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1. Does Varicocele Repair Improve Conventional Semen Parameters? A Meta-Analytic Study of Before-After Data

Author

Rossella Cannarella, Rupin Shah, Taha Abo-Almagd Abdel-Meguid Hamoda, Florence Boitrelle, Ramadan Saleh, Murat Gul, Amarnath Rambhatla, Parviz Kavoussi, Tuncay Toprak, Ahmed M. Harraz, Edmund Ko, Gökhan Çeker, Damayanthi Durairajanayagam, Noora Alkahidi, Shinnosuke Kuroda, Andrea Crafa, Ralf Henkel, Gianmaria Salvio, Berk Hazir, Mahsa Darbandi, Marion Bendayan, Sara Darbandi, Marco Falcone, Raghavender Kosgi, Raneen Sawaid Kaiyal, Keshab Karna, Nguyen Ho Vinh Phuoc, Ponco Birowo, Giovanni M. Colpi, Jean de la Rosette, Germar-Michael Pinggera, Quang Nguyen, Armand Zini, Wael Zohdy, Rajender Singh, Pallavi Saini, Sidney Glina, Haocheng Lin, Taymour Mostafa, Cesar Rojas-Cruz, Mohamed Arafa, Aldo E. Calogero, Fotios Dimitriadis, Priyank Kothari, Vilvapathy Senguttuvan Karthikeyan, Keisuke Okada, Koji Chiba, Ates Kadıoglu, Baris Altay, Tahsin Turunc, Birute Zilaitiene, Fatih Gokalp, Aram Adamyan, Darren Katz, Eric Chung, Tiago Cesar Mierzwa, Daniel Suslik Zylbersztejn, Gustavo Marquesine Paul, Nikolaos Sofikitis, Ioannis Sokolakis, Vineet Malhotra, Sakti Ronggowardhana Brodjonegoro, Ricky Adriansjah, Akira Tsujimura, Toshiyasu Amano, Giancarlo Balercia, Imad Ziouziou, Isaac Ardianson Deswanto, Marlon Martinez, Hyun Jun Park, Mustafa Emre Bakırcıoglu, Erman Ceyhan, Kaan Aydos, Jonathan Ramsay, Suks Minhas, Manaf Al Hashimi, Ramy Abou Ghayda, Nicholas Tadros, Puneet Sindhwani, Christopher C.K. Ho, Rinaldo Indra Rachman, Marcelo Rodriguez Pena, Ahmad Motawi, Arun Karthik Ponnusamy, Satish Dipankar, Azwar Amir, Saleh Binsaleh, Ege Can Serefoglu, Ravi Banthia, Kareim Khalafalla, Ari Basukarno, Nguyen Hoai Bac, Karun Singla, Rafael F. Ambar, Konstantinos Makarounis, Shivam Priyadarshi, Gede Wirya Kusuma Duarsa, Widi Atmoko, Sunil Jindal, Eko Arianto, Hamed Akhavizadegan, Haitham El Bardisi, Ohad Shoshany, Gian Maria Busetto, Mohamad Moussa, Mounir Jamali, Mohamed S. Al-Marhoon, Mikhail Ruzaev, Hasan M. A. Farsi, Shingai Mutambirwa, Dong Sup Lee, Deniz Kulaksiz, Yu-Sheng Cheng, Abderrazak Bouzouita, Selcuk Sarikaya, Hussein Kandil, Georgios Tsampoukas, Ala’a Farkouh, Kasonde Bowa, Missy Savira, Nasser Mogharabian, Tan V. Le, Maruto Harjanggi, Dang Tuan Anh, Tran Quang Tien Long, Mohammad Ayodhia Soebadi, Lukman Hakim, Marko Tanic, Umut Cagin Ari, Firuza R. Parikh, Gokhan Calik, Vinod KV, Gyem Dorji, Andri Rezano, Osvaldo Rajmil, Dung Mai Ba Tien, Yiming Yuan, Juan Francisco Lizarraga-Salas, Balantine Eze, Kay Seong Ngoo, Joe Lee, Umut Arslan, and Ashok Agarwal

Subjects
controlled before-after studies, infertility, male, meta-analysis, varicocele, Medicine, Diseases of the genitourinary system. Urology, RC870-923
Abstract

Purpose: The purpose of this meta-analysis is to study the impact of varicocele repair in the largest cohort of infertile males with clinical varicocele by including all available studies, with no language restrictions, comparing intra-person conventional semen parameters before and after the repair of varicoceles. Materials and Methods: The meta-analysis was performed according to PRISMA-P and MOOSE guidelines. A systematic search was performed in Scopus, PubMed, Cochrane, and Embase databases. Eligible studies were selected according to the PICOS model (Population: infertile male patients with clinical varicocele; Intervention: varicocele repair; Comparison: intraperson before-after varicocele repair; Outcome: conventional semen parameters; Study type: randomized controlled trials [RCTs], observational and case-control studies). Results: Out of 1,632 screened abstracts, 351 articles (23 RCTs, 292 observational, and 36 case-control studies) were included in the quantitative analysis. The before-and-after analysis showed significant improvements in all semen parameters after varicocele repair (except sperm vitality); semen volume: standardized mean difference (SMD) 0.203, 95% CI: 0.129–0.278; p

Published
2024
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2. Consensus and Diversity in the Management of Varicocele for Male Infertility: Results of a Global Practice Survey and Comparison with Guidelines and Recommendations

Author

Rupin Shah, Ashok Agarwal, Parviz Kavoussi, Amarnath Rambhatla, Ramadan Saleh, Rossella Cannarella, Ahmed M. Harraz, Florence Boitrelle, Shinnosuke Kuroda, Taha Abo-Almagd Abdel-Meguid Hamoda, Armand Zini, Edmund Ko, Gokhan Calik, Tuncay Toprak, Hussein Kandil, Murat Gül, Mustafa Emre Bakırcıoğlu, Neel Parekh, Giorgio Ivan Russo, Nicholas Tadros, Ates Kadioglu, Mohamed Arafa, Eric Chung, Osvaldo Rajmil, Fotios Dimitriadis, Vineet Malhotra, Gianmaria Salvio, Ralf Henkel, Tan V. Le, Emrullah Sogutdelen, Sarah Vij, Abdullah Alarbid, Ahmet Gudeloglu, Akira Tsujimura, Aldo E. Calogero, Amr El Meliegy, Andrea Crafa, Arif Kalkanli, Aykut Baser, Berk Hazir, Carlo Giulioni, Chak-Lam Cho, Christopher C.K. Ho, Ciro Salzano, Daniel Suslik Zylbersztejn, Dung Mai Ba Tien, Edoardo Pescatori, Edson Borges, Ege Can Serefoglu, Emine Saïs-Hamza, Eric Huyghe, Erman Ceyhan, Ettore Caroppo, Fabrizio Castiglioni, Fahmi Bahar, Fatih Gokalp, Francesco Lombardo, Franco Gadda, Gede Wirya Kusuma Duarsa, Germar-Michael Pinggera, Gian Maria Busetto, Giancarlo Balercia, Gianmartin Cito, Gideon Blecher, Giorgio Franco, Giovanni Liguori, Haitham Elbardisi, Hakan Keskin, Haocheng Lin, Hisanori Taniguchi, Hyun Jun Park, Imad Ziouziou, Jean de la Rosette, Jim Hotaling, Jonathan Ramsay, Juan Manuel Corral Molina, Ka Lun Lo, Kadir Bocu, Kareim Khalafalla, Kasonde Bowa, Keisuke Okada, Koichi Nagao, Koji Chiba, Lukman Hakim, Konstantinos Makarounis, Marah Hehemann, Marcelo Rodriguez Peña, Marco Falcone, Marion Bendayan, Marlon Martinez, Massimiliano Timpano, Mesut Altan, Mikkel Fode, Mohamed S. Al-Marhoon, Mohammad Ali Sadighi Gilani, Mohammad Ayodhia Soebadi, Nazim Gherabi, Nikolaos Sofikitis, Oğuzhan Kahraman, Ponco Birowo, Priyank Kothari, Puneet Sindhwani, Qaisar Javed, Rafael F. Ambar, Raghavender Kosgi, Ramy Abou Ghayda, Ricky Adriansjah, Rosita Angela Condorelli, Sandro La Vignera, Sava Micic, Shannon Hee Kyung Kim, Shinichiro Fukuhara, Sun Tae Ahn, Taymour Mostafa, Teng Aik Ong, Teppei Takeshima, Toshiyasu Amano, Trenton Barrett, Umut Arslan, Vilvapathy Senguttuvan Karthikeyan, Widi Atmoko, Yasushi Yumura, Yiming Yuan, Yuki Kato, Davor Jezek, Bryan Kwun-Chung Cheng, Georgios Hatzichristodoulou, Jun Dy, Eduard Ruiz Castañé, Ahmed I. El-Sakka, Quang Nguyen, Selcuk Sarikaya, Luca Boeri, Ronny Tan, Mohamad A. Moussa, Ahmed El-Assmy, Hamed Alali, Naif Alhathal, Yasser Osman, Dragoljub Perovic, Hesamoddin Sajadi, Hamed Akhavizadegan, Miroslav Vučinić, Said Kattan, Mohamed S. Kattan, Nasser Mogharabian, Nguyen Ho Vinh Phuoc, Kay Seong Ngoo, Mohammad H. Alkandari, Shaheed Alsuhaibani, Ioannis Sokolakis, Mehdi Babaei, Mak Siu King, Thorsten Diemer, Marcelo M. Gava, Raphael Henrique, Rodrigo Spinola e Silva, Gustavo Marquesine Paul, Tiago Cesar Mierzwa, Sidney Glina, Kashif Siddiqi, Han Wu, Jana Wurzacher, Ala’a Farkouh, Hwancheol Son, Suks Minhas, Joe Lee, Nikko Magsanoc, Paolo Capogrosso, German Jose Albano, Sheena E. M. Lewis, Channa N. Jayasena, Juan G. Alvarez, Colin Teo, Ryan P. Smith, Jo Ben M. Chua, Christian Fuglesang S. Jensen, Sijo Parekattil, Renata Finelli, Damayanthi Durairajanayagam, Keshab Kumar Karna, Abdelkareem Ahmed, Don Evenson, Yukihiro Umemoto, Ana Puigvert, Gökhan Çeker, and Giovanni M Colpi

Subjects
consensus, disease management, male infertility, survey, varicocele, Medicine, Diseases of the genitourinary system. Urology, RC870-923
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.

Published
2023
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3. Antisperm Antibody Testing: A Comprehensive Review of Its Role in the Management of Immunological Male Infertility and Results of a Global Survey of Clinical Practices

Author

Sajal Gupta, Rakesh Sharma, Ashok Agarwal, Florence Boitrelle, Renata Finelli, Ala’a Farkouh, Ramadan Saleh, Taha Abo-Almagd Abdel-Meguid, Murat Gül, Birute Zilaitiene, Edmund Ko, Amarnath Rambhatla, Armand Zini, Kristian Leisegang, Shinnosuke Kuroda, Ralf Henkel, Rossella Cannarella, Ayad Palani, Chak-Lam Cho, Christopher C.K. Ho, Daniel Suslik Zylbersztejn, Edoardo Pescatori, Eric Chung, Fotios Dimitriadis, Germar-Michael Pinggera, Gian Maria Busetto, Giancarlo Balercia, Gianmaria Salvio, Giovanni M. Colpi, Gökhan Çeker, Hisanori Taniguchi, Hussein Kandil, Hyun Jun Park, Israel Maldonado Rosas, Jean de la Rosette, Joao Paulo Greco Cardoso, Jonathan Ramsay, Juan Alvarez, Juan Manuel Corral Molina, Kareim Khalafalla, Kasonde Bowa, Kelton Tremellen, Evangelini Evgeni, Lucia Rocco, Marcelo Gabriel Rodriguez Peña, Marjan Sabbaghian, Marlon Martinez, Mohamed Arafa, Mohamed S. Al-Marhoon, Nicholas Tadros, Nicolas Garrido, Osvaldo Rajmil, Pallav Sengupta, Paraskevi Vogiatzi, Parviz Kavoussi, Ponco Birowo, Raghavender Kosgi, Saleem Bani-Hani, Sava Micic, Sijo Parekattil, Sunil Jindal, Tan V. Le, Taymour Mostafa, Tuncay Toprak, Yoshiharu Morimoto, Vineet Malhotra, Azin Aghamajidi, Damayanthi Durairajanayagam, and Rupin Shah

Subjects
antibodies, infertility, male, spermatozoa, sperm agglutination, survey, Medicine, Diseases of the genitourinary system. Urology, RC870-923
Abstract

Antisperm antibodies (ASA), as a cause of male infertility, have been detected in infertile males as early as 1954. Multiple causes of ASA production have been identified, and they are due to an abnormal exposure of mature germ cells to the im-mune system. ASA testing (with mixed anti-globulin reaction, and immunobead binding test) was described in the WHO manual 5th edition and is most recently listed among the extended semen tests in the WHO manual 6th edition. The relation-ship between ASA and infertility is somewhat complex. The presence of sperm agglutination, while insufficient to diagnose immunological infertility, may indicate the presence of ASA. However, ASA can also be present in the absence of any sperm agglutination. The andrological management of ASA depends on the etiology and individual practices of clinicians. In this ar-ticle, we provide a comprehensive review of the causes of ASA production, its role in immunological male infertility, clinical indications of ASA testing, and the available therapeutic options. We also provide the details of laboratory procedures for as-sessment of ASA together with important measures for quality control. Additionally, laboratory and clinical scenarios are pre-sented to guide the reader in the management of ASA and immunological male infertility. Furthermore, we report the results of a recent worldwide survey, conducted to gather information about clinical practices in the management of immunological male infertility.

Published
2022
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4. Post-Vasectomy Semen Analysis: Optimizing Laboratory Procedures and Test Interpretation through a Clinical Audit and Global Survey of Practices

Author

Ashok Agarwal, Sajal Gupta, Rakesh K. Sharma, Renata Finell, Shinnosuke Kuroda, Sarah C. Vij, Florence Boitrelle, Parviz Kavoussi, Amarnath Rambhata, Ramadan Saleh, Eric Chung, Taymour Mostafa, Armand Zini, Edmund Ko, Neel Parekh, Marlon Martinez, Mohamed Arafa, Nicholas Tadros, Jean de la Rosette, Tan V. Le, Osvaldo Rajmil, Hussein Kandil, Gideon Blecher, Giovanni Liguori, Ettore Caroppo, Christopher C.K. Ho, Andrew Altman, Petar Bajic, David Goldfarb, Bradley Gill, Daniel Suslik Zylbersztejn, Juan Manuel Corral Molina, Marcello M. Gava, Joao Paulo Greco Cardoso, Raghavender Kosgi, Gökhan Çeker, Birute Zilaitiene, Edoardo Pescatori, Edson Borges Jr, Gede Wirya Kusuma Duarsa, Germar-Michael Pinggera, Gian Maria Busetto, Giancarlo Balercia, Giorgio Franco, Gökhan Çalik, Hassan N. Sallam, Hyun Jun Park, Jonathan Ramsay, Juan Alvarez, Kareim Khalafalla, Kasonde Bowa, Lukman Hakim, Mara Simopoulou, Marcelo Gabriel Rodriguez, Marjan Sabbaghian, Haitham Elbardisi, Massimiliano Timpano, Mesut Altan, Mohamed Elkhouly, Mohamed S. Al-Marhoon, Mohammad Ali Sadighi Gilani, Mohammad Ayodhia Soebadi, Mohammad Hossein Nasr-Esfahani, Nicolas Garrido, Paraskevi Vogiatzi, Ponco Birowo, Premal Patel, Qaisar Javed, Rafael F. Ambar, Ricky Adriansjah, Sami AlSaid, Sava Micic, Sheena E. Lewis, Shingai Mutambirwa, Shinichiro Fukuhara, Sijo Parekattil, Sun Tae Ahn, Sunil Jindal, Teppei Takeshima, Ana Puigvert, Toshiyasu Amano, Trenton Barrett, Tuncay Toprak, Vineet Malhotra, Widi Atmoko, Yasushi Yumura, Yoshiharu Morimoto, Thiago Fernandes Negris Lima, Yannic Kunz, Yuki Kato, Yukihiro Umemoto, Giovanni M. Colpi, Damayanthi Durairajanayagam, and Rupin Shah

Subjects
male contraception, semen, sperm, survey, vasectomy, Medicine, Diseases of the genitourinary system. Urology, RC870-923
Abstract

Purpose:Purpose: The success of vasectomy is determined by the outcome of a post-vasectomy semen analysis (PVSA). This article describes a step-by-step procedure to perform PVSA accurately, report data from patients who underwent post vasectomy se-men analysis between 2015 and 2021 experience, along with results from an international online survey on clinical practice. Materials and Methods:Materials and Methods: We present a detailed step-by-step protocol for performing and interpretating PVSA testing, along with recommendations for proficiency testing, competency assessment for performing PVSA, and clinical and laboratory sce-narios. Moreover, we conducted an analysis of 1,114 PVSA performed at the Cleveland Clinic’s Andrology Laboratory and an online survey to understand clinician responses to the PVSA results in various countries. Results:Results: Results from our clinical experience showed that 92.1% of patients passed PVSA, with 7.9% being further tested. A total of 78 experts from 19 countries participated in the survey, and the majority reported to use time from vasectomy rather than the number of ejaculations as criterion to request PVSA. A high percentage of responders reported permitting unpro-tected intercourse only if PVSA samples show azoospermia while, in the presence of few non-motile sperm, the majority of responders suggested using alternative contraception, followed by another PVSA. In the presence of motile sperm, the major-ity of participants asked for further PVSA testing. Repeat vasectomy was mainly recommended if motile sperm were observed after multiple PVSA’s. A large percentage reported to recommend a second PVSA due to the possibility of legal actions. Conclusions:Conclusions: Our results highlighted varying clinical practices around the globe, with controversy over the significance of non-motile sperm in the PVSA sample. Our data suggest that less stringent AUA guidelines would help improve test compli-ance. A large longitudinal multi-center study would clarify various doubts related to timing and interpretation of PVSA and would also help us to understand, and perhaps predict, recanalization and the potential for future failure of a vasectomy.

Published
2022
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5. Sperm Vitality and Necrozoospermia: Diagnosis, Management, and Results of a Global Survey of Clinical Practice

Author

Ashok Agarwal, Rakesh K. Sharma, Sajal Gupta, Florence Boitrelle, Renata Finelli, Neel Parekh, Damayanthi Durairajanayagam, Ramadan Saleh, Mohamed Arafa, Chak Lam Cho, Ala’a Farkouh, Amarnath Rambhatla, Ralf Henkel, Paraskevi Vogiatzi, Nicholas Tadros, Parviz Kavoussi, Edmund Ko, Kristian Leisegang, Hussein Kandil, Ayad Palani, Gianmaria Salvio, Taymour Mostafa, Osvaldo Rajmil, Saleem Ali Banihani, Samantha Schon, Tan V. Le, Ponco Birowo, Gökhan Çeker, Juan Alvarez, Juan Manuel Corral Molina, Christopher C.K. Ho, Aldo E. Calogero, Kareim Khalafalla, Mesut Berkan Duran, Shinnosuke Kuroda, Giovanni M. Colpi, Armand Zini, Christina Anagnostopoulou, Edoardo Pescatori, Eric Chung, Ettore Caroppo, Fotios Dimitriadis, Germar-Michael Pinggera, Gian Maria Busetto, Giancarlo Balercia, Haitham Elbardisi, Hisanori Taniguchi, Hyun Jun Park, Israel Maldonado Rosas, Jean de la Rosette, Jonathan Ramsay, Kasonde Bowa, Mara Simopoulou, Marcelo Gabriel Rodriguez, Marjan Sabbaghian, Marlon Martinez, Mohamed Ali Sadighi Gilani, Mohamed S. Al-Marhoon, Raghavender Kosgi, Rossella Cannarella, Sava Micic, Shinichiro Fukuhara, Sijo Parekattil, Sunil Jindal, Taha Abo-Almagd Abdel-Meguid, Yoshiharu Morimoto, and Rupin Shah

Subjects
asthenozoospermia, eosine yellowish-(ys), infertility, nigrosin, spermatozoa, vitality, Medicine, Diseases of the genitourinary system. Urology, RC870-923
Abstract

Sperm vitality testing is a basic semen examination that has been described in the World Health Organization (WHO) Laboratory Manual for the Examination and Processing of Human Semen from its primary edition, 40 years ago. Several methods can be used to test sperm vitality, such as the eosin-nigrosin (E-N) stain or the hypoosmotic swelling (HOS) test. In the 6th (2021) edition of the WHO Laboratory Manual, sperm vitality assessment is mainly recommended if the total motility is less than 40%. Hence, a motile spermatozoon is considered alive, however, in certain conditions an immotile spermatozoon can also be alive. Therefore, the differentiation between asthenozoospermia (pathological decrease in sperm motility) and necrozoospermia (pathological decrease in sperm vitality) is important in directing further investigation and management of infertile patients. The causes leading to necrozoospermia are diverse and can either be local or general, testicular or extra-testicular. The andrological management of necrozoospermia depends on its etiology. However, there is no standardized treatment available presently and practice varies among clinicians. In this study, we report the results of a global survey to understand current practices regarding the physician order of sperm vitality tests as well as the management practices for necrozoospermia. Laboratory and clinical scenarios are presented to guide the reader in the management of necrozoospermia with the overall objective of establishing a benchmark ranging from the diagnosis of necrozoospermia by sperm vitality testing to its clinical management.

Published
2022
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6. Encrusted and incarcerated urinary bladder catheter: what are the options?

Author

Christopher C.K. Ho, Yugasaravanan Khandasamy, Praveen Singam, Eng Hong Goh, and Zulkifli M. Zainuddin

Subjects
encrustations, bladder, catheter, complications, incarcerated, stuck, urinary, Medicine
Abstract

Urinary bladder catheter encrustations are known complications of long-term urinary catheterisation, which is commonly seen in clinical practice. These encrustations can impede deflation of the balloon and therefore cause problems in the removal of the catheter. The options in managing an encrusted and incarcerated urinary bladder catheter include extracorporeal shock wave lithotripsy and lithoclast. We describe here another technique of dealing with a stuck and encrustated catheter, via direct crushing of the encrustations with a rigid cystoscope inserted through a suprapubic cystostomy tract.

Published
2010
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