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1. Global Practice Patterns and Variations in the Medical and Surgical Management of Non- Obstructive Azoospermia: Results of a World-Wide Survey, Guidelines and Expert Recommendations

Author

Amarnath Rambhatla, Rupin Shah, Imad Ziouziou, Priyank Kothari, Gianmaria Salvio, Murat Gul, Taha Hamoda, Parviz Kavoussi, Widi Atmoko, Tuncay Toprak, Ponco Birowo, Edmund Ko, Mohamed Arafa, Ramy Abou Ghayda, Vilvapathy Senguttuvan Karthikeyan, Giorgio Ivan Russo, Germar-Michael Pinggera, Eric Chung, Ahmed M. Harraz, Marlon Martinez, Nguyen Ho Vinh Phuoc, Nicholas Tadros, Ramadan Saleh, Missy Savira, Giovanni M. Colpi, Wael Zohdy, Edoardo Pescatori, Hyun Jun Park, Shinichiro Fukuhara, Akira Tsujimura, Cesar Rojas-Cruz, Angelo Marino, Siu King Mak, Edouard Amar, Wael Ibrahim, Puneet Sindhwani, Naif Alhathal, Gian Maria Busetto, Manaf Al Hashimi, Ahmed El-Sakka, Asci Ramazan, Fotios Dimitriadis, Massimiliano Timpano, Davor Jezek, Baris Altay, Daniel Suslik Zylbersztejn, Michael YC Wong, Du Geon Moon, Christine Wyns, Safar Gamidov, Hamed Akhavizadegan, Alessandro Franceschelli, Kaan Aydos, Nguyen Quang, Shedeed Ashour, Adel Al Dayel, Mohammed S. Al-Marhoon, Sava Micic, Saleh Binsaleh, Alayman Hussein, Haitham Elbardisi, Taymour Mostafa, Jonathan Ramsay, Athanasios Zachariou, Islam Fathy Soliman Abdelrahman, Osvaldo Rajmil, Arif Kalkanli, Juan Manuel Corral Molina, Kadir Bocu, Gede Wirya Kusuma Duarsa, Gökhan Çeker, Ege Can Serefoglu, Fahmi Bahar, Nazim Gherabi, Shinnosuke Kuroda, Abderrazak Bouzouita, Ahmet Gudeloglu, Erman Ceyhan, Mohamed Saeed Mohamed Hasan, Muhammad Ujudud Musa, Ahmad Motawi, Chak-Lam Cho, Hisanori Taniguchi, Christopher Chee Kong Ho, Jesus Fernando Solorzano Vazquez, Shingai Mutambirwa, Nur Dokuzeylul Gungor, Marion Bendayan, Carlo Giulioni, Aykut Baser, Marco Falcone, Luca Boeri, Gideon Blecher, Alireza Kheradmand, Tamilselvi Sethupathy, Ricky Adriansjah, Nima Narimani, Charalampos Konstantinidis, Tuan Thanh Nguyen, Andrian Japari, Parisa Dolati, Keerti Singh, Cevahir Ozer, Selcuk Sarikaya, Nadia Sheibak, Ndagijimana Jean Bosco, Mehmet Serkan Özkent, Sang Thanh Le, Ioannis Sokolakis, Darren Katz, Ryan Smith, Manh Nguyen Truong, Tan V. Le, Zhongwei Huang, Muslim Dogan Deger, Umut Arslan, Gokhan Calik, Giorgio Franco, Ayman Rashed, Oguzhan Kahraman, Sotiris Andreadakis, Rosadi Putra, Giancarlo Balercia, Kareim Khalafalla, Rossella Cannarella, Anh Đặng Tuấn, Amr El Meliegy, Birute Zilaitiene, Marlene Lizbeth Zamora Ramirez, Filippo Giacone, Aldo E. Calogero, Konstantinos Makarounis, Sunil Jindal, Bac Nguyen Hoai, Ravi Banthia, Marcelo Rodriguez Peña, Dharani Moorthy, Aram Adamyan, Deniz Kulaksiz, Hussein Kandil, Nikolaos Sofikitis, Ciro Salzano, Andreas Jungwirth, Surendra Reddy Banka, Tiago Cesar Mierzwa, Tahsin Turunç, Divyanu Jain, Armen Avoyan, Pietro Salacone, Ateş Kadıoğlu, Chirag Gupta, Haocheng Lin, Iman Shamohammadi, Nasser Mogharabian, Trenton Barrett, Yavuz Onur Danacıoğlu, Andrea Crafa, Salima Daoud, Vineet Malhotra, Abdulmalik Almardawi, Osama Mohamed Selim, Mohamad Moussa, Saeid Haghdani, Mesut Berkan Duran, Yannic Kunz, Mirko Preto, Elena Eugeni, Thang Nguyen, Ahmed Rashad Elshahid, Seso Sulijaya Suyono, Dyandra Parikesit, Essam Nada, Eduardo Gutiérrez Orozco, Florence Boitrelle, Nguyen Thi Minh Trang, Mounir Jamali, Raju Nair, Mikhail Ruzaev, Franco Gadda, Charalampos Thomas, Raphael Henrique Ferreira, Umit Gul, Serena Maruccia, Ajay Kanbur, Ella Kinzikeeva, Saad Mohammed Abumelha, Raghavender Kosgi, Fatih Gokalp, Mohammad Ayodhia Soebadi, Gustavo Marquesine Paul, Hesamoddin Sajadi, Deepak Gupte, Rafael F. Ambar, Emrullah Sogutdelen, Karun Singla, Ari Basukarno, Shannon Hee Kyung Kim, Mohammad Ali Sadighi Gilani, Koichi Nagao, Sakti Ronggowardhana Brodjonegoro, Andri Rezano, Mohamed Elkhouly, Rossella Mazzilli, Hasan M. A. Farsi, Hung Nguyen Ba, Hamed Alali, Dimitrios Kafetzis, Tran Quang Tien Long, Sami Alsaid, Hoang Bao Ngoc Cuong, Knigavko Oleksandr, Akhmad Mustafa, Herik Acosta, Hrishikesh Pai, Bahadır Şahin, Eko Arianto, Colin Teo, Sanjay Prakash Jayaprakash, Rinaldo Indra Rachman, Mustafa Gurkan Yenice, Omar Sefrioui, Shivam Priyadarshi, Marko Tanic, Noor Kareem Alfatlaw, Fikri Rizaldi, Ranjit B. Vishwakarma, George Kanakis, Dinesh Thomas Cherian, Joe Lee, Raisa Galstyan, Hakan Keskin, Janan Wurzacher, Doddy Hami Seno, Bambang S Noegroho, Ria Margiana, Qaisar Javed, Fabrizio Castiglioni, Raman Tanwar, Ana Puigvert, Coşkun Kaya, Medianto Purnomo, Chadi Yazbeck, Azwar Amir, Edson Borges, Marina Bellavia, Isaac Ardianson Deswanto, Vinod KV, Giovanni Liguori, Dang Hoang Minh, Kashif Siddiqi, Fulvio Colombo, Armand Zini, Niket Patel, Selahittin Çayan, Ula Al-kawaz, Maged Ragab, Guadalupe Hernández Hebrard, Jean de la Rosette, Ozan Efesoy, Ivan Hoffmann, Thiago Afonso Teixeira, Barış Saylam, Daniela Delgadillo, and Ashok Agarwal

Subjects
azoospermia, hypogonadism, infertility, male, semen, sperm retrieval, Medicine, Diseases of the genitourinary system. Urology, RC870-923
Abstract

Purpose: Non-obstructive azoospermia (NOA) is a common, but complex problem, with multiple therapeutic options and a lack of clear guidelines. Hence, there is considerable controversy and marked variation in the management of NOA. This survey evaluates contemporary global practices related to medical and surgical management for patients with NOA. Materials and Methods: A 56-question online survey covering various aspects of the evaluation and management of NOA was sent to specialists around the globe. This paper analyzes the results of the second half of the survey dealing with the management of NOA. Results have been compared to current guidelines, and expert recommendations have been provided using a Delphi process. Results: Participants from 49 countries submitted 336 valid responses. Hormonal therapy for 3 to 6 months was suggested before surgical sperm retrieval (SSR) by 29.6% and 23.6% of participants for normogonadotropic hypogonadism and hypergonadotropic hypogonadism respectively. The SSR rate was reported as 50.0% by 26.0% to 50.0% of participants. Interestingly, 46.0% reported successful SSR in

Published
2025
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2. 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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3. THE USE OF RIGISCAN® EXAMINATION IN DIAGNOSING PATIENTS WITH ERECTILE DYSFUNCTION IN JAKARTA

Author

Ari Basukarno, Ponco Birowo, Dimas Tri Prasetyo, and Nur Rasyid

Subjects
Erectile dysfunction, impotence, Rigiscan®, penile rigidity, Diseases of the genitourinary system. Urology, RC870-923
Abstract

Objective: The aim of this study is to describe the characteristic of patients with Erectile Dysfunction (ED) and results of Nocturnal penile tumescence and rigidity (NPTR) based on Rigiscan® examination in patients with ED in Jakarta. Material & Methods: Descriptive-prospective study of patients with ED in Cipto Mangunkusumo Referral Hospital, Bunda General Hospital Jakarta, and ASRI-Siloam Urology Hospital are recorded during 2015. Patients’ age (in years), marital status (yes/no), duration of ED (in months), and International Index of Erectile Function-5 (IIEF-5) were recorded. NPTR examination were performed while patients were sleeping. Number of events, duration of each event (in minutes) as well as the rigidity (in percentage) and tumescence (in cm) were recorded. The elevation of tip and base penile circumference (in cm) during erection were also noted. Results: There were 34 patients who agreed to perform NPTR test. Most patients were married with the average age of 40.94 ± 10.81 years old. The duration of ED were varied from 5 to 96 months with average duration of 33.7 ± 44.34 months and IIEF-5 score was 6.38 ± 5.14. In general number of erections was 4 ± 3 with 23.4% of them had normal erection. The comparison between organic and psychogenic ED showed that the increment of circumference was significantly less in organic ED patients. Other parameters showed insignificant difference in statistical results. Conclusion: NPTR examination is an objective, effective, and easy-to-use measurement in order to differentiate between organic and psychogenic ED. One third of patients who complained with ED suffered from psychogenic ED and needed referral to other specialists.

Published
2018
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4. ETIOLOGY OF MALE INFERTILITY IN JAKARTA

Author

Ari Basukarno, Ponco Birowo, and Nur Rasyid

Subjects
Infertility, male, etiology, Jakarta, azoospermia, Diseases of the genitourinary system. Urology, RC870-923
Abstract

Objective: The etiology and risk factors of male infertility in huge Indonesian population has not yet been defined. This study was aim to evaluate the distribution and pattern of male infertility in Jakarta. Material & Methods: Retrospective study of Infertility database of Cipto Mangunkusumo Referral Hospital Jakarta, Bunda Hospital Jakarta, and ASRI Hospital Jakarta from 2005 until 2015 were analyzed using SPSS ver. 20. Patients’ characteristic and demography were stated. Results: There were 1062 patients with most of them suffered from primary infertility of their first time-marriage. Average age of husband, wife, and duration of marriage were 36.63± 7.10, 32.32 ± 4.92, and 5.7 ± 4.18 years old respectively. Smoking habit was recorded in 25% of patients while exposure and occupational hazard were only found in less than 2% of them. Coital problems occured in 17% of patients with 30% of them did not have routine sexual intercourse per week. Physical examination revealed that more than 70% of them had varicocele while USG Doppler of scrotum found varicocele in less than 50%. Only 5.13% of patients had normal sperm analysis, mostly azoospermia. Hormonal abnormality occured in more than 30% patients, varied in testosterone, FSH, and LH level.Conclusion: Male infertility was mostly caused by abnormal sperm characteristics followed by abnormal hormonal analysis. Exposure and occupational hazard did not play a big role in male infertility. Future study in risk factors of abnormal sperm characteristics could be done.

Published
2016
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5. Management of bladder stones: the move towards non-invasive treatment

Author

Isaac Ardianson Deswanto, Ari Basukarno, Ponco Birowo, and Nur Rasyid

Subjects
medicine.medical_specialty, medicine.medical_treatment, 030232 urology & nephrology, Bladder stone, 03 medical and health sciences, 0302 clinical medicine, medicine, Outpatient clinic, cystholithotripsy, lcsh:R5-920, business.industry, Medical record, Non invasive, Retrospective cohort study, General Medicine, medicine.disease, Extracorporeal shock wave lithotripsy, Surgery, sectio alta, Tolerability, 030220 oncology & carcinogenesis, Bladder stones, lcsh:Medicine (General), business, ESWL
Abstract

Background: Bladder stone accounts for 5% of all cases of urolithiasis. Bladder stones management has evolved over the last decades from open bladder surgery (sectio alta) to intracorporeal cystholithotripsy as well as extracorporeal shock wave lithotripsy (ESWL). ESWL presents to be a promising modality in the management of bladder calculi due to its simplicity and well tolerability. This study is thus conducted to present data on the safety and effectiveness of ESWL in the management of bladder stone patients.Methods: This is a retrospective study evaluating the medical records of 92 bladder calculi patients admitted to Cipto Mangunkusumo General Hospital (RSCM) from January 2011 to April 2015. Patient’s age, gender, type of stone and procedure being done, status of stone disintegration, length of hospital stay, and any complications that may occur are noted down and statistically analyzed using SPSS v. 20.Results: Majority of the patients underwent ESWL (49 out of 92, 53.3%). The stone free rates for ESWL, intracorporeal lithotripsy, and sectio alta are 93.9%, 97.0% and 100% respectively. One patient had to repeat ESWL. The ESWL group had the smallest stone size average compared to the intracorporeal lithotripsy and section alta group (2.5 cm±2.0 cm vs 4.8 cm±3.7 cm vs 7.4 cm±5.4 cm respectively). The ESWL sessions were conducted in the outpatient clinic, and thus no hospital stay was required.Conclusion: ESWL can be suggested as an effective non-invasive approach in the disintegration of bladder stone of ≤25 mm with a promisingly high stone-free rate (93.9%) Furthermore, ESWL can be performed on an outpatient basis with minimal complications.

Published
2017
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6. THE USE OF RIGISCAN® EXAMINATION IN DIAGNOSING PATIENTS WITH ERECTILE DYSFUNCTION IN JAKARTA

Author

Nur Rasyid, Ari Basukarno, Ponco Birowo, and Dimas Tri Prasetyo

Subjects
medicine.medical_specialty, Average duration, Tumescence, Referral, Rigiscan®, business.industry, impotence, medicine.disease, lcsh:Diseases of the genitourinary system. Urology, lcsh:RC870-923, Erectile dysfunction, Internal medicine, Nocturnal penile tumescence, medicine, Psychogenic disease, penile rigidity, In patient, General hospital, business
Abstract

Objective: The aim of this study is to describe the characteristic of patients with Erectile Dysfunction (ED) and results of Nocturnal penile tumescence and rigidity (NPTR) based on Rigiscan® examination in patients with ED in Jakarta. Material & Methods: Descriptive-prospective study of patients with ED in Cipto Mangunkusumo Referral Hospital, Bunda General Hospital Jakarta, and ASRI-Siloam Urology Hospital are recorded during 2015. Patients’ age (in years), marital status (yes/no), duration of ED (in months), and International Index of Erectile Function-5 (IIEF-5) were recorded. NPTR examination were performed while patients were sleeping. Number of events, duration of each event (in minutes) as well as the rigidity (in percentage) and tumescence (in cm) were recorded. The elevation of tip and base penile circumference (in cm) during erection were also noted. Results: There were 34 patients who agreed to perform NPTR test. Most patients were married with the average age of 40.94 ± 10.81 years old. The duration of ED were varied from 5 to 96 months with average duration of 33.7 ± 44.34 months and IIEF-5 score was 6.38 ± 5.14. In general number of erections was 4 ± 3 with 23.4% of them had normal erection. The comparison between organic and psychogenic ED showed that the increment of circumference was significantly less in organic ED patients. Other parameters showed insignificant difference in statistical results. Conclusion: NPTR examination is an objective, effective, and easy-to-use measurement in order to differentiate between organic and psychogenic ED. One third of patients who complained with ED suffered from psychogenic ED and needed referral to other specialists.

Published
2018

8. Success Rate of Pregnancy after PESA/TESE and ICSI in Jakarta

Author

Ari Basukarno, Nur Rasyid, and Ponco Birowo

Subjects
Gynecology, Infertility, medicine.medical_specialty, Pregnancy, urogenital system, business.industry, Obstetrics, Obstructive azoospermia, medicine.disease, Sperm, Male infertility, Sperm injection, Primary infertility, Sperm Retrieval, medicine, business, reproductive and urinary physiology
Abstract

Male infertility is a major problem in infertility. It can be caused by obstructive azoospermia. Sperm retrieval surgery (SRS) is the best approach to gain the sperm used Intra Cystoplasmic Sperm Injection (ICSI). However, the success rate of pregnancy after SRS and ICSI in Cipto Mangunkusumo National Hospital has not yet been defined. There were 123 patients had SRS with most of them performed PESA. Sperm were found in more than 77% of patients with most of them directly performed ICSI. Only 40 patients could be contacted with average age of husband, wife, and duration of marriage were 40.3 + 8.2, 33.2 + 5.1, 7.6 + 4.6 years old respectively. Most of patients were suffered from primary infertility. The success rate of pregnancy is 72.5%, with success rate of birth is 30.0%. There are 2 patients waiting for delivery date. Sperm retrieval surgery such as PESA/TESE is the best approach to gain sperm in obstructive azoospermia patient. The success rate of pregnancy after PESA/TESE and ICSI is high with almost half of patients have succeed in giving birth.

Published
2016
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9. Cut-off Value of Testosterone and FSH Level In Patient With Azoospermia

Author

Nur Rasyid, Ponco Birowo, and Ari Basukarno

Subjects
Azoospermia, medicine.medical_specialty, education.field_of_study, business.industry, Cut off value, Population, Testosterone (patch), Abnormal spermatogenesis, medicine.disease, Endocrinology, Internal medicine, medicine, In patient, business, education, Spermatogenesis, Hormone
Abstract

Follicle-stimulating hormone(FSH) and Testosterone are important for spermatogenesis. Increased serum FSH and decreased testosterone are related to abnormal spermatogenesis. Azoospermia can be classified as obstructive and non-obstructive azoospermia. This study aims to discover cut-off value of Testosterone and FSH in predicting obstructive and non-obstructive azoospermia. From 1064 patients, 120 fulfilled inclusion and exclusion criteria. There were 66.7% in obstructive with 33.3% in non-obstructive group. No difference in terms of age (36,83 vs 36,62 y.o). Testosterone were 405.54 + 186.14 ng/dL vs 298.84 + 161.45 ng/dL (p=0.002) while FSH was 8,53 + 8,43 mIU/mL vs 20,12 + 11,89 mIU/mL (p+ 4.03 cc and 17.50 + 4.23 cc while in non-obstructive group are 12.97 + 5.18 cc and 13.37 + 5.31 cc for right and left testis respectively. FSH value above 10.36 mIU/mL has sensitivity 82.1% and specificity 79.5% for predicting non-obstructive azoospermia. Unfortunately, Testosterone could not be used in predicting azoospermia classification. Obstructive and non-obstructive azoospermia could be predicted using FSH but not testosterone serum level. Higher testosterone population should be used for further study.

Published
2016
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