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Reversão de vasectomia

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Reversão de vasectomia

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Reversão de vasectomia

  1. 1. REVERSÃO DE VASECTOMIA<br />Rodrigo L. Pagani<br />
  2. 2. REVERSÃO DE VASECTOMIA<br /><ul><li>Preditores de sucesso no pré-operatório
  3. 3. Intervalo de obstrução
  4. 4. Fertilidadeprévia
  5. 5. Reversão de vasectomiaprévia
  6. 6. Mesmaparceira
  7. 7. Idadedaparceira</li></li></ul><li>INTERVALO DE OBSTRUÇÃOBelkeretal, J. Urol 1991<br />
  8. 8. INTERVALO DE OBSTRUÇÃOKolettisetal, Urology, 2002.<br />
  9. 9. FERTILIDADE PRÉVIA<br /><ul><li>Existe diferença estatisticamente significante quando a parceira atual possui história prévia de fertilidade.
  10. 10. 57% com fertilidade prévia;
  11. 11. 49% sem fertilidade prévia.</li></ul>(Belkeretal, J Urol, 1991)<br />
  12. 12. REVERSÃO DE VASECTOMIA PRÉVIABelkeretal, J Urol, 1991.<br />
  13. 13. REVERSÃO DE VASECTOMIA PRÉVIA<br />Hernandez e Sabanegh, J Urol, 1999<br /><ul><li> 41 re-reversões
  14. 14. Taxa de patência – 79%
  15. 15. Taxa de gravidez – 31%</li></ul>Pasqualottoetal, J Urol, 1999<br /><ul><li> 18 re-VE
  16. 16. Taxa de patência – 66,7%</li></li></ul><li>MESMA PARCEIRABelkeretal, J Urol, 1991.<br />
  17. 17. IDADE DA PARCEIRAGERRARD ET AL, FERTIL STERIL, 2007.<br />
  18. 18. Reversão de VasectomiaApós 15 Anos de Obstrução e IdadedaEsposa<br />Fuchs et al, Fertil & Steril, 2002<br />AnosObst SPTZ + (%) Grav (%) Nasc (%)<br /> 15-19 89 49 39<br /> 20-25 78 33 31<br />IdadeesposaGrav (%) Nasc(%)<br /> < 30 64 45<br /> > 40 28 14<br /> < 36 54 31<br />> 36 48 24<br />
  19. 19. Reversão de VasectomiaApós 15 Anos de Obstrução e IdadedaEsposa<br />Comparação de reversão com MESA/ICSI<br />Taxa de GravTaxa de nasc<br />Reversão 43 (50/116) 36 %<br />MESA/ICSI 40 (338/970) 27 %<br />IdadedaesposaGrav(%) Nasc(%)<br />VV > 40 28 14<br />ICSI >40 15 9<br />
  20. 20. REVERSÃO DE VASECTOMIA<br /><ul><li>Preditores de sucesso no intra-operatório
  21. 21. Habilidademicrocirúrgica
  22. 22. Qualidade do fluido
  23. 23. Comprimento do coto do deferente testicular
  24. 24. Granuloma</li></li></ul><li>COMPARAÇÃO ENTRE TÉCNICAS<br />
  25. 25. REVERSÃO DE VASECTOMIA<br />
  26. 26.
  27. 27. REMANESCENTE DO COTO TESTICULAR<br /> Sperm Present<br /># men%<br />> 2.7 cm 30/32 94%<br />< 2.7 cm 3/20 15%<br />Witt M, Heron S, Lipshultz LI: J Urol 151:892, 1994.<br />
  28. 28. SPERM GRANULOMA<br />
  29. 29. GRANULOMA<br />
  30. 30. Incisição escrotal<br />
  31. 31. Aspectos Técnicos<br />Mobilização suficiente dos cotos<br />Thomas AJ, in Surgery for Male Infertility, 2006<br />
  32. 32. Aspectos Técnicos: Secção do Deferente<br />Thomas AJ, in Surgery for Male Infertility, 2006<br />
  33. 33. ASPECTOS TÉCNICOS<br />Thomas AJ, in Surgery for Male Infertility, 2006<br />
  34. 34. ASPECTOS TÉCNICOS: UM PLANO<br />Thomas AJ, in Surgery for Male Infertility, 2006<br />
  35. 35.
  36. 36.
  37. 37. ASPECTOS TÉCNICOS: DOIS PLANOS<br />Thomas AJ, in Surgery for Male Infertility, 2006<br />
  38. 38.
  39. 39.
  40. 40. VASOVASOANASTOMOSE: RESULTADOS DE ANASTOMOSE EM DUAS CAMADAS VS. UMA CAMADA<br />
  41. 41. Reversão de vasectomiana era da ICSI<br />Custopornascimento<br /> Autores RV ICSI<br />Pavlovich & Schlegel U$ 25,475 U$ 72,521<br />Kolettis & Thomas U$ 31,099 U$ 51,024<br />Donavan et al. U$ 14,892 U$ 35,570<br />RV:Reversão de vasectomiainclui VV e/ou VE com microcirurgia<br />ICSI: Obtençãode espermatozóides + FIV/ICSI <br />Pavlovich C P, Schlegel P N., Fertil. Steril., v(67), 1997<br />Kolettis P N., Thomas A J., J. Urol., v(158), 1997<br />Donavan J F J., et al., Hum. Reprod., v(13), 1998<br />

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