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Hipospádia

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Hipospádia

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Hipospádia

  1. 1. Hipospádia Rodrigo Pastor( R1 ) Residência de Urologia HC-UFG Goiânia, 22 de Março de 2011
  2. 2. Introdução <ul><li>Definição: </li></ul><ul><ul><li>Abertura ventral anormal </li></ul></ul><ul><ul><li>Curvatura ventral (chordee) </li></ul></ul><ul><ul><li>Excesso de prepúcio </li></ul></ul><ul><li>Dificuldade de micção </li></ul><ul><li>Problemas no desenvolvimento da sexualidade </li></ul>Campbell’s Urology – 9th Edition; vol. 4; p. 3703.
  3. 3. Embriologia Campbell’s Urology – 9th Edition; vol. 4; p. 3142.
  4. 4. Embriologia Campbell’s Urology – 9th Edition; vol. 4; p. 3143.
  5. 5. Epidemiologia <ul><li>A mais freqüente deformidade congênita da genitália masculina </li></ul><ul><li>5 : 1000 nascimentos </li></ul><ul><li>Aumento da incidência nos EUA, Noruega e Dinamarca </li></ul>Campbell’s Urology – 9th Edition; vol. 4; p. 3709.
  6. 6. Etiologia <ul><li>Incapacidade genética </li></ul><ul><li>Síntese de testosterona </li></ul><ul><li>Conversão da testosterona em diidrotestoterona pela 5-alfa-redutase </li></ul><ul><li>Sinalização epitélio-mesenquimal </li></ul><ul><li>Incapacidade do receptor hormonal </li></ul>Campbell’s Urology – 9th Edition; vol. 4; p. 3707.
  7. 7. Etiologia <ul><li>Incapacidade enzimática na biossíntese de testosterona </li></ul><ul><li>Fatores de risco maternos: </li></ul><ul><ul><li>Primiparidade </li></ul></ul><ul><ul><li>Idade avançada </li></ul></ul><ul><li>Fatores de risco paternos: </li></ul><ul><ul><li>Anormalidade escrotal e testicular </li></ul></ul><ul><ul><li>Astenospermia, teratozzospermia </li></ul></ul>Campbell’s Urology – 9th Edition; vol. 4; p. 3708.
  8. 8. Anomalias associadas <ul><li>Criptorquidia (+ comum em hipospádias posteriores) </li></ul><ul><li>Hérnia inguinal </li></ul><ul><li>Hidrocele </li></ul><ul><li>Condições intersexo </li></ul><ul><li>Hipospádia posterior -> Pesquisar condições intersexo </li></ul>Campbell’s Urology – 9th Edition; vol. 4; p. 3709.
  9. 9. Diagnóstico Campbell’s Urology – 9th Edition; vol. 4; p. 3704.
  10. 10. Classificação 50% 30% 20% Campbell’s Urology – 9th Edition; vol. 4; p. 3705.
  11. 11. Tratamento <ul><li>Aspectos avaliados para a cirurgia: </li></ul><ul><ul><li>Idade entre 6 e 12 meses </li></ul></ul><ul><ul><li>Classificação da hipospádia </li></ul></ul><ul><ul><li>Curvatura peniana </li></ul></ul><ul><ul><li>Presença de tecido viável </li></ul></ul>Campbell’s Urology – 9th Edition; vol. 4; p. 3718.
  12. 12. Tratamento <ul><li>Hipospádia distal: </li></ul><ul><ul><li>Técnicas de avanço uretral </li></ul></ul><ul><ul><li>Técnicas de tubulização </li></ul></ul><ul><li>Hipospádia média: </li></ul><ul><ul><li>Técnicas de tubulização </li></ul></ul><ul><li>Hipospádia proximal: </li></ul><ul><ul><li>Técnicas de tubulização </li></ul></ul><ul><ul><li>Técnica de reparo com tecido de outro sítio </li></ul></ul><ul><ul><li>Técnica de reparo em dois tempos </li></ul></ul>Campbell’s Urology – 9th Edition; vol. 4; p. 3722.
  13. 13. <ul><li>Técnicas de avanço uretral </li></ul><ul><li>MAGPI </li></ul>Tratamento Campbell’s Urology – 9th Edition; vol. 4; p. 3723.
  14. 14. <ul><li>Técnicas de tubulização </li></ul><ul><li>TIP </li></ul>Tratamento Campbell’s Urology – 9th Edition; vol. 4; p. 3724.
  15. 15. Tratamento <ul><li>Técnicas de tubulização </li></ul><ul><li>TIP </li></ul>Campbell’s Urology – 9th Edition; vol. 4; p. 3724.
  16. 16. Tratamento <ul><li>Técnicas de tubulização </li></ul><ul><li>TIP </li></ul>Campbell’s Urology – 9th Edition; vol. 4; p. 3724.
  17. 17. Tratamento <ul><li>Técnicas de tubulização </li></ul><ul><li>TIP </li></ul>Campbell’s Urology – 9th Edition; vol. 4; p. 3724.
  18. 18. <ul><li>Técnicas de tubulização </li></ul><ul><li>Mathieu </li></ul>Tratamento Campbell’s Urology – 9th Edition; vol. 4; p. 3726.
  19. 19. Tratamento <ul><li>Técnicas de tubulização </li></ul><ul><li>Mathieu </li></ul>Campbell’s Urology – 9th Edition; vol. 4; p. 3727.
  20. 20. Tratamento <ul><li>Técnicas de tubulização </li></ul><ul><li>Retalho em ilha de Onlay </li></ul>Campbell’s Urology – 9th Edition; vol. 4; p. 3728.
  21. 21. Tratamento <ul><li>Técnicas de tubulização </li></ul><ul><li>Retalho em ilha de Onlay </li></ul>Campbell’s Urology – 9th Edition; vol. 4; p. 3729.
  22. 22. <ul><li>Técnicas de tubulização </li></ul><ul><li>Retalho prepucial transverso em ilha </li></ul>Tratamento Campbell’s Urology – 9th Edition; vol. 4; p. 3732.
  23. 23. Tratamento <ul><li>Técnicas de tubulização </li></ul><ul><li>Retalho prepucial transverso em ilha </li></ul>Campbell’s Urology – 9th Edition; vol. 4; p. 3733.
  24. 24. Tratamento <ul><li>Técnicas de reparo com tecido de outro sítio </li></ul>Campbell’s Urology – 9th Edition; vol. 4; p. 3738.
  25. 25. Tratamento <ul><li>Técnica de reparo em dois tempos </li></ul>Campbell’s Urology – 9th Edition; vol. 4; p. 3736.
  26. 26. Tratamento <ul><li>Técnica de reparo em dois tempos </li></ul>Campbell’s Urology – 9th Edition; vol. 4; p. 3737.
  27. 27. <ul><li>Técnica de reparo em dois tempos </li></ul>Tratamento Campbell’s Urology – 9th Edition; vol. 4; p. 3737.
  28. 28. <ul><li>Sangramento </li></ul><ul><ul><li>Mais comum </li></ul></ul><ul><li>Fístula uretrocutânea </li></ul><ul><ul><li>Retalho bem vascularizado </li></ul></ul><ul><ul><li>Catgut Cromado </li></ul></ul><ul><li>Estenose </li></ul><ul><ul><li>Ocorre mais freq. no meato uretral ou na anastomose proximal com a uretra. </li></ul></ul>Complicações Campbell’s Urology – 9th Edition; vol. 4; p. 3740.
  29. 29. Reoperação em hipospádia <ul><li>Como regra a reoperação não deve ser realizada menos de 6 meses após o reparo primário </li></ul><ul><li>Técnicas para reparo primário podem ser utilizadas </li></ul><ul><li>Múltiplas reoperações: </li></ul><ul><ul><li>Correção em dois tempos </li></ul></ul>Campbell’s Urology – 9th Edition; vol. 4; p. 3741.
  30. 30. OBRIGADO

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