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: 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: 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: 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.

Purpose Sperm DNA fragmentation (SDF) has been associated with male infertility and poor outcomes of assisted reproductive technology (ART). The purpose of this study was to investigate global practices related to the management of elevated SDF in infertile men, summarize the relevant professional society recommendations, and provide expert recommendations for managing this condition. Materials and Methods An online global survey on clinical practices related to SDF was disseminated to reproductive clinicians, according to the CHERRIES checklist criteria. Management protocols for various conditions associated with SDF were captured and compared to the relevant recommendations in professional society guidelines and the appropriate available evidence. Expert recommendations and consensus on the management of infertile men with elevated SDF were then formulated and adapted using the Delphi method. Results A total of 436 experts from 55 different countries submitted responses. As an initial approach, 79.1% of reproductive experts recommend lifestyle modifications for infertile men with elevated SDF, and 76.9% prescribe empiric antioxidants. Regarding antioxidant duration, 39.3% recommend 4–6 months and 38.1% recommend 3 months. For men with unexplained or idiopathic infertility, and couples experiencing recurrent miscarriages associated with elevated SDF, most respondents refer to ART 6 months after failure of conservative and empiric medical management. Infertile men with clinical varicocele, normal conventional semen parameters, and elevated SDF are offered varicocele repair immediately after diagnosis by 31.4%, and after failure of antioxidants and conservative measures by 40.9%. Sperm selection techniques and testicular sperm extraction are also management options for couples undergoing ART. For most questions, heterogenous practices were demonstrated. Conclusions This paper presents the results of a large global survey on the management of infertile men with elevated SDF and reveals a lack of consensus among clinicians. Furthermore, it demonstrates the scarcity of professional society guidelines in this regard and attempts to highlight the relevant evidence. Expert recommendations are proposed to help guide clinicians.

Background The aim of this study is to investigate the impact of robotic‐assisted radical prostatectomy (RARP) on the health‐related quality of life (HRQOL). Methods We prospectively reviewed HRQOL parameters using Short‐Form Health Survey, patient self‐reporting of urinary incontinence and International Index of Erectile Function, among patients who underwent RARP between 2010 and 2016. Results Among 249 men studied, all had significantly worse HRQOL domain scores at 1 month post operatively but 24 months after surgery, all domains reached or surpassed their baseline values. Only Bodily Pain, General Health, Role‐Emotional, Mental Health domains, and Mental Health Composite were significantly improved. Improvement in urinary continence was mirrored by improvements in both Mental and Physical Component Scores. Conclusions Within a 2‐year post‐operative period, men who underwent RARP had regained their overall quality of life. The recovery of urinary continence significantly impacted the mental, physical, emotional, and social well‐being of those patients.

Objective The Coronavirus Disease 2019 (Covid‐19) pandemic affected surgical training in many ways. This observational study was carried out to evaluate the impact of Covid‐19 on urological residencies across Asia. Methodology An open‐ended survey questionnaire examining key areas in a urology training program was distributed to several urologists in Asia. The survey evaluated seven areas including the burden of Covid‐19 disease, the need for re‐deployment of residents, the impact on clinical work, the effect on research work for residents, the delivery of teaching to the residents, the impact on training and assessments, the effects on mental, personal health and social welfare of residents. Results Reports from 11 Asian countries were analysed. There is stark variability in Covid‐19 disease burden across Asia. Re‐deployment occurred in selected Asian countries. Affected residents reported challenges obtaining personal protective equipment and training. Clinical workload and research were generally reduced except for countries reporting low volume Covid‐19 cases. Residents teaching evolved from in‐person to online platforms. Almost all residency program postponed their examinations. Mental health disturbance was more pronounced than personal health. Conclusions The Covid‐19 pandemic presented multiple obstacles to Asian urology residencies. The understanding of these challenges will assist program directors in developing mitigating measures.

No abstract