RESUMO
OBJECTIVE: To evaluate the impact of systematic use of intraoperative Doppler ultrasound during microsurgical subinguinal varicocele repair. DESIGN: Prospective clinical study. SETTING: Andrology laboratory and male infertility section of the urology department of a tertiary care hospital. PATIENT(S): Two hundred and thirteen men with clinical varicocele. INTERVENTION(S): Subinguinal microsurgical varicocele ligation using an intraoperative vascular Doppler flow detector. MAIN OUTCOME MEASURE(S): Number of veins ligated, lymphatic spared, arteries identified or accidentally ligated. RESULT(S): A statistically significant greater number of arteries were identified and preserved when intraoperative vascular Doppler was used. In addition, the average number of internal spermatic veins ligated was statistically significantly greater in the same group. Accidental artery ligation occurred in two cases (1.1%) in which the Doppler was not applied. There was no statistically significant difference in number of lymphatics spared between groups. CONCLUSION(S): Our findings showed that concomitant use of intraoperative vascular Doppler during microsurgical varicocelectomy allows more arterial branches to be preserved, and more internal spermatic veins are likely to be ligated. This device should be considered an attractive tool to improve surgical outcomes and safety.
Assuntos
Microcirurgia/métodos , Testículo/irrigação sanguínea , Ultrassonografia Doppler/métodos , Procedimentos Cirúrgicos Urogenitais/métodos , Varicocele/cirurgia , Procedimentos Cirúrgicos Vasculares/métodos , Adulto , Humanos , Impotência Vasculogênica/prevenção & controle , Infertilidade Masculina/etiologia , Infertilidade Masculina/cirurgia , Canal Inguinal/cirurgia , Período Intraoperatório , Ligadura/métodos , Masculino , Monitorização Intraoperatória/instrumentação , Monitorização Intraoperatória/métodos , Complicações Pós-Operatórias/prevenção & controle , Testículo/cirurgia , Procedimentos Cirúrgicos Urogenitais/efeitos adversos , Varicocele/complicações , Varicocele/reabilitação , Procedimentos Cirúrgicos Vasculares/efeitos adversos , Adulto JovemRESUMO
El varicocele, cuadro clínico frecuentemente visto, es la causa corregible más común de infertilidad;sin embargo, a pesar de múltiples estudios aún existen muchas preguntas sin respuesta y mucho de hipóteticoen los conceptos respecto a la entidad. En el presemte artículo se revisan los diferentes criterios existentes sobre el varicocele: las posibles hipótesis etiológicas, la clínica, las ayudas diagnósticas, el tratamiento principalmente quirúrgico, y por último, se plantean las posibles teorías que causan su estrecha relación con la infertilidad. Se pretende que al aumentar el conocimiento sobre el varicocele se le otorgue mayor importancia y se logre prevenir sus complicaciones y secuelas, principalmente la infertilidad