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Siegal AR, Ferrer FA, Herndon CDA, Wallis MC, Schaeffer AJ, Malhotra NR. Inter-disciplinary provider development of an online, interactive adolescent varicocele decision aid prototype. Andrology 2024; 12:429-436. [PMID: 37417400 PMCID: PMC10771535 DOI: 10.1111/andr.13491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 06/05/2023] [Accepted: 07/02/2023] [Indexed: 07/08/2023]
Abstract
BACKGROUND Decision-making regarding varicocele management can be a complex process for patients and families. However, to date, no studies have presented ways to mitigate the decisional conflict surrounding varicoceles. OBJECTIVE To facilitate a discussion among physicians in order to develop a framework of the decision-making process regarding adolescent varicocele management, which will inform the development of the first online, interactive decision aid. MATERIALS AND METHODS Semi-structured interviews with pediatric urologists and interventional radiologists were conducted to discuss their rationale for varicocele decision-making. Interviews were audio recorded, transcribed, and coded. Key themes were identified, grouped, and then qualitatively analyzed using thematic analysis. Utilizing the common themes identified and the Ottawa Decision Support Framework, a decision aid prototype was developed and transformed into a user-friendly website: varicoceledecisionaid.com. RESULTS Pediatric urologists (n = 10) and interventional radiologists (n = 2) were interviewed. Key themes identified included: (1) definition/epidemiology; (2) observation as an appropriate management choice; (3) reasons to recommend repair; (4) types of repair; (5) reasons to recommend one repair over another; (6) shared decision-making; and (7) appropriate counseling. With this insight, a varicocele decision aid prototype was developed that engages patients and parents in the decision-making process. DISCUSSION AND CONCLUSIONS This is the first interactive and easily accessible varicocele decision aid prototype developed by inter-disciplinary physicians for patients. This tool aids in decision-making surrounding varicocele surgery. It can be used before or after consultation to help families understand more about varicoceles and their repair, and why intervention may or may not be offered. It also considers a patient and family's personal values. Future studies will incorporate the patient and family perspective into the decision-making aid as well as implement and test the usability of this decision aid prototype in practice and in the wider urologic community.
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Affiliation(s)
- Alexandra R Siegal
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Fernando A Ferrer
- Department of Pediatric Urology, Mount Sinai Kravis Children's Hospital, New York, New York, USA
| | - C D Anthony Herndon
- Division of Urology, Children's Hospital of Richmond at Virginia Commonwealth University, Richmond, Virginia, USA
| | - M Chad Wallis
- Division of Pediatric Urology, Intermountain Primary Children at the University of Utah, Salt Lake City, Utah, USA
| | - Anthony J Schaeffer
- Division of Pediatric Urology, Intermountain Primary Children at the University of Utah, Salt Lake City, Utah, USA
| | - Neha R Malhotra
- Department of Pediatric Urology, Mount Sinai Kravis Children's Hospital, New York, New York, USA
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Itani M, Kipper B, Corwin MT, Burgan CM, Fetzer DT, Shenoy-Bhangle AS, Althubaity A, Loehfelm TW, Middleton WD, Fananapazir G. Right-sided scrotal varicocele and its association with malignancy: a multi-institutional study. Abdom Radiol (NY) 2021; 46:2140-2145. [PMID: 33151361 DOI: 10.1007/s00261-020-02840-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 10/15/2020] [Accepted: 10/20/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE To determine the prevalence of isolated right-sided varicocele due to an obstructing malignancy in patients with no other evidence of malignancy. METHODS This retrospective, multi-institutional study included a text search for right-sided varicocele in consecutive reports of scrotal ultrasound studies performed between 4/22/1999 and 06/24/2018. Diagnosis was confirmed by a radiologist based on the following criteria: pampiniform plexus vein diameter of ≥ 2 mm, which has augmented flow or increases by ≥ 1 mm on Valsalva. Inclusion criteria for adequate follow-up were (1) abdominopelvic CT or MRI performed within 3 months prior to, or any time after, the ultrasound study; or (2) presence of clinical documentation more than 2 years after the ultrasound date. Exclusion criteria were existing cancer diagnosis in the abdomen or pelvis, epididymo-orchitis, intratesticular or intrascrotal mass, and prior scrotal surgery. Images of available CT or MRI studies were reviewed for presence of any explanation of right-sided varicocele. RESULTS 210 patients with right-sided varicocele met inclusion and exclusion criteria. 118/210 had abdominopelvic CT or MRI in the assigned timeframe. Of these, no patients had malignancy that could account for right-sided varicoceles. Of the 92/210 patients without CT or MRI but with available clinical follow-up, none had a malignancy that could have caused an isolated right-sided varicocele. There was no underlying malignancy to explain the right-sided varicocele in any of the patients, 0/210, 95% CI [0.0-1.4%]. CONCLUSION No associated malignancy was found in patients with isolated right-sided varicoceles to support additional imaging for malignancy screening.
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Affiliation(s)
- Malak Itani
- Mallinckrodt Institute of Radiology, Washington University in St. Louis, St. Louis, MO, USA
| | - Benjamin Kipper
- Department of Radiology, University of California Davis Medical Center, Sacramento, CA, USA
| | - Michael T Corwin
- Department of Radiology, University of California Davis Medical Center, Sacramento, CA, USA
| | | | - David T Fetzer
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | | | - Afnan Althubaity
- Department of Radiology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Thomas W Loehfelm
- Department of Radiology, University of California Davis Medical Center, Sacramento, CA, USA
| | - William D Middleton
- Mallinckrodt Institute of Radiology, Washington University in St. Louis, St. Louis, MO, USA
| | - Ghaneh Fananapazir
- Department of Radiology, University of California Davis Medical Center, Sacramento, CA, USA.
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Mittal PK, Little B, Harri PA, Miller FH, Alexander LF, Kalb B, Camacho JC, Master V, Hartman M, Moreno CC. Role of Imaging in the Evaluation of Male Infertility. Radiographics 2017; 37:837-854. [DOI: 10.1148/rg.2017160125] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
Affiliation(s)
- Pardeep K. Mittal
- From the Department of Radiology and Imaging Sciences (P.K.M., B.L., P.A.H., L.F.A., J.C.C., C.C.M.) and Department of Urology (V.M.), Emory University School of Medicine, 1364 Clifton Rd NE, Atlanta, GA 30322; Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (F.H.M.); Department of Medical Imaging, University of Arizona School of Medicine, Tucson, Ariz (B.K.); and Department of Radiology, West Penn Allegheny Health System, Pittsburgh, Pa (M.H.)
| | - Brent Little
- From the Department of Radiology and Imaging Sciences (P.K.M., B.L., P.A.H., L.F.A., J.C.C., C.C.M.) and Department of Urology (V.M.), Emory University School of Medicine, 1364 Clifton Rd NE, Atlanta, GA 30322; Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (F.H.M.); Department of Medical Imaging, University of Arizona School of Medicine, Tucson, Ariz (B.K.); and Department of Radiology, West Penn Allegheny Health System, Pittsburgh, Pa (M.H.)
| | - Peter A. Harri
- From the Department of Radiology and Imaging Sciences (P.K.M., B.L., P.A.H., L.F.A., J.C.C., C.C.M.) and Department of Urology (V.M.), Emory University School of Medicine, 1364 Clifton Rd NE, Atlanta, GA 30322; Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (F.H.M.); Department of Medical Imaging, University of Arizona School of Medicine, Tucson, Ariz (B.K.); and Department of Radiology, West Penn Allegheny Health System, Pittsburgh, Pa (M.H.)
| | - Frank H. Miller
- From the Department of Radiology and Imaging Sciences (P.K.M., B.L., P.A.H., L.F.A., J.C.C., C.C.M.) and Department of Urology (V.M.), Emory University School of Medicine, 1364 Clifton Rd NE, Atlanta, GA 30322; Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (F.H.M.); Department of Medical Imaging, University of Arizona School of Medicine, Tucson, Ariz (B.K.); and Department of Radiology, West Penn Allegheny Health System, Pittsburgh, Pa (M.H.)
| | - Lauren F. Alexander
- From the Department of Radiology and Imaging Sciences (P.K.M., B.L., P.A.H., L.F.A., J.C.C., C.C.M.) and Department of Urology (V.M.), Emory University School of Medicine, 1364 Clifton Rd NE, Atlanta, GA 30322; Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (F.H.M.); Department of Medical Imaging, University of Arizona School of Medicine, Tucson, Ariz (B.K.); and Department of Radiology, West Penn Allegheny Health System, Pittsburgh, Pa (M.H.)
| | - Bobby Kalb
- From the Department of Radiology and Imaging Sciences (P.K.M., B.L., P.A.H., L.F.A., J.C.C., C.C.M.) and Department of Urology (V.M.), Emory University School of Medicine, 1364 Clifton Rd NE, Atlanta, GA 30322; Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (F.H.M.); Department of Medical Imaging, University of Arizona School of Medicine, Tucson, Ariz (B.K.); and Department of Radiology, West Penn Allegheny Health System, Pittsburgh, Pa (M.H.)
| | - Juan C. Camacho
- From the Department of Radiology and Imaging Sciences (P.K.M., B.L., P.A.H., L.F.A., J.C.C., C.C.M.) and Department of Urology (V.M.), Emory University School of Medicine, 1364 Clifton Rd NE, Atlanta, GA 30322; Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (F.H.M.); Department of Medical Imaging, University of Arizona School of Medicine, Tucson, Ariz (B.K.); and Department of Radiology, West Penn Allegheny Health System, Pittsburgh, Pa (M.H.)
| | - Viraj Master
- From the Department of Radiology and Imaging Sciences (P.K.M., B.L., P.A.H., L.F.A., J.C.C., C.C.M.) and Department of Urology (V.M.), Emory University School of Medicine, 1364 Clifton Rd NE, Atlanta, GA 30322; Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (F.H.M.); Department of Medical Imaging, University of Arizona School of Medicine, Tucson, Ariz (B.K.); and Department of Radiology, West Penn Allegheny Health System, Pittsburgh, Pa (M.H.)
| | - Matthew Hartman
- From the Department of Radiology and Imaging Sciences (P.K.M., B.L., P.A.H., L.F.A., J.C.C., C.C.M.) and Department of Urology (V.M.), Emory University School of Medicine, 1364 Clifton Rd NE, Atlanta, GA 30322; Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (F.H.M.); Department of Medical Imaging, University of Arizona School of Medicine, Tucson, Ariz (B.K.); and Department of Radiology, West Penn Allegheny Health System, Pittsburgh, Pa (M.H.)
| | - Courtney C. Moreno
- From the Department of Radiology and Imaging Sciences (P.K.M., B.L., P.A.H., L.F.A., J.C.C., C.C.M.) and Department of Urology (V.M.), Emory University School of Medicine, 1364 Clifton Rd NE, Atlanta, GA 30322; Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (F.H.M.); Department of Medical Imaging, University of Arizona School of Medicine, Tucson, Ariz (B.K.); and Department of Radiology, West Penn Allegheny Health System, Pittsburgh, Pa (M.H.)
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