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Original article
The factors that cause penile shortening after plication surgery in patients with congenital penile curvature
C. Sahina, C. Yesildalb,
Corresponding author
c_yesildal@hotmail.com

Corresponding author.
a Private Ada Tip Hospital, Istanbul, Turkey
b University of Health and Science Sultan Abdulhamid Han Training and Research Hospital, Istanbul, Turkey
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    "subtitulo" => "&#91;&#91;es&#93;&#93;Los factores causantes del acortamiento de pene despu&#233;s de la cirug&#237;a con plicatura en pacientes con incurvaci&#243;n peneana cong&#233;nita"
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Congenital penile curvature &#40;CPC&#41; is defined as the non-straightness of the penis without any urethral or penile pathology&#46; Curvature can be in any direction&#59; however&#44; it is emphasized in the literature that it is seen more ventrally<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a>&#46; The prevalence of CPC is between 0&#46;04&#8722;0&#46;6<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#44;3</span></a>&#46; Developmental defects in embryogenesis such as orthotopic urethral meatus and disproportion of cavernous bodies are thought to play a role in CPC etiology<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a>&#46; CPC is usually diagnosed by families&#46; The most common symptom is a curvature of the penis during a morning erection&#46; Cases that cannot be detected by the family appear with the child&#8217;s curvature complaint along with puberty&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Diagnosis of CPC before puberty and planning its treatment are important for the psychosocial development of the child&#46; It is obvious that children with high curvature will feel functionally deficient&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">History and physical examination are crucial in the diagnosis of CPC&#46; In the anamnesis&#44; reasons such as genital trauma and palpable stiffness suggest acquired penile curvature&#46; A complete urological physical examination should be done in order not to overlook additional uropathology<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a>&#46; Besides&#44; photographic documentation will protect the doctor from medicolegal events and will be useful for operative planning&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">The guidelines recommend postponing curvatures below 30&#176; to be treated after puberty&#46; Besides&#44; curvatures above 30&#176; should be treated regardless of age<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a>&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Curvatures above 60&#176; may prevent successful sexual intercourse after puberty so that it is prominent to be treated before puberty<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a>&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Management of the disease should be planned with the family&#46; The definitive method of treatment is surgery&#46; Many surgical fashions have been described in the treatment of CPC&#46; The simplest and most effective treatment method among these is the tunica albuginea plication &#40;TAP&#41; method<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a>&#46; Its side effects and complications are very few&#46; The most common complications are loss of penile sensation&#44; shortening of penile length&#44; and recurrence in puberty<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">9&#44;10</span></a>&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">In our study&#44; we aimed to find the causes of shortness of the penis in patients with CPC who underwent TAP&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Materials and methods</span><p id="par0040" class="elsevierStylePara elsevierViewall">Following the approval of the ethics committee&#44; 130 CPK cases treated with TAP between November 2010 and December 2020 were evaluated retrospectively&#46; CPC patients were included in our study with the obtained consent of patients or family&#46; Patients with penile and urethral &#40;hypospadias&#44; epispadias&#44; divergence corpus spongiosum&#44; etc&#46;&#41; pathologies were excluded from the study&#46; Before the procedure&#44; patients&#8217; ages&#44; curvature side&#44; and degrees&#44; stretched penile lengths were recorded&#46; Surgical treatment performed by a single surgeon&#46; All patients were uncircumcised&#46; First of all&#44; routine circumcision was applied&#46; Then degloving was done up to the radix penis&#46; Meanwhile&#44; the stretched penis length was measured again&#46; After the proximal tourniquet placement&#44; an artificial erection was performed with saline solution&#46; And then the side and degree of the curvature were determined&#46; The curvature was plicated 180&#176; opposite side of the curvature with 3&#46;0&#47;4&#46;0 non-absorbable suture&#46; Cases with 60&#176; and higher curvatures&#44; necessitated 2 or more plication sutures to different points to achieve full correction&#46; No tunical incision or excision was made in any of the cases&#46; The curvature of 10&#176; or less was considered a successful orthoplasty&#46; After the treatment&#44; penile lengths were measured and recorded again&#46; Early and late period results were recorded&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Statistical analyses were performed using the SPSS software version 21&#46; The variables were investigated using visual &#40;histograms&#44; probability plots&#41; and analytical methods &#40;Kolmogorov-Simirnov&#47;Shapiro-Wilk&#39;s test&#41; to determine whether or not they are normally distributed&#46; Descriptive analyses were presented &#40;&#42;using tables of frequencies for the ordinal variables&#44; and&#41; using medians and minimum-maximum values for the non-normally distributed and ordinal variables&#46; Penis length before treatment&#44; penis length after treatment and shortening percent not normally distributed the Kruskal-Wallis and Mann-Whitney <span class="elsevierStyleItalic">U</span> tests were conducted to compare these parameters and the ordinal variables among the curvature side &#40;Dorsal&#47;Ventral&#47;Lateral&#41; and curvature degree &#40;above 30&#176;&#47;below 30&#176;&#41; groups&#46; The Mann-Whitney <span class="elsevierStyleItalic">U</span> test was performed to test the significance of pairwise differences between curvature side using Bonferroni correction to adjust for multiple comparisons&#46; An overall &#37;5 type-1 error level was used to infer statistical significance&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Results</span><p id="par0050" class="elsevierStylePara elsevierViewall">Plication surgery was performed in 130 patients due to CPK&#46; The age range of the patients was 16&#8211;47 years&#44; and the median was 24&#46; Of the 76 patients with ventral CPC&#44; 44 &#40;57&#46;9&#37;&#41; had curvature below 30&#176; and 32 &#40;42&#46;1&#37;&#41; had curvature above 30&#176;&#46; Respectively&#44; 15&#40;68&#46;2&#37;&#41; of 22 patients with dorsal CPC were below 30&#176;&#44; 7 &#40;31&#46;8&#37;&#41; of them were above 30&#176;&#44; 22 &#40;68&#46;8&#37;&#41; of 32 patients with lateral CPC had curvature below 30&#176;&#44; and 10 &#40;31&#46;2&#37;&#41; of them had a curvature above 30&#176; &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0055" class="elsevierStylePara elsevierViewall">While the lowest curvature was in the lateral curvature group&#44; the highest curvature was in the ventral curvature group&#46; Patients&#8217; pre-treatment penis length was&#59; According to the curvature directions degrees&#58; below 30&#176;&#58; lateral 13&#46;8&#8239;cm &#40;12&#8211;16&#41;&#44; dorsal 14&#46;6&#8239;cm &#40;13&#46;4&#8211;17&#41;&#44; ventral 14&#46;4&#8239;cm &#40;12&#46;8&#8211;17&#46;5&#41;&#46; Patients with curvatures above 30&#176; were&#58; 14&#46;2&#8239;cm &#40;13&#8211;16&#46;8&#41;&#44; 15&#46;8&#8239;cm &#40;15&#8211;18&#46;8&#41;&#44; 16&#46;6&#8239;cm &#40;14&#46;4&#8211;21&#41;&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">After the informed consent obtained from the patient and&#47;or patient relatives&#44; circumcision and orthoplasty surgery were performed&#46; All patients were curvature-free after treatment&#46; Patients&#39; post-treatment penis length was&#59; According to the curvature directions and degrees&#58; below 30&#176;&#58; ventral 13&#46;2&#8239;cm &#40;12&#8211;16&#41;&#44; dorsal 13&#46;4&#8239;cm &#40;12&#46;8&#8722;16&#41;&#44; lateral 12&#46;75&#8239;cm &#40;11&#46;5&#8211;15&#41;&#46; Patients with curvatures above 30&#176; were&#58; ventral 14&#46;9&#8239;cm &#40;13&#8211;19&#41;&#44; dorsal 14&#46;6&#8239;cm &#40;13&#46;5&#8211;18&#41;&#44; lateral 13&#46;2&#8239;cm &#40;12&#46;5&#8211;16&#41;&#46; Average shortening of penile length in patients with curvature below 30&#176; was&#58; ventral 8&#8722;16&#8239;mm&#44; dorsal 6&#8722;13&#8239;mm&#44; lateral 5&#8722;12&#8239;mm&#46; Patients with curvatures above 30&#176; were&#58; ventral 12&#8722;22&#8239;mm&#44; dorsal 8&#8722;20&#8239;mm&#44; lateral 2&#8722;12&#8239;mm &#40;<a class="elsevierStyleCrossRefs" href="#tbl0010">Tables 2&#8211;4</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><elsevierMultimedia ident="tbl0020"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Discussion</span><p id="par0065" class="elsevierStylePara elsevierViewall">This study and current literature do not give an idea about the development and natural course of CPC&#46; Therefore&#44; there is no consensus about the timing of the surgery and the clear treatment scheme&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">The purpose of penile curvature surgery is orthoplasty&#46; For this purpose&#44; two types of operation methods have been defined&#46; The ones lengthening and the ones shortening the penis&#46; The methods that lengthen the penis are more invasive and open to more complications&#46; The methods that shorten the penis are the main plication methods&#46; Those methods involve fewer complications and can be applied more easily<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">11&#8211;14</span></a>&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">In the literature first defined method was Nesbit&#8217;s method&#46; He made full-layer tunica albuginea excision&#44; then closed it with nonabsorbable sutures<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a>&#46; Then Yashia modified this technique&#46; He did not perform tissue excision&#46; He made a longitudinal incision on the curvature and then horizontally sutured the incision and achieved similar success<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a>&#46; Essed and Shroder are the first described the plication technique<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a>&#46; Knispel et al&#46; have modified these techniques&#46; They make sutures non-palpable by inverting them<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a>&#46; In 2002 the use of the 16 dot plication and suturation in extended Lembert fashion technique of Tom Lue became popular in larger curvatures like the banana-shaped penis<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a>&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">Greenfield and colleagues retrospectively examined the factors affecting the complication of penile length reduction in patients who underwent surgery with the TAP method due to Peyronie&#39;s disease or cordia&#46; They determined that the direction and degree of curvature are factors affecting the penis shortness&#46; They found that patients with ventral curvature and patients with higher curvature degrees had higher penile length shortening<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a>&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">There is no study in the literature evaluating the factors affecting the postoperative penile length and shortening of patients who underwent plication surgery due to CPC&#46; Our study is the first in this area&#46; In our study&#44; it was shown that those with ventral curvature were exposed to a higher penile length shortening than those with dorsal and lateral curvature after the TAP&#44; and it was found to be clinically significant &#40;<span class="elsevierStyleItalic">p</span>&#8239;&#60;&#8239;0&#46;001&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0025">Table 5</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0025"></elsevierMultimedia><p id="par0090" class="elsevierStylePara elsevierViewall">In addition&#44; it was found that as the degrees of curvature increased&#44; the shortening of the penis length increased in direct proportion&#46; Also it was found that as the curvature degrees of the patients increased&#44; their penile length also increased&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">The limitations of our study are Long-term results of the patients could not be evaluated&#44; early postoperative and 1st-month results were evaluated&#46; In addition&#44; with randomized controlled prospective studies with a higher number of patients&#44; the factors affecting the shortening of the penis after TAP operation and the relationship between the degree of chordate and penis length can be obtained more clearly&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Conclusion</span><p id="par0100" class="elsevierStylePara elsevierViewall">With TAP techniques CPC can be treated easily and safely&#46; Penile length shortness after TAP is inevitable&#46; Curvature degree and direction are factors affecting penile length after the operation&#46; Therefore&#44; patients and their relatives should be informed about this complication in more detail&#46;</p></span></span>"
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    "fechaRecibido" => "2021-09-07"
    "fechaAceptado" => "2021-12-19"
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          "clase" => "keyword"
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          "palabras" => array:3 [
            0 => "Congenital penile curvature"
            1 => "Plication surgery"
            2 => "Penile length"
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          "palabras" => array:3 [
            0 => "Incurvaci&#243;n cong&#233;nita del pene"
            1 => "Cirug&#237;a con plicatura"
            2 => "Longitud del pene"
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    "resumen" => array:2 [
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        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objective</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Congenital penile curvature is defined as the non-straightness of the penis without any urethral or penile pathology&#46; We aimed to evaluate the factors that cause penile shortening after plication surgery in patients with congenital penile curvature&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Between November 2010 and December 2020&#44; we retrospectively reviewed patients with CPC undergoing tunica albuginea plication surgery&#46; Before the procedure&#44; patients&#39; age&#44; curvature location and degrees&#44; as well as penile length were recorded&#46; After the treatment&#44; penile lengths were measured and recorded again&#46; Early and late period results were recorded&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Plication surgery was performed in 130 patients&#46; The median age was 24 years&#46;</p><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Seventy-six patients had ventral curvature&#44; 22 had dorsal curvature&#44; 32 had lateral curvature&#46; Average shortening of penile length in patients with curvature below 30&#176; was&#58; ventral 8&#8722;16&#8239;mm&#44; dorsal 6&#8722;13&#8239;mm&#44; lateral 5&#8722;12&#8239;mm&#46; Patients with curvatures above 30&#176; were&#58; ventral 12&#8722;22&#8239;mm&#44; dorsal 8&#8722;20&#8239;mm&#44; lateral 2&#8722;12&#8239;mm&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusion</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Penile length shortening after plication is inevitable&#46; Curvature degree and direction are factors affecting penile length after surgery&#46; Therefore&#44; patients and relatives should be informed in more detail about this complication&#46;</p></span>"
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        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Objetivo</span><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">La incurvaci&#243;n peneana cong&#233;nita se define como la incurvaci&#243;n del pene en ausencia de patolog&#237;a uretral o peneana&#46; Nuestro objetivo es evaluar los factores causantes del acortamiento del pene despu&#233;s de la plicatura en pacientes con incurvaci&#243;n peneana cong&#233;nita&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">M&#233;todos</span><p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Entre noviembre de 2010 y diciembre de 2020 revisamos de forma retrospectiva a los pacientes con incurvaci&#243;n peneana cong&#233;nita que se sometieron a una cirug&#237;a mediante t&#233;cnica de plicatura de la t&#250;nica albug&#237;nea&#46; Antes del procedimiento&#44; se registr&#243; la edad de los pacientes&#44; la ubicaci&#243;n y los grados de la desviaci&#243;n&#44; y la longitud del pene&#46; Tras el tratamiento se midi&#243; y registr&#243; de nuevo la longitud del pene&#46; Se registraron los resultados de los per&#237;odos inicial y final&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Se realiz&#243; cirug&#237;a con plicatura en 130 pacientes&#46; La media de edad era de 24 a&#241;os&#46;</p><p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Setenta y seis pacientes ten&#237;an incurvaci&#243;n ventral&#44; 22 dorsal y 32 lateral&#46; El acortamiento medio de la longitud del pene en aquellos pacientes con incurvaci&#243;n inferior a 30&#176; fue&#58; ventral 8&#8722;16&#8239;mm&#44; dorsal 6&#8722;13&#8239;mm&#44; lateral 5&#8722;12&#8239;mm&#46; En los pacientes con incurvaci&#243;n superior a 30&#176; fue&#58; ventral 12&#8722;22&#8239;mm&#46;&#44; dorsal 8&#8722;20&#8239;mm&#46;&#44; lateral 2&#8722;12&#8239;mm&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusi&#243;n</span><p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">El acortamiento del pene despu&#233;s de la plicatura es inevitable&#46; El grado y la direcci&#243;n de la desviaci&#243;n son factores que afectan la longitud del pene despu&#233;s de la operaci&#243;n&#46; Por lo tanto&#44; los pacientes y sus familiares deben recibir informaci&#243;n detallada sobre esta complicaci&#243;n&#46;</p></span>"
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Total &#40;<span class="elsevierStyleItalic">n</span>&#8239;&#61;&#8239;130&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t">Ventral&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">44 &#40;57&#46;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Penis length before treatment &#40;cm&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Penis length after treatment &#40;cm&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Shortening percent &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ventral &#40;median min-max&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15&#46;0 &#40;12&#46;8&#8722;21&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13&#46;7 &#40;12&#46;0&#8722;19&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&#46;0 &#40;4&#46;3&#8722;7&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Dorsal &#40;median min-max&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14&#46;7 &#40;13&#46;4&#8722;18&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13&#46;3 &#40;12&#46;8&#8722;18&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&#46;2 &#40;5&#46;1&#8722;7&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Lateral &#40;median min-max&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13&#46;6 &#40;12&#46;0&#8722;16&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12&#46;6 &#40;11&#46;4&#8722;16&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&#46;7 &#40;5&#46;7&#8722;7&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">P</span>&#42;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Penis length before treatment &#40;cm&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Penis length after treatment &#40;cm&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Shortening percent &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t">Below 30&#176;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14&#46;2 &#40;12&#46;0&#8722;17&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13&#46;0 &#40;11&#46;4&#8722;16&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&#46;4 &#40;5&#46;2&#8722;7&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">30&#176; and above&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15&#46;5 &#40;13&#46;0&#8722;21&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">14&#46;1 &#40;12&#46;5&#8722;19&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#46;9 &#40;4&#46;3&#8722;7&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;001&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\tvoid\n
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                  \t\t\t\t\ttop\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Shortening percent &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Below 30&#176;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15&#46;0 &#40;12&#46;8&#8722;21&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13&#46;7 &#40;12&#46;0&#8722;19&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">6&#46;0 &#40;4&#46;3&#8722;7&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">30&#176; and above&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">16&#46;1 &#40;14&#46;4&#8722;21&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">14&#46;7 &#40;13&#46;0&#8722;19&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">5&#46;4 &#40;4&#46;3&#8722;6&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " rowspan="2" align="left" valign="\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Below 30&#176;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">14&#46;7 &#40;13&#46;4&#8722;18&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13&#46;3 &#40;12&#46;8&#8722;18&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&#46;2 &#40;5&#46;1&#8722;7&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">30&#176; and above&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15&#46;1 &#40;15&#46;0&#8722;18&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">14&#46;0 &#40;13&#46;5&#8722;18&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">6&#46;1 &#40;5&#46;1&#8722;6&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
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                        "tituloSerie" => "Br J Urol"
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