Varicocele Repair - Principals and Microsurgical Technique
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Transcript of Varicocele Repair - Principals and Microsurgical Technique
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Va r i c o c e l eP r i n c í p i o s e c i r u r g i a c o m e n t a d a
G u i l h e r m e L e m e
w w w . d r g u i l h e r m e l e m e . c o m . b rg u i l h e r m e @ d r g u i l h e r m e l e m e . c o m . b r
Especialista em Cirurgia Geral e Urologia/Andrologia – HC-FMUSPEspecialista em Reprodução Assistida – Setor Integrado de Reprodução Humana – EPM-UNIFESP
Membro Titular da Sociedade Brasileira de Urologia [TiSBU]Médico Andrologista – Engravida Reprodução Humana
Médico Urologista – Clínica Vivere Sanus – Saúde Masculina Integral
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Varicocele
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Varicocele varizes escrotais “dilatação veias p. pampiniforme” 15% dos homens 40% homens inférteis 75% das causas
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Varicocele
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Varicocele
ESQ >>> dir calor refluxo
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Calor ROS Apoptose epitélio germinativo Cells imaturas Peroxidação lipídica
Agarwal, Esteves, 2012. Nature Reviews Urology
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Varicocele - diagnosticando
exame físico!! US doppler não substitui
EF difícil Quantificação - seguimento
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Varicocele - diagnosticando
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Varicocele e Ultra-Som
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Varicocele e Ultra-Som
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Varicocele e Ultra-Som
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Varicocele e Ultra-Som
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Varicocele infertilidade varicocele palpável alteração na qualidade do sêmen
Aumentar sucesso em FIV (45% 60%) opção em falhas de FIV
Quando operamos?
Adolescentes devem ser operados? sinais de redução do volume do testículo
ASRM, 2014
ASRM, 2008
Esteves, Oliveira, Bertolla. JUrol, 2010
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atenção às falhas de FIV aumenta GESTAÇÃO CLÍNICA E NASCIDOS VIVOS
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Exposição e mobilização do cordão
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Abertura cremaster
Exposição fascia espermática externa
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Abertura fascia espermática interna
Abertura fascia espermática externa
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Preservação artéria
Preservação linfático
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Doppler intra-op
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Dissecção plexo venoso
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Tratamento do plexo
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Aspecto final e síntese do cremaster
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