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ABSTRACT The objective of this manuscript is to present intracavernous therapy to readers, serving as a model and guide for physicians on how to introduce and manage it in their patients. Furthermore, we propose a strategy designed to ensure maximum safety with minor complications and provide an effective implementation of intracavernosal injection (ICI) therapy for the management of erectile dysfunction (ED). While phosphodiesterase type 5 inhibitors (PDE5i) are recognized as first-line therapy, approximately one-third of patients do not achieve satisfactory clinical outcomes, highlighting the importance of ICI as a highly effective second-line option. This comprehensive review details patient selection, drug formulation, structured patient education, stepwise dose titration, management of adverse events, and longitudinal follow-up. This approach is intended to minimize treatment-related complications, enhance patient confidence and adherence, and optimize long-term therapeutic outcomes. By suggesting a standardized clinical application of ICI therapy, this review aims to address key barriers that currently restrict its broader adoption in routine clinical practice.

Resumo em Inglês:

ABSTRACT This review aims to provide a comprehensive analysis of the anatomy of the clitoris, focusing on its complex internal structure, topographic relationships, and neurovascular supply highlighting its morphological features and clinical implications in aesthetic, reconstructive and transgender surgery. We analyzed papers published in the past 70 years in the databases of Pubmed, Embase and Scielo. We excluded case reports, editorials and opinions of specialists. Studies were excluded if they lacked clear anatomical descriptions of the clitoris, if full-text access was unavailable, or if they were published in languages other than Portuguese, English, or Spanish. Long overshadowed by other anatomical studies, the clitoris is now understood as a multi-planar organ with significant depth and extensive innervation with several applications and surgical techniques, such as clitoral hood reduction (hoodectomy) or labiaplasty. The clitoris is a very important structure to female physiology, specially orgasm. Knowledge of clitoris anatomy is a fundamental step in aesthetic surgery and in reconstruction. In aesthetic and reconstructive clitoroplasty, Buck's fascia is a critical anatomical landmark. The neurovascular bundle resides just beneath this fascia on the dorsal aspect of the clitoris. By staying superficial to or carefully dissecting within this layer, surgeons can ensure that the blood supply and sensory fibers remain intact, preventing glans necrosis and desensitization. This narrative review addresses the anatomical integration, surgical techniques, and functional importance of the clitoral complex in the transgender population and transgender surgery.

Resumo em Inglês:

ABSTRACT Objective: To evaluate the efficacy of Veriset™ hemostatic patch as a substitute for conventional renorrhaphy in retroperitoneal robot-assisted partial nephrectomy (RAPN). Materials and Methods: A total of 113 patients underwent retroperitoneal RAPN between January 2024 and January 2025. After propensity score matching on age, BMI, and R.E.N.A.L nephrometry score, 32 and 40 patients underwent Veriset™ placement and renorrhaphy, respectively, were included for final analysis. The clinico-demographic data, R.E.N.A.L. nephrometry score, blood loss, hemoglobin-drop, hospital stay, complications, and renal function on follow-up were prospectively recorded. Results: The mean age, body-mass-index, and R.E.N.A.L. score were 52.6 ± 9.86 years, 27.41 ± 4.06 kg/m2, and 5.24 ± 1.17, respectively. As per the low, intermediate, and high-risk categories of nephrometry, the patients were evenly distributed. The console time and warm ischemia time (WIT) were significantly less in the Veriset group (47.26 ± 17.51 vs. 71.67 ± 22.6 minutes, and 12.86 ± 6.14 vs 17.48 ± 5.40 minutes, respectively, p<0.001). Blood loss was significantly higher in the renorrhaphy group (57.74 ± 22.83 vs. 87.34 ± 33.81 mL, p=0.008). The change in GFR was significantly less in the Veriset group on postoperative day-1 (p=0.008), but became comparable after six months. The postoperative pain score at 6, 12, and 24 hours, blood transfusion, hospital stay, and readmission rates were similar in both groups. Conclusion: As compared to the renorrhaphy group, Veriset group patients had less console time, WIT, blood loss and immediate reduction of GFR. Sutureless retroperitoneal RAPN can produce good perioperative results without increasing complications.

Resumo em Inglês:

ABSTRACT Purpose: To critically evaluate the clinical presentation, imaging performance and surgical findings of malleable penile prosthesis (MPP) fractures in a high-volume tertiary center. Materials and Methods: Medical reports of men who underwent revision surgery with intraoperative confirmation of MPP fracture between January 2008 and January 2025 were reviewed. MPP from a single manufacturer (Promedon®, Cordoba, Argentina) were inserted, and no comparisons were possible. Demographic data, presenting symptoms, imaging findings, and fracture location were analyzed. Diagnostic performance of physical examination and imaging modalities was descriptively compared. Results: Among 741 penile prosthetic procedures, 98 were revisions and 52 (53.1%) were due to MPP fracture. Median time from implantation to fracture was 59 months (IQR 24.8–84.0). Penile instability was the most common symptom (96.1%), while pain was reported in 21.1%. Physical examination correctly identified fractures in 88.5% of cases, outperforming radiography and magnetic resonance imaging. Bilateral fractures occurred in 51.9% of revisions, most commonly in the proximal segment. Recurrent fractures occurred in 28.2% of patients. Conclusions: MPP fractures are more prevalent than expected and a clinically relevant complication in high-volume centers. Diagnosis relies primarily on clinical assessment, with physical examination outperforming imaging modalities. Increased awareness of typical presentation patterns may support earlier recognition and more efficient management. Prospective studies are needed to identify modifiable risk factors, improve device design and quality, and advise patients on use to potentially improve prosthesis lifetime.