ahlia Hospital Abu Dhabi UAE, Abu Dhabi, UAE.
  • Faculdade de Medicina do ABC (BR)
  • Department of Urology and Andrology, AIG Hospitals, Hyderabad, Telangana, India.
  • University Hospitals of Cleveland (US)
  • Dr. Hasan Sadikin General Hospital (ID)
  • Department of Andrology, Uromedica Polyclinic, Belgrade, Serbia.
  • Macquarie University (AU)
  • The University of Osaka (JP)
  • Korea University (KR)
  • University of Malaya (MY)
  • Yokohama City University Medical Center (JP)
  • Nagano Red Cross Hospital (JP)
  • Perth Urology Clinic, Perth, WA, Australia.
  • Apollo Hospitals (IN)
  • Asian Institute of Gastroenterology (IN)
  • Kanazawa University (JP)
  • Department for Transfusion Medicine and Transplantation Biology, Reproductive Tissue Bank, University of Zagreb, School of Medicine, University Hospital Zagreb, Zagreb, Croatia.
  • United Christian Hospital (CN)
  • Martha-Maria Hospital (DE)
  • St. Luke's Medical Center (PH)
  • Department of Andrology, Fundació Puigvert, Universitat Autònoma de Barcelona, Barcelona, Spain.
  • Department of Urology, Faculty of Medicine, Suez Canal University, Ismailia, Egypt.
  • Vietnam National University, Hanoi (VN)
  • Department of Urology, Gülhane Research and Training Hospital, University of Health Sciences, Ankara, Turkey.
  • Mount Elizabeth Hospital (SG)
  • Lebanese University (LB)
  • Mansoura University Urology and Nephrology Center, Mansoura, Egypt.
  • King Fahad Specialist Hospital (SA)
  • King Faisal Specialist Hospital & Research Centre (SA)
  • University of Montenegro (ME)
  • Sina Hospital (IR)
  • General Hospital Uzice (RS)
  • Shahroud University of Medical Sciences (IR)
  • Urology Unit, Department of Surgery, Hospital Angkatan Tentera Tuanku Mizan, Kuala Lumpur, Malaysia.
  • Mubarak Al Kabeer Hospital (KW)
  • Imam Abdulrahman Bin Faisal University (SA)
  • Tehran University of Medical Sciences (IR)
  • Division of Urology, Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China.
  • Department of Urology, Pediatric Urology and Andrology, Justus-Liebig-University Giessen (GER), University Hospital Giessen and Marburg GmbH, Campus Giessen, Giessen, Germany.
  • Department of Urology, Centro Universitario em Saude do ABC, Santo André, Brazil.
  • Santa Casa de Ribeirão Preto, Ribeirão Preto, Brazil.
  • Hospital de Clínicas Universidade Federal do Paraná (BR)
  • Androlab, Fertility Clinic, Curitiba, Brazil.
  • Cleveland Clinic Abu Dhabi (AE)
  • Universität Innsbruck (AT)
  • Seoul National University (KR)
  • National University Hospital (SG)
  • University of the Philippines Manila (PH)
  • University of Insubria (IT)
  • Examenlab Ltd., Northern Ireland, UK.
  • Department of Andrology, Centro ANDROGEN, La Coruña, Spain.
  • Gleneagles Hospital (SG)
  • University of Virginia (US)
  • East Avenue Medical Center (PH)
  • Herlev Hospital (DK)
  • University of Central Florida (US)
  • Department of Urology, Sabah Al Ahmad Urology Center, Kuwait City, Kuwait.
  • SCSA Diagnostics, Brookings, SD, USA.
  • Nagoya City University West Medical Center (JP)
  • Urological and Human Reproduction Unit, Quiron Hospital, Barcelona, Spain.
  • Zonguldak Bülent Ecevit University (TR)
  • Next Fertility Procrea, Lugano, Switzerland.
Corresponding author
Agarwal, Ashok
ORCID
Venue
The World Journal of Men's Health
Publisher
XMLink
Published
2023
Volume
41
Issue
1
Pages
164
ISSN
  • 2287-4208 (ISSN-L)
  • 2287-4690
DOI
10.5534/wjmh.220048
PMC
PMC9826919
OpenAlex
W4284692190
Cited by
67
References
4
Citations by year
2026: 16 · 2025: 16 · 2024: 22 · 2023: 10 · 2022: 3
FWCI
10.40
Type
journal article
Language
en
Open access
Licence
Locations
  • The World Journal of Men s Health (publishedVersion, cc-by-nc)
  • PubMed Central (publishedVersion, cc-by-nc)
  • PubMed (publishedVersion)
  • Research at the University of Copenhagen (University of Copenhagen) (publishedVersion, cc-by)
  • Archivio Istituzionale della Ricerca (Universita Degli Studi Di Milano) (submittedVersion, other-oa)
  • ArTS Archivio della ricerca di Trieste (University of Trieste https://www.units.it/) (submittedVersion, cc-by-nc)
  • Università Politecnica delle Marche (Università Politecnica delle Marche) (submittedVersion, cc-by-nc)
  • HAL (submittedVersion)
  • Zonguldak Bülent Ecevit University Institutional Repository (submittedVersion, cc-by-nc-nd)
  • Dipòsit Digital de Documents de la UAB (Universitat Autònoma de Barcelona) (submittedVersion, cc-by-nc)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
  • IrInSubria (University of Insubria) (submittedVersion)
  • Archivio Istituzionale della Ricerca - Università degli Studi della Campania "Luigi Vanvitelli" (submittedVersion)
  • Lund University Publications (Lund University) (submittedVersion)
  • Spiral (Imperial College London) (submittedVersion, cc-by-nc)
Funders
  • Cleveland Clinic
  • National Institute for Health and Care Research (PDF-2017-10-098)
  • American Center for Reproductive Medicine, Cleveland Clinic
Topics
  • Health Sciences › Medicine › Reproductive Medicine › Sperm and Testicular Function
  • Health Sciences › Health Professions › General Health Professions › Male Reproductive Health Studies
  • Health Sciences › Medicine › Reproductive Medicine › Reproductive Health and Technologies
Keywords
varicocele, male infertility, varicocelectomy, clinical practice patterns, practice guideline adherence, subclinical varicocele, azoospermia, varicocele diagnosis, clinician consensus

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review