Barriers to use of semen analysis in the adolescent with a varicocele: Survey of patient, parental, and practitioner attitudes
| Autor: | Jordan Gitlin, Edward F. Reda, Lane S. Palmer, Ronnie G. Fine |
|---|---|
| Rok vydání: | 2015 |
| Předmět: |
Adult
Male Parents medicine.medical_specialty Adolescent Attitude of Health Personnel Urology media_common.quotation_subject Varicocele Population 030232 urology & nephrology Reproductive medicine Fertility Male infertility 03 medical and health sciences Young Adult 0302 clinical medicine Surveys and Questionnaires medicine Humans Young adult education Infertility Male Multiple choice media_common Gynecology education.field_of_study Physician-Patient Relations business.industry medicine.disease Pediatric urology Semen Analysis 030220 oncology & carcinogenesis Family medicine Pediatrics Perinatology and Child Health Clinical Competence business |
| Zdroj: | Journal of pediatric urology. 12(1) |
| ISSN: | 1873-4898 |
| Popis: | Summary Background The American Society for Reproductive Medicine Practice Committee recommends obtaining a semen analysis (SA) in pediatric patients presenting with a varicocele in the absence of significant testicular atrophy. Among infertile adults with a varicocele, surgery is indicated in the presence of abnormal semen analysis regardless of testicular atrophy. Despite these two statements, semen analysis is not widely utilized by pediatric urologists in the USA managing a patient with a varicocele. Objective We explored the attitudes of patients, parents, and practitioners toward SA to identify potential barriers to the use of SA in the evaluation of the adolescent varicocele. Study design We conducted a survey of Society for Pediatric Urology members regarding their management of adolescent varicoceles, with focus on the utilization of SA. The survey consisted of 14 multiple choice questions and two open-ended questions regarding use of SA in practice, barriers to its use, indications for varicocelectomy, and demographics. We also surveyed patients presenting for initial evaluation of a varicocele, as well as their parents, regarding their knowledge about SA and their attitude towards obtaining it. Statistical analysis was performed ( p Results The practitioner survey response rate was 53% (168). Only 13.1% routinely incorporated SA in their practice, with 48% of all responders having some degree of discomfort asking for a SA. Of practitioners who cited discomfort, 90% never order a SA for patients with varicoceles. From the 46% of physicians who ordered a SA, we noted significant practice variability (see Figure). The patient/parent survey demonstrated that this population was uncomfortable with the notion of obtaining a SA, with most patients/parents citing lack of knowledge about SA as the main barrier. Patient and parent knowledge was found to correlate. Discussion This study uniquely addresses an issue that has not been discussed in the adolescent varicocele literature to date. It can increase awareness of the option of incorporating SA data in management of the adolescent who presents with a varicocele. Conclusion Recognizing and then breaking through the barriers to obtaining a SA, would improve patient care, providing a direct assessment of the impact of a varicocele on fertility potential and thus best determining which patients require surveillance versus surgical intervention. This study suggested that the barriers to SA are surmountable. |
| Databáze: | OpenAIRE |
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