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[PMID]:28911932
[Au] Autor:Samplaski MK; Lo KC; Grober ED; Zini A; Jarvi KA
[Ad] Endereço:Institute of Urology, University of Southern California, Los Angeles, California. Electronic address: mary.samplaski@med.usc.edu.
[Ti] Título:Varicocelectomy to "upgrade" semen quality to allow couples to use less invasive forms of assisted reproductive technology.
[So] Source:Fertil Steril;108(4):609-612, 2017 Oct.
[Is] ISSN:1556-5653
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: To determine the magnitude of improvement in semen parameters after a varicocelectomy and the fraction that have improvements such that couples needing IVF or IUI are "upgraded" to needing less invasive assisted reproductive technology (ART). DESIGN: Retrospective review of prospectively collected data. SETTING: Academic medical centers. PATIENT(S): Men presenting for a fertility evaluation with a clinical varicocele. INTERVENTION(S): Varicocele repair (surgical or embolization). MAIN OUTCOME MEASURE(S): Total motile sperm count (TMSC) before and after repair, and the proportion of men considered candidates for: natural pregnancy (NP) >9 million, IUI 5-9 million, or IVF < 5 million. RESULT(S): A total of 373 men underwent varicocele repair. The TMSC increased from 18.22 ± 38.32 to 46.72 ± 210.92 (P=.007). The most pronounced increase was with baseline TMSC <5 million, from 2.32 ± 1.50 to 15.97 ± 32.92 (P=.0000002); 58.8% of men were upgraded from IVF candidacy to IUI or NP. For baseline TMSC 5-9 million, the mean TMSC increased from 6.96 ± 1.16 to 24.29 ± 37.17 (P=.0004), allowing 64.9% of men to become candidates for NP. For baseline TMSC of >9 million, TMSC increased from 36.26 ± 52.08 to 81.80 ± 310.83 (P=.05). CONCLUSION(S): Varicocele repair has an important role in the treatment of infertility. Even for low TMSCs, a varicocelectomy may reduce the need for IVF. Varicocele repair (by embolization or microsurgery) potentially reduces the need for IVF and IUI.
[Mh] Termos MeSH primário: Infertilidade Masculina/cirurgia
Técnicas de Reprodução Assistida
Análise do Sêmen
Procedimentos Cirúrgicos Urogenitais/métodos
Varicocele/cirurgia
[Mh] Termos MeSH secundário: Adulto
Características da Família
Feminino
Seres Humanos
Infertilidade Masculina/epidemiologia
Infertilidade Masculina/etiologia
Masculino
Microcirurgia/métodos
Meia-Idade
Gravidez
Taxa de Gravidez
Estudos Retrospectivos
Contagem de Espermatozoides
Varicocele/complicações
Varicocele/epidemiologia
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171013
[Lr] Data última revisão:
171013
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170916
[St] Status:MEDLINE


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[PMID]:28865536
[Au] Autor:Kohn TP; Kohn JR; Pastuszak AW
[Ad] Endereço:Baylor College of Medicine, Houston, Texas.
[Ti] Título:Varicocelectomy before assisted reproductive technology: are outcomes improved?
[So] Source:Fertil Steril;108(3):385-391, 2017 Sep.
[Is] ISSN:1556-5653
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Clinical varicoceles have been associated with impaired semen parameters and male-factor infertility. Varicocele repair can improve live birth rates for men with clinical varicocele. Varicocelectomy is often combined with assisted reproductive techniques (ART) such as intrauterine insemination (IUI), in vitro fertilization (IVF), or intracytoplasmic sperm injection (ICSI). Here we review the literature examining varicocelectomy before ART to evaluate whether improved pregnancy outcomes are realized. Although insufficient evidence exists to determine if correcting a varicocele improves IUI outcomes, a clinical benefit is observed when correcting a clinical varicocele in oligospermic and nonobstructed azoospermic men before IVF/ICSI. In couples seeking fertility with the use of ART, varicocele repair may offer improvement in semen parameters and may decrease the level of ART needed to achieve successful pregnancy.
[Mh] Termos MeSH primário: Infertilidade Masculina/epidemiologia
Infertilidade Masculina/terapia
Resultado da Gravidez/epidemiologia
Injeções de Esperma Intracitoplásmicas/utilização
Varicocele/epidemiologia
Varicocele/cirurgia
[Mh] Termos MeSH secundário: Sítios de Ligação
Comorbidade
Medicina Baseada em Evidências
Feminino
Seres Humanos
Masculino
Gravidez
Prevalência
Melhoria de Qualidade
Técnicas de Reprodução Assistida
Fatores de Risco
Resultado do Tratamento
Procedimentos Cirúrgicos Urogenitais
[Pt] Tipo de publicação:JOURNAL ARTICLE; META-ANALYSIS; REVIEW
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170929
[Lr] Data última revisão:
170929
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170904
[St] Status:MEDLINE


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[PMID]:28865535
[Au] Autor:Johnson D; Sandlow J
[Ad] Endereço:Department of Urology, Medical College of Wisconsin, Milwaukee, Wisconsin.
[Ti] Título:Treatment of varicoceles: techniques and outcomes.
[So] Source:Fertil Steril;108(3):378-384, 2017 Sep.
[Is] ISSN:1556-5653
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Varicoceles, a dilation of veins within the pampiniform plexus, are present in ∼15% of the general male population. This paper reviews the indications for treatment of varicoceles, post-intervention outcomes following treatment, and the various techniques for treatment of varicoceles. The aim of this review is to describe and compare complications associated with each approach to varicocele treatment.
[Mh] Termos MeSH primário: Embolização Terapêutica/métodos
Infertilidade Masculina/prevenção & controle
Laparoscopia/métodos
Procedimentos Cirúrgicos Urogenitais/métodos
Varicocele/diagnóstico
Varicocele/terapia
Procedimentos Cirúrgicos Vasculares/métodos
[Mh] Termos MeSH secundário: Terapia Combinada/métodos
Medicina Baseada em Evidências
Seres Humanos
Infertilidade Masculina/diagnóstico
Infertilidade Masculina/etiologia
Masculino
Resultado do Tratamento
Varicocele/complicações
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170929
[Lr] Data última revisão:
170929
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170904
[St] Status:MEDLINE


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[PMID]:28865534
[Au] Autor:Clavijo RI; Carrasquillo R; Ramasamy R
[Ad] Endereço:Department of Urology, University of Miami Miller School of Medicine, Miami, Florida.
[Ti] Título:Varicoceles: prevalence and pathogenesis in adult men.
[So] Source:Fertil Steril;108(3):364-369, 2017 Sep.
[Is] ISSN:1556-5653
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Varicocele, or dilation of the pampiniform venous plexus, affects up to 15% of men. However, few of these men encounter problems with fertility. This discrepancy between men with varicocele and the number of adversely affected men has led to abundant research to identify the mechanisms for formation of varicocele as well as the pathologic mechanisms by which varicoceles affect fertility potential. In this review, we discuss the prevalence of varicocele in adults, the anatomic features of varicocele, the leading theories as to how varicocele can negatively affect fertility potential, and finally, the current literature on the impact of varicocele on testosterone production.
[Mh] Termos MeSH primário: Velocidade do Fluxo Sanguíneo
Infertilidade Masculina/epidemiologia
Infertilidade Masculina/fisiopatologia
Testículo/fisiopatologia
Varicocele/epidemiologia
Varicocele/fisiopatologia
[Mh] Termos MeSH secundário: Adulto
Causalidade
Comorbidade
Seres Humanos
Infertilidade Masculina/patologia
Masculino
Modelos Biológicos
Prevalência
Fatores de Risco
Testículo/irrigação sanguínea
Varicocele/patologia
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170929
[Lr] Data última revisão:
170929
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170904
[St] Status:MEDLINE


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[PMID]:28865533
[Au] Autor:Brannigan RE
[Ad] Endereço:Department of Urology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois. Electronic address: r-brannigan@northwestern.edu.
[Ti] Título:Introduction: Varicoceles: a contemporary perspective.
[So] Source:Fertil Steril;108(3):361-363, 2017 Sep.
[Is] ISSN:1556-5653
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:In this Views and Reviews section, four groups of authors address the timely and highly relevant issue of varicoceles across the male life spectrum. Varicoceles are very prevalent among men presenting for an infertility workup. While reduction in bulk semen parameters (including sperm concentration, motility, and morphology) has long been recognized as a deficit caused by varicoceles, in recent years a number of investigators have shown that varicoceles can have broader, multi-faceted effects on male reproductive health. Sperm DNA integrity and other aspects of sperm function appear to be impacted by the presence of varicoceles, and varicocele correction can result in significant improvement in not only semen parameters, but also fertilization and pregnancy rates.
[Mh] Termos MeSH primário: Embolização Terapêutica/métodos
Infertilidade Masculina/diagnóstico
Infertilidade Masculina/prevenção & controle
Varicocele/diagnóstico
Varicocele/terapia
Procedimentos Cirúrgicos Vasculares/métodos
[Mh] Termos MeSH secundário: Terapia Combinada/métodos
Medicina Baseada em Evidências
Seres Humanos
Infertilidade Masculina/etiologia
Masculino
Resultado do Tratamento
Procedimentos Cirúrgicos Urogenitais/métodos
Varicocele/complicações
[Pt] Tipo de publicação:INTRODUCTORY JOURNAL ARTICLE
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170929
[Lr] Data última revisão:
170929
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170904
[St] Status:MEDLINE


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[PMID]:28845931
[Au] Autor:Gamidov SI; Ovchinnikov RI; Popova AY; Avakyan AY; Sukhikh GT
[Ad] Endereço:Department of Andrology and Urology, V.I. Kulakov Research Center for Obstetrics, Gynecology and Perinatology of Minzdrav of Russia, Moscow, Russia.
[Ti] Título:[Adjuvant antioxidant therapy in varicocele infertility].
[So] Source:Urologiia;(2 (supplement)):64-72, 2017 Jun.
[Is] ISSN:1728-2985
[Cp] País de publicação:Russia (Federation)
[La] Idioma:rus
[Ab] Resumo:INTRODUCTION: Infertility affects an estimated 15% of couples globally. Male factor infertility accounts for about a half of infertility cases. About 40% of infertile men have varicocele. The aim of this study was to investigate the efficacy and safety of a complex of acetyl-L-carnitine, L-carnitine fumarate and alpha-lipoic acid (SpermActin-forte) (SA) for adjuvant antioxidant therapy after microsurgical varicocelectomy (MVE) in men with varicocele and assess its impact on the level of DNA fragmentation in sperm cells. MATERIALS AND METHODS: This is an open, prospective, randomized trial comprising 114 men aged 25-45 (mean 34.1+/-12.1) years who underwent MVE. The patients were allocated to receive either adjuvant SA (n=38), SA in combination with a vitamin complex (VC) (n=38) or no adjuvant therapy (n=38). The efficacy was assessed at 3 months by testing standard semen parameters and the level of sperm DNA fragmentation. RESULTS: MVE led to a 21.7% increase in the progressive sperm motility compared to the baseline level. In patients receiving SA, this was by 76.7% due to active sperm motility (category A) at 3 months. MVE with concurrent supplementation of SA resulted in a 22.3% decrease in the level of sperm DNA fragmentation at 3 months. When used in the postoperative period after MVE, SA and VC resulted in a 27% increase in the sperm concentration at 3 months. There were no side effects of pharmacotherapy. The statistical significance of the change in variables was calculated using the Wilcoxon test. Critical level =0.05 was established for all criteria. CONCLUSION: Using nutraceuticals (SA) after MVE is an effective and safe adjuvant antioxidant therapy of male infertility in patients with varicocele which leads to an improvement in the basic sperm parameters (sperm concentration and motility) and a decrease in the level of sperm DNA fragmentation in the short term. Adjuvant antioxidant therapy of varicocele infertility potentiates the effects of monotherapy (both medical and surgical), leads to an increase in its effectiveness and shortens the time to pregnancy. Further studies in this field are needed to assess long-term outcomes of the treatment.
[Mh] Termos MeSH primário: Antioxidantes/uso terapêutico
Infertilidade Masculina/terapia
Varicocele/cirurgia
[Mh] Termos MeSH secundário: Adulto
Terapia Combinada
Seres Humanos
Infertilidade Masculina/fisiopatologia
Masculino
Meia-Idade
Contagem de Espermatozoides
Motilidade Espermática
[Pt] Tipo de publicação:JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL
[Nm] Nome de substância:
0 (Antioxidants)
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171025
[Lr] Data última revisão:
171025
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170829
[St] Status:MEDLINE


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[PMID]:28834886
[Au] Autor:Wu X; Liu Q; Zhang R; Wang W; Gao Y
[Ad] Endereço:aAndrology Center bDepartment of Anorectal Surgery, People's Hospital of Ningxiang County, Hunan University of Traditional Chinese Medicine Affiliated Ningxiang People's Hospital, Changsha, Hunan, China.
[Ti] Título:Therapeutic efficacy and safety of laparoscopic surgery versus microsurgery for varicocele of adult males: A meta-analysis.
[So] Source:Medicine (Baltimore);96(34):e7818, 2017 Aug.
[Is] ISSN:1536-5964
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVES: This study aimed to systemically evaluate the efficacy and safety of laparoscopy versus microsurgery in the surgical therapy of varicocele in male adults. METHODS: Relevant literature, published between January 1995 and October 2012, were searched in Pubmed/Medline database, OVID, EMBASE, Chinese Biology Medicine disc (CBMdisc), CNKI, CEBM\CCD, and Cochrane database. The newly published papers were also manually searched. Randomized controlled trials (RCT) related to the surgical interventions of varicocele were included, and full texts were obtained. Each study was evaluated with the Cochrane Risk of Bias tool. Two investigators collected data independently to produce the meta-analysis. RESULTS: Five RCTs met the inclusion criteria and included 554 patients. Data were merged by the RevMan5.1 software. The sperm concentration increased significantly after surgery (WMD = 4.28; 95% CI = 4.16, 6.99; P < .00001, Z = 7.72). There was no significant difference in the postoperative hospital stay between laparoscopy and microsurgery (WMD = 0.24, 95% CI = 0.44, 0.93; P = .49, Z = 0.69). The operation time of laparoscopy was significantly shorter than that of microsurgery (WMD = 40.31, 95% CI = 37.77, 42.86; P < .00001, Z = 31.03). The incidence of hydrocele reduced significantly after microsurgery as compared to laparoscopy (WMD = 0.05, 95% CI = 0.01, 0.27; P = .0005, Z = 3.49). The postoperative recurrence rate after microsurgery was significantly lower than that after laparoscopy (WMD = 0.10, 95% CI = 0.04, 0.25; P < .00001, Z = 5.01). CONCLUSION: No significant differences were found between microsurgery and laparoscopy for the increase of sperm concentration and operation time. Compared to the laparoscopy group, the microsurgery group had lower postoperative incidence of hydrocele and recurrence rate, but longer in the operation time.
[Mh] Termos MeSH primário: Laparoscopia/métodos
Microcirurgia/métodos
Varicocele/cirurgia
[Mh] Termos MeSH secundário: Adulto
Seres Humanos
Laparoscopia/efeitos adversos
Tempo de Internação
Masculino
Microcirurgia/efeitos adversos
Duração da Cirurgia
Complicações Pós-Operatórias/epidemiologia
Ensaios Clínicos Controlados Aleatórios como Assunto
Recidiva
[Pt] Tipo de publicação:JOURNAL ARTICLE; META-ANALYSIS
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170912
[Lr] Data última revisão:
170912
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170824
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000007818


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[PMID]:28803635
[Au] Autor:Jacobson DL; Johnson EK
[Ad] Endereço:Division of Pediatric Urology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois; Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
[Ti] Título:Varicoceles in the pediatric and adolescent population: threat to future fertility?
[So] Source:Fertil Steril;108(3):370-377, 2017 Sep.
[Is] ISSN:1556-5653
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Determining the effect of varicoceles on future fertility is challenging owing to multiple issues in children/adolescents, including: limitations in obtaining and interpreting semen analyses; potential for unequal differential testicular growth during puberty regardless of varicocele presence; and the potential for a lengthy interval between surgical intervention for varicocele in adolescence and attempts at paternity. This review presents a summary and evaluation of the available evidence relating to future fertility among children and adolescents with varicoceles. Data relating to proxy fertility measures in children/adolescents, including testicular size asymmetry and semen analysis abnormalities, demonstrate that these proxy measures are imperfect predictors of future fertility. Two large, recently published series of adolescents undergoing varicocele treatment showed conflicting paternity outcomes. Pediatric and adolescent varicocele will remain a clinical conundrum, subject to both over- and under-treatment, until more definitive prospective data are available.
[Mh] Termos MeSH primário: Saúde do Adolescente/estatística & dados numéricos
Infertilidade Masculina/epidemiologia
Infertilidade Masculina/prevenção & controle
Varicocele/epidemiologia
Varicocele/terapia
[Mh] Termos MeSH secundário: Adolescente
Causalidade
Comorbidade
Medicina Baseada em Evidências
Seres Humanos
Incidência
Infertilidade Masculina/diagnóstico
Masculino
Fatores de Risco
Resultado do Tratamento
Varicocele/diagnóstico
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170929
[Lr] Data última revisão:
170929
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170815
[St] Status:MEDLINE


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[PMID]:28767606
[Au] Autor:Zhang Y; Ma T; Su Z; Ye M; Tian H; Li J; Liu J
[Ad] Endereço:aDepartment of Urology, the First Affiliated Hospital of Jinan University, Guangzhou bReproductive Medicine Center, Affiliated Hospital of Guangdong Medical University cLaboratory of Urology, Guangdong Medical University, Zhanjiang, China.
[Ti] Título:Varicoceles affect semen quality of infertile men in Southern China: A cross-sectional study of 5447 cases.
[So] Source:Medicine (Baltimore);96(31):e7707, 2017 Aug.
[Is] ISSN:1536-5964
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:The association of varicoceles with infertility is well established, but the exact effect of varicoceles on semen quality among patients with infertility is still poorly known. The study aimed to examine the prevalence of varicoceles among Chinese men with infertility and to examine the factors associated with semen quality.This was a cross-sectional study of 5447 male patients treated for infertility at the Affiliated Hospital of Guangdong Medical University from October 2012 to December 2015. The patients were divided on the basis of the presence of varicoceles. Examinations of the amount of semen and sperm morphology were performed according to seminal parameter detection methods recommended by the World Health Organization.Patients with varicoceles (n = 1429/5447, 26.2%) were slightly younger (P = .046), and had smaller testis (P = .019), higher frequency of abnormal epididymis (P < .001), slightly shorter infertility duration (P = .046), and lower frequency of smokers (P = .012). There was no difference in the distribution of occupations (P = .777). Using multiple linear regression analysis, varicoceles were shown to be independently associated with semen volume [B = -0.153, 95% confidence interval (95% CI): -0.245 to -0.062, P = .001], sperm concentration (B = 9.633, 95% CI: 7.152-12.114, P < .001), proportion of sperms with normal morphology (B = 0.951, 95% CI: 0.623-1.278, P < .001), motility (B = 3.835, 95% CI: 2.675, 4.995, P < .001), total sperm count (B = 22.481, 95% CI: 13.333-31.629, P < .001), and forward movement sperm count (B = 15.553, 95% CI: 9.777-21.329, P < .001). Varicoceles were present in 26% of Chinese male patients with infertility.Varicoceles were independently associated with sperm volume, sperm concentration, proportion of sperms with normal morphology, motility, total sperm count, and forward movement sperm count.
[Mh] Termos MeSH primário: Contagem de Espermatozoides
Motilidade Espermática
Varicocele/fisiopatologia
[Mh] Termos MeSH secundário: Fatores Etários
China
Estudos Transversais
Seres Humanos
Infertilidade Masculina/patologia
Infertilidade Masculina/fisiopatologia
Infertilidade Masculina/terapia
Modelos Lineares
Masculino
Ocupações
Varicocele/patologia
Varicocele/terapia
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1708
[Cu] Atualização por classe:171013
[Lr] Data última revisão:
171013
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170803
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000007707


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[PMID]:28727390
[Au] Autor:Cho CL; Ho KL; Chan WK; Chu RW; Law IC
[Ad] Endereço:Division of Urology, Department of Surgery, Kwong Wah Hospital, Hong Kong.
[Ti] Título:Use of indocyanine green angiography in microsurgical subinguinal varicocelectomy - lessons learned from our initial experience.
[So] Source:Int Braz J Urol;43(5):974-979, 2017 Sep-Oct.
[Is] ISSN:1677-6119
[Cp] País de publicação:Brazil
[La] Idioma:eng
[Ab] Resumo:Microsurgical subinguinal varicocelectomy (MSV) is generally considered the gold standard nowadays in view of the lower risk of complications and recurrence. To achieve complete ligation of veins while preserving testicular artery (TA) during the procedure remains challenging despite the application of high power optical magnification and micro-Doppler ultrasonography. The use of intraoperative indocyanine green angiography (ICGA) with infrared fluorescence operative micro-scope in MSV potentially lowers the incidence of TA injury and shortens the learning curve of nov-ice surgeons. We present our initial experience in the application of the technique in nine patients and explore the potential of the new adjunct.
[Mh] Termos MeSH primário: Angiografia/métodos
Verde de Indocianina/administração & dosagem
Canal Inguinal/cirurgia
Procedimentos Cirúrgicos Urogenitais/métodos
Varicocele/cirurgia
[Mh] Termos MeSH secundário: Seres Humanos
Canal Inguinal/diagnóstico por imagem
Período Intraoperatório
Masculino
Microscopia de Fluorescência
Microcirurgia
Índice de Gravidade de Doença
Varicocele/diagnóstico por imagem
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
IX6J1063HV (Indocyanine Green)
[Em] Mês de entrada:1711
[Cu] Atualização por classe:171117
[Lr] Data última revisão:
171117
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170721
[St] Status:MEDLINE
[do] DOI:10.1590/S1677-5538.IBJU.2017.0107



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