Journal Article Ppublish 6 citations
PubMed: 38606867 DOI: 10.5534/wjmh.230339
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.
World J Mens Health 43(1):92-122
Authors: 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 … and 214 other authors
Affiliations
- Department of Urology, Henry Ford Health System, Vattikuti Urology Institute, Detroit, MI, USA.
- Division of Andrology, Department of Urology, Lilavati Hospital and Research Centre, Mumbai, India.
- Department of Urology, College of Medicine and Pharmacy, Ibn Zohr University, Agadir, Morocco.
- Department of Urology, Topiwala National Medical College, B.Y.L Nair Charitable Hospital, Mumbai, India.
- Department of Endocrinology, Polytechnic University of Marche, Ancona, Italy.
- Department of Urology, Selçuk University School of Medicine, Konya, Turkey.
- Department of Urology, King Abdulaziz University, Jeddah, Saudi Arabia.
- Department of Urology, Faculty of Medicine, Minia University, Minia, Egypt.
- Department of Reproductive Urology, Austin Fertility & Reproductive Medicine/Westlake IVF, Austin, TX, USA.
- Department of Urology, Dr. Cipto Mangunkusumo Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia.
- Department of Urology, Fatih Sultan Mehmet Training and Research Hospital, University of Health Sciences, Istanbul, Turkey.
- Department of Urology, Loma Linda University Health, Loma Linda, CA, USA.
- Department of Urology, Hamad Medical Corporation, Doha, Qatar.
- Department of Andrology, Sexology and STIs, Faculty of Medicine, Cairo University, Cairo, Egypt.
- Department of Urology, Weill Cornell Medical-Qatar, Doha, Qatar.
- Urology Institute, University Hospitals, Case Western Reserve University, Cleveland, OH, USA.
- Andrology Unit, Department of Urology, Apollo Hospitals, Chennai, India.
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy.
- Department of Urology, University Hospital Innsbruck, Innsbruck, Austria.
- Department of Urology, Princess Alexandra Hospital, University of Queensland, Brisbane, Australia.
- Department of Urology, Mansoura University Urology and Nephrology Center, Mansoura, Egypt.
- Department of Surgery, Urology Unit, Farwaniya Hospital, Farwaniya, Kuwait.
- Department of Urology, Sabah Al Ahmad Urology Center, Kuwait City, Kuwait.
- Section of Urology, Department of Surgery, University of Santo Tomas Hospital, Manila, Philippines.
- Department of Andrology, Binh Dan Hospital, Ho Chi Minh City, Vietnam.
- Division of Urology, Southern Illinois University School of Medicine, Springfield, IL, USA.
- Department of Dermatology, Venereology and Andrology, Faculty of Medicine, Sohag University, Sohag, Egypt.
- Andrology and IVF Center, Next Fertility Procrea, Lugano, Switzerland.
- Andrology and Reproductive Medicine Unit, Next Fertility GynePro, Bologna, Italy.
- Department of Urology, Pusan National University School of Medicine, Busan, Korea.
- Medical Research Institute of Pusan National University Hospital, Busan, Korea.
- Department of Urology, Graduate School of Medicine, Osaka University, Osaka, Japan.
- Department of Urology, Juntendo University Urayasu Hospital, Chiba, Japan.
- Department of Urology, University Hospital of Rostock, Rostock, Germany.
- Reproductive Medicine Unit, ANDROS Day Surgery Clinic, Palermo, Italy.
- Department of Surgery, Union Hospital Reproductive Medicine Centre (Tsim Sha Tsui), Kowloon, China.
- Department of Urology, American Hospital of Paris, Paris, France.
- Department of Obstetrics Gynecology and Reproductive Medicine, Fertility Care Center in Cairo, Cairo, Egypt.
- Department of Urology, College of Medicine and Life Sciences, University of Toledo, Toledo, OH, USA.
- Department of Urology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia.
- Department of Urology and Organ Transplantation, University of Foggia, Foggia, Italy.
- Department of Urology, Burjeel Hospital, Abu Dhabi, UAE.
- Department of Urology, Khalifa University College of Medicine and Health Science, Abu Dhabi, UAE.
- Department of Urology, Faculty of Medicine, Suez Canal University, Ismailia, Egypt.
- 45Department of Urology, Faculty of Medicine, Ondokuz Mayis University, Samsun, Turkey.
- 1st Urology Department, Aristotle University of Thessaloniki, Thessaloniki, Greece.
- Department of Urology, Molinette Hospital, A.O.U. Città della Salute e della Scienza, University of Turin, Torino, Italy.
- Department for Transfusion Medicine and Transplantation Biology, Reproductive Tissue Bank, University Hospital Zagreb, University of Zagreb School of Medicine, Zagreb, Croatia.
- Department of Urology, Ege University Medical School, Bornova, Turkey.
- Department of Surgery, Discipline of Urology, Fleury Group and Hospital Israelita Albert Einstein, São Paulo, Brazil.
- Department of Andrology, International Urology, Fertility and Gynecology Centre, Mount Elizabeth Hospital, Singapore.
- Department of Urology, Korea University Guro Hospital, Seoul, Korea.
- Department of Gynaecology-Andrology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium.
- V.I. Kulakov National Medical Research Center of Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia, Moscow, Russia.
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 <10% of men with Klinefelter syndrome and 41.3% routinely recommended preimplantation genetic testing. Varicocele repair prior to SSR is recommended by 57.7%. Half of the respondents (57.4%) reported using ultrasound to identify the most vascularized areas in the testis for SSR. One-third proceed directly to microdissection testicular sperm extraction (mTESE) in every case of NOA while others use a staged approach. After a failed conventional TESE, 23.8% wait for 3 months, while 33.1% wait for 6 months before proceeding to mTESE. The cut-off of follicle-stimulating hormone for positive SSR was reported to be 12-19 IU/mL by 22.5% of participants and 20-40 IU/mL by 27.8%, while 31.8% reported no upper limit.
CONCLUSIONS
This is the largest survey to date on the real-world medical and surgical management of NOA by reproductive experts. It demonstrates a diverse practice pattern and highlights the need for evidence-based international consensus guidelines.
MeSH
Hypogonadism, Azoospermia, Therapeutics, Spermatozoa
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