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