Impact of the baseline study with penile doppler ultrasound in patients with prostate cancer before radical prostatectomy | Actas Urológicas Españolas (English Edition)

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"apellidos" => "Navarro" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servicio de Urología, Hospital Universitari Parc Taulí, Universitat Autònoma de Barcelona, Sabadell, Barcelona, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Cirugía General y Digestiva, Hospital Universitari Parc Taulí, Universitat Autònoma de Barcelona, Sabadell, Barcelona, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Impacto del estudio basal con ecografía doppler en pacientes con cáncer de próstata previo a prostatectomía radical" ] ] "textoCompleto" => "IntroductionWith a life expectancy for patients of more than 10 years,<a class="elsevierStyleCrossRef" href="#bib0130">1</a> radical prostatectomy is one of mail the organ-confined prostate cancer treatments. This treatment has an impact on the quality of life, with a urinary incontinence rate at 12 months after laparoscopic surgery between 44 and 91.7% depending on the series and the definition of incontinence.<a class="elsevierStyleCrossRef" href="#bib0135">2</a> Its erectile dysfunction (ED) rate is between 31.7 and 71.1% according to the series and the definition used.<a class="elsevierStyleCrossRef" href="#bib0140">3</a>Taking into account that the prevalence of ED can reach up to 52% of the population between 40 and 70 years,<a class="elsevierStyleCrossRef" href="#bib0145">4</a> it is important to have a baseline examination of patients before undergoing a radical prostatectomy in order to assess realistic expectations regarding their recovery.Material and methodsA prospective study was conducted from February 2012 to August 2016 to evaluate sexual function prior to laparoscopic radical prostatectomy in patients with prostate cancer willing to preserve their erectile function (EF).Before surgery, patients responded to validated ED and sexual questionnaires: the EF Domain (questions 1–5 and 15) of the International Index of Erectile Function (IIEF)<a class="elsevierStyleCrossRef" href="#bib0150">5</a> and Erection Hardness Score (EHS).<a class="elsevierStyleCrossRef" href="#bib0155">6</a> According to the IIEF test, patients are classified as normal EF (≥26) or altered EF (mild 17–25, moderate 11–16, and severe 6–10).In addition, patients also completed the EORTC QLQ-C-30<a class="elsevierStyleCrossRef" href="#bib0160">7</a> and PR-25<a class="elsevierStyleCrossRef" href="#bib0165">8</a> quality of life questionnaires.After the administration of 20μg intracavernous prostaglandin E1, all patients underwent a Penile Doppler Ultrasound (PDU) to assess the diameter of the cavernous arteries and to judge their haemodynamic status. All ultrasounds have been performed by a urologist specialised in this technique.A peak systolic velocity (PSV) >30cm/s, and an end-diastolic velocity (EDV) <5cm/s were taken as normal values. In this way, a study was considered normal with a PSV >30cm/s and a EDV <5cm/s. Arterial insufficiency was considered when <30cm/s PSV and <5cm/s EDV. Corporal veno-occlusive dysfunction (CVOD) was considered with a >30cm/s PSV and a >5cm/s EDV, When both parameters were altered,<a class="elsevierStyleCrossRef" href="#bib0170">9</a> we considered it as combined dysfunction.Comorbidities, the Charlson Comorbidity Index (CCI)<a class="elsevierStyleCrossRef" href="#bib0175">10</a> and drugs that could influence the patients’ EF were collected.After surgery, penile rehabilitation with daily use of vardenafil 5mg was recommended to patients. Apparently, an early use of these drug could improve the intracavernous smooth muscle preservation.<a class="elsevierStyleCrossRefs" href="#bib0180">11,12</a>Statistical studyThe items of the EORTC QLQ C-30 and PR-25 questionnaires were scaled according to the scoring manual.<a class="elsevierStyleCrossRef" href="#bib0190">13</a>The description of the qualitative variables has been made by their absolute and relative frequencies. The description of the quantitative variables, by the mean and the standard deviation (with normal distribution) or by the median and the interquartile range (with non-normal distribution).A univariate study has been performed using the Chi-squared test for qualitative variables. The Student's t test has been used for quantitative variables with normal distribution. The Mann–Whitney U test for those with non-normal distributions, and the Student's t test has been used for paired data to compare the variables of the quality of life questionnaires.The statistical significance will be established as p<0.05 in all inferential tests.ResultsA total of 112 patients whose characteristics are described in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>, have been included in the study. Due to the fact that it is a cohort of patients who are candidates for surgery, we found little comorbidity, with 78.6% presenting a CCI<2. There is only 14.3% of diabetes, 2.7% of ischaemic heart disease, 35.7% of hypertension and 32.1% of dyslipidemia. 43.8% of the patients are non-smokers. Only 5.4% take beta blockers, 14.3% diuretics, 26.8% angiotensin-converting enzyme inhibitors and 25.9% statins.<elsevierMultimedia ident="tbl0005"></elsevierMultimedia>Quality of life scores from the QLQ C-30 and PR-25 questionnaires are shown in <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>. We should note that: 32 patients reported urinary incontinence prior to surgery, although with little repercussion in their quality of life (all scored 0), and 14 patients did not score in the sexual function scale, for they did not maintain sexual activity in the previous 4 weeks.<elsevierMultimedia ident="tbl0010"></elsevierMultimedia>The EF assessed with the IIEF and the EHS is shown in <a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>. As occurred with the quality of life test, 14 patients could not be evaluated by the IIEF, due to the absence of sexual intercourse in the last 4 weeks. According to the IIEF questionnaire, 50.9% of the population had a normal EF. The rest of the patients already presented some degree of ED. In contrast, up to 75.9% had a grade 3–4 erection in the EHS.<elsevierMultimedia ident="tbl0015"></elsevierMultimedia>Taking into account the patient's age, the CCI and the IIEF score, Briganti et al.<a class="elsevierStyleCrossRef" href="#bib0195">14</a> categorised the patients into prognostic groups for the loss of EF after surgery with preservation of the neurovascular bundles. The study population shows a similar distribution in all 3 risk categories.<a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a> shows the results of the EF evaluated with PDU. Only 28.6% of the patients presented values within normality. 51.8% showed some degree of arterial insufficiency (pure and associated with CVOD). These results are reflected in the medians of the PSV, which are very close to the cutoff value considered as normal.<elsevierMultimedia ident="tbl0020"></elsevierMultimedia>5.4% (6 patients) were taking PDE5 inhibitors before surgery.We found a significant association (p<0.0001) between the categorised EF-IIEF (normal, mild/moderate/severe) and the EHS value.The relation between the presence of PDU (normal vs. pathological) and the EHS (3–4 vs. 1–2), was found as statistically significant association (p=0.005). We found that 92.6% of the patients with EHS 1–2 presented a pathologic ultrasound. In contrast, in patients with a 3–4 EHS, only 35.3% had a normal ultrasound.We evaluated the association between the EF assessed in the PDU (normal vs. pathologic) and FE according to the IIEF (≥26 vs. <26). A statistically significant association was found (p=0.043). We have seen that 80% of the patients with an IIEF <26 had a pathologic ultrasound. However, only 36.6% of the patients with an IIEF ≥26 had a normal ultrasound. In the group of patients with <26 IIEF and pathologic PDU we found: 42.8% of arterial insufficiency, 28.5% CVOD and another 28.5% combined dysfunction.With the IIEF test used as reference test for normal vs. pathologic EF classification of the patients, we have seen PDU was a positive predictive value in 48.5% and a negative predictive value in 73% of the cases.We have not found a statistically significant association between ED valued with EHS and the IIEF or PDU and the presence of the following: diabetes, ischaemic heart disease, smoking, hypertension, dyslipidemia with CHF and taking beta-blockers, diuretics, angiotensin-converting enzyme inhibitors or statins.We have not found significant association between the existence of ED and the Gleason of the biopsy, nor with the piece or the local stadium.We have studied the relationship between age and BMI and ED according to EHS, IIEF and PDU. Thus, we find that the age is associated with the presence of ED evaluated with IIEF (p=0.004) and PDU (p=0.029). We found no association with EHS (p=0.346). We found no relationship between BMI and IIEF (p=0.519), ED (p=0.566) or EHS (p=0.669).When we selected the 14 patients who had not had sexual activity in the previous month (their score in the IIEF was not assessable) we found that only 2 of them had a normal penile ultrasound. There were ten patients with arterial insufficiency and 2 with CVOD. In addition to the 5 patients presenting an EHS grade 3, 80% had a pathologic ultrasound.Regarding quality of life questionnaires, we found that patients with IIEF <26 present a lower score both in the sexual function item (60.64 vs. 40.5; p<0.0001) as in the sexual activity item (58.68 vs. 39.12; p=0.001) of the EORTC PR-25. When assessing patients with EHS ≤2, we found the same low score in erectile function (55.28 vs. 32.98; p=0.01) and sexual activity (47.65 vs. 30.44; p=0.14). In contrast, no differences were found in these items between patients with normal ED vs. pathologic.Regarding the remaining functions, it is important to note that the emotional scored less than the rest of the function items. Regarding symptoms, insomnia scored significantly higher (p<0.0001)DiscussionIt is very important to carry out a baseline study of quality of life before applying treatments that can affect it, as happens with radical prostatectomy. In addition, it is crucial to assess baseline EF, as it is one of the items of quality of life that may be highly affected.EF before radical surgery has been studied in every aspect. We have not found EF-risk factors in our population in any of the diagnostic tests performed (EHS, IIEF, PDU). In contrast to other series’ results,<a class="elsevierStyleCrossRef" href="#bib0180">11</a> the presence of a higher comorbidity valued with the CCI has not appeared as a risk factor. Cardiovascular disease (diabetes mellitus, dyslipidemia, hypertension, smoking) risk factors have shown to be ED risk factors as well. In spite of sharing common aspects for endothelial dysfunction,<a class="elsevierStyleCrossRef" href="#bib0200">15</a> a previous history of ischaemic heart disease was not associated with the presence of ischaemic heart disease. Recent studies have shown that poor glycemic control in type 2 diabetic patients and the presence of a high BMI are also risk factors.<a class="elsevierStyleCrossRef" href="#bib0205">16</a> We have probably not found an association due to the selection bias of patients who are candidates for surgical treatment and, therefore, have a low rate of comorbidities. This is shown by the fact that the majority of patients had a CCI<2. Only 2.7% were affected by ischaemic heart disease and 14.3% were diabetic. Moreover, as our patients had been selected for surgery, we did not find many patients with obesity criteria (as shown in the BMI median).In contrast to what other authors have mentioned (they have even found that this relationship depends on the dose<a class="elsevierStyleCrossRef" href="#bib0210">17</a>), we have not found association between ED and smoking.Treatment with beta-blockers or diuretics in hypertensive patients has been associated with a worse EF.<a class="elsevierStyleCrossRef" href="#bib0215">18</a> Hypertensive patients were mainly treated with angiotensin-converting enzyme inhibitors. The use of beta-blockers or diuretics was very low. This may explain the absence of association between these drugs and a worse EF.Both the performance of prostate biopsies and the diagnosis of prostate cancer have an impact on EF. Murray et al. found that 34% of the patients with normal EF presented a decreased IIEF one week later. They also found that the diagnosis of prostate cancer was a factor for the decrease in the IIEF<a class="elsevierStyleCrossRef" href="#bib0220">19</a> score.Anxiety towards the probability of having cancer also plays an important role in the EF of patients undergoing prostate biopsy.<a class="elsevierStyleCrossRef" href="#bib0225">20</a> Moreover, Helfand et al. found that patients with a prostate cancer diagnosis have worse IIEF than patients with negative prostate biopsy.<a class="elsevierStyleCrossRef" href="#bib0230">21</a>This would explain why 14 patients had not had sexual intercourse during the previous 4 weeks. The systematic use of a questionnaire like IIEF to evaluate EF may not be the best option in patients diagnosed with prostate cancer. It would be advisable to carry out a more complete evaluation of the EF in order to achieve a more realistic approach, not only based on questionnaires. This way, we would be able to know the real expectations we could have on the recovery of this function after surgery.In addition, this anxiety would show why our population had the emotional function more altered than the rest of the functions, as well as having insomnia as the highest symptom. All this could be due to the recent diagnosis of prostate cancer.As far as we know, there has only been one study evaluating EF through PDU. Kawanishi et al.<a class="elsevierStyleCrossRef" href="#bib0235">22</a> performed one previous PDU with a second performance 4–6 weeks post-surgery, only in cases where EF was preserved. They only reveal the PSV, which is slightly higher than the one obtained in our series (36.1 and 37.7cm/s for the right and left sides, respectively). They did not find changes in the PSV in the subsequent control. We ignore long-term changes, and evolution in the PDU of patients with ED, as 4–6 weeks is a short period for the EF recovery.We believe that it is important to assess the EF with all the tools available, with subjective data (IIEF and the EHS), as well as objective data (PDU) which can provide information on the aetiology of EF. Blander et al.,<a class="elsevierStyleCrossRef" href="#bib0240">23</a> have already doubted whether the questionnaires could replace the EF test. They concluded that the IIEF is a good starting point that should probably be complemented with objective techniques, especially to assess the efficacy of treatments. In our series, PDV has been very useful to evaluate the EF in those patients who had not had sexual intercourse during the last 4 weeks, since the IIEF did not provide information in these cases.Ultrasound has also been very useful in the group of patients with IIEF ≥26. 61.4% of the cases had a pathologic ultrasound, and this could be the first indication of an underlying ED and would probably have an impact on the EF recovery after surgery. This would explain why the positive predictive value of the PDU was only of 48.5%. PDU is convenient when results are normal, since in most cases the patient will present a IIEF ≥26, due to the high negative predictive value.Regarding quality of life, we found association between the self-administered tests IIEF and EHS and the EORTC PR-25 test when it grades function and sexual activity. As logical as it seems, we found the same results in our patients using the same method with different questions. However, we did not obtain differences in the results of patients with normal and with pathological PDU. This is why we believe there is a group of patients in which the pathological PDU is the first sign of a possible underlying ED.In relation to the remaining quality of life items, Pompe et al.,<a class="elsevierStyleCrossRef" href="#bib0245">24</a> conducted a baseline study using the QoL item of the EORTC QLQ C-30, with a mean of 74, much lower than that of our series.Lennernäs et al.,<a class="elsevierStyleCrossRef" href="#bib0250">25</a> also used the EORTC QLQ C-30 in patients who were undergoing radical prostatectomy. Their scores on the functional scale were similar to ours, but our patients scored lower in relation to fatigue and pain (the mean was 14 and 7, respectively). The scale of financial difficulties (mean 8) is also lower, which could be due to differences between Sweden and Spain's National Health Systems.The main limitation of our study is having a small patient cohort. Our study provides an assessment of the overall situation of the patient in terms of their general health condition and those aspects that may be harmed by surgical treatment. In particular, it presents an important assessment of the EF in all its aspects, with the aid of subjective, validated questionnaires, as well as with objective explorations.ConclusionsIt is very important to perform a baseline assessment of every aspect concerning the patient's quality of life that may be affected by radical prostatectomy. In particular, it is important to carry out a global analysis of the EF (not only through IIEF) in order to assess its recovery expectations after surgery. PDU can play a very significant role in this evaluation.Conflict of interestsThe authors declare that they have no conflict of interests." "textoCompletoSecciones" => array:1 [ "secciones" => array:12 [ 0 => array:3 [ "identificador" => "xres1158559" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Material and methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1085405" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres1158560" "titulo" => "Resumen" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Introducción" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Material y métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1085406" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:3 [ "identificador" => "sec0010" "titulo" => "Material and methods" "secciones" => array:1 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Statistical study" ] ] ] 6 => array:2 [ "identificador" => "sec0020" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "sec0025" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0030" "titulo" => "Conclusions" ] 9 => array:2 [ "identificador" => "sec0035" "titulo" => "Conflict of interests" ] 10 => array:2 [ "identificador" => "xack395345" "titulo" => "Acknowledgements" ] 11 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2018-05-07" "fechaAceptado" => "2018-08-02" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1085405" "palabras" => array:3 [ 0 => "Prostate cancer" 1 => "Erectile dysfunction" 2 => "Penile doppler ultrasound" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1085406" "palabras" => array:3 [ 0 => "Cáncer de próstata" 1 => "Disfunción eréctil" 2 => "Ecografía doppler de pene" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "IntroductionGiven the high prevalence of erectile dysfunction in male population between 40 and 70 years old and the effect of radical prostatectomy on this domain, it is important to perform a baseline study. Material and methodsPrior radical prostatectomy, erectile function has been assessed prospectively in 112 prostate cancer patients using the erectile function (EF) domain of the International Index of Erectile Function (EF-IIEF), Erectile Hardness Score (EHS) and a penile doppler ultrasound (PDUS). Comorbidities and Charlson index were collected. The EORTC QLQ C-30 and PR-25 tests were administered. ResultsAccording to EF-IIEF questionnaire, 50.9% of patients showed normal EF and EHS grade 3–4 erection was achieved in the 75.9%. PDUS was normal only in 28.6% of patients and 51.8% showed arterial insufficiency. We found a significant association (p<0001) between categorised EF-IIEF (normal, mild/moderate/severe) and the EHS value. Between PDUS (normal vs. pathologic) and EHS (3–4 vs. 1–2) statistically significant association (p=0.005) was found. Just 35.3% of patients with EHS 3–4 showed normal PDUS. Correlation between the PDUS and the EF-IIEF (≥26 vs. 26) was statistically significant (p=0.043). Moreover, only 38.6% of patients with EF-IIEF≥26 had a normal PDUS. ConclusionsIn order to predict EF recovery after surgery, global assessment is required. Solely self-administered tests are not enough. In this baseline study, PDUS can play an important role." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Material and methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "IntroducciónLa disfunción eréctil peneana tiene una prevalencia alta entre los 40-70 años, por lo que es importante su valoración basal antes de la prostatectomía radical. Material y métodosSe ha evaluado la función eréctil (FE) de 112 pacientes con cáncer de próstata previamente a la prostatectomía radical, mediante el dominio de la FE del Índice Internacional de Función Eréctil (IIEF), el test Erectile Hardness Score (EHS) y una ecografía doppler de pene (EDP). Se recogieron comorbilidades, el índice de Charlson y se administró el test de calidad de vida de la EORTC QLQ C-30 y PR-25. ResultadosUn 50,9% de la población tenían una FE normal usando el cuestionario IIEF y un 75,9% conseguían una erección grado 3-4 en el EHS. Únicamente el 28,6% presentaban una EDP normal, y el 51,8% mostraron insuficiencia arterial. Encontramos una asociación significativa (p<0,0001) entre el IIEF categorizado y el valor de EHS. Se encontró una asociación significativa (p=0,005) entre la presencia en la EDP (normal vs. patológico) y el EHS (3-4 vs. 1-2). Solo el 35,3% de los pacientes con un EHS de 3-4 tenían una EDP normal. También encontramos una asociación significativa (p=0,043) entre la EDP y la FE valorada según el IIEF (≥26 vs. 26). Únicamente tenían una EDP normal el 38,6% de los pacientes con IIEF≥26. ConclusionesEs importante una valoración global de la FE para poder valorar las expectativas de recuperación de dicha función tras la cirugía y no reducirla únicamente a test autoadministrados, pudiendo jugar un papel importante la EDP." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Introducción" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Material y métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "Please cite this article as: Muñoz-Rodríguez J, Hannaoui N, Domínguez A, Centeno C, Parejo V, Rosado MA, et al. Impacto del estudio basal con ecografía doppler en pacientes con cáncer de próstata previo a prostatectomía radical. Actas Urol Esp. 2019;43:84–90." ] ] "multimedia" => array:4 [ 0 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "SD: standard deviation; IQR: interquartile range." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Age (years), mean (SD) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">61.77 (5.90) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Body mass index (kg/m2), mean (SD) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">27.76 (3.29) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top">Charlson comorbidity index, n (%)</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">53 (47.3) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">35 (31.3) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">15 (13.4) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">>2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">9 (8.1) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Prostate-specific antigen (ng/ml), median (IQR) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6.33 (5.29–9.33) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top">Biopsy Gleason, n (%)</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">≤6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">55 (49.1) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">51 (45.5) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">≥8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6 (5.4) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top">Pathological stage, n (%)</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">pT2a-b \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">31 (28.57) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">pT2c \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">66 (58.92) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">pT3a-b \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">14 (12.5) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top">Pathological Gleason, n (%)</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">≤6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">43 (38.39) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">66 (58.92) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">≥8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 (2.67) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top">Neurovascular bundles’ preservation, n (%)</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">No preservation \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">30 (26.78) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Unilateral \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">26 (23.21) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Bilateral \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">56 (50) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1978076.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Patient and tumour characteristics." ] ] 1 => array:8 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at2" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:3 [ "leyenda" => "SD: standard deviation." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <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="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Mean (SD) \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top">QLQ C-30 functioning<a class="elsevierStyleCrossRef" href="#tblfn0005">a</a></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Physical functioning \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">96.9 (0.67) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Role functioning \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">97.91 (0.73) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Emotional functioning \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">78.71 (1.91) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Cognitive functioning \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">93.52 (1.07) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Social functioning \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">94.19 (1.49) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top">QLQ C-30 symptoms<a class="elsevierStyleCrossRef" href="#tblfn0010">b</a></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Fatigue \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6.94 (1.1) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Nausea and vomiting \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.44 (0.33) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Pain \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7.88 (1.43) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Dyspnoea \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5.35 (1.23) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Insomnia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">17.85 (2.19) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Appetite loss \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4.46 (1.23) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Constipation \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6.54 (1.39) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Diarrhoea \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3.57 (0.97) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Financial difficulties \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.38 (0.91) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top">QLQ C-30 quality of life<a class="elsevierStyleCrossRef" href="#tblfn0005">a</a></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Quality of life \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">81.26 (1.69) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">QLQ Summary Score \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">92.58 (0.66) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top">EORTC PR-25 functioning and symptoms</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Sexual activity <a class="elsevierStyleCrossRef" href="#tblfn0005">a</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">51.04 (2.55) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Sexual functioning<a class="elsevierStyleCrossRef" href="#tblfn0005">a</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">77.81 (2.21) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Urinary symptoms<a class="elsevierStyleCrossRef" href="#tblfn0010">b</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">15.65 (1.24) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Bowel symptoms<a class="elsevierStyleCrossRef" href="#tblfn0010">b</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4.01 (0.63) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Hormonal treatment side-effects<a class="elsevierStyleCrossRef" href="#tblfn0010">b</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4.21 (0.54) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Urinary incontinence symptoms<a class="elsevierStyleCrossRef" href="#tblfn0010">b</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 (0) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1978077.png" ] ] ] "notaPie" => array:2 [ 0 => array:3 [ "identificador" => "tblfn0005" "etiqueta" => "a" "nota" => "Functioning scales go from 0 to 100, with higher scores representing better functioning." ] 1 => array:3 [ "identificador" => "tblfn0010" "etiqueta" => "b" "nota" => "Symptom scales go from 0 to 100, with lower scores representing less symptoms." ] ] ] "descripcion" => array:1 [ "en" => "Results of the EORT QLQ C-30 and PR-25 questionnaires." ] ] 2 => array:8 [ "identificador" => "tbl0015" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at3" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top">Erectile Hardness Score, n (%)</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">I \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6 (5.4) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">II \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">21 (18.8) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">III \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">68 (60.7) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">IV \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">17 (15.2) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top">Erectile function domain of the International Index of Erectile Function, n (%)</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Normal \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">57 (50.9) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Mild \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">24 (21.4) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Moderate \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">13 (11.6) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Severe \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4 (3.6) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">No sexual activity \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">14 (12.5) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top">Risk groups for the recovery of sexual functioning, n (%)</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Low risk \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">34 (30.4) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Intermediate risk \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">38 (33.9) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">High risk \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">40 (35.7) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1978075.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Erectile Hardness Score, International Index of Erectile Function and Briganti risk groups." ] ] 3 => array:8 [ "identificador" => "tbl0020" "etiqueta" => "Table 4" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at4" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "IQR: interquartile range." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Right cavernosal artery diameter (mm), median (IQR) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.70 (0.59–0.81) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Left cavernosal artery diameter (mm) median (IQR) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.69 (0.62–0.81) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Peak systolic velocity of the right cavernosal artery (cm/s), median (IQR) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">30.63 (21.72–39.97) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Peak systolic velocity of the left cavernosal artery (cm/s), median (IQR) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">30.07 (20.22–39.27) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">End-diastolic velocity of the right cavernosal artery (cm/s), median (IQR) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5.34 (2.52–8.0) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">End-diastolic velocity of the left cavernosal artery (cm/s), median (IQR) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5.03 (2.32–7.67) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top">Doppler ultrasound result, n (%)</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Normal \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">32 (28.6) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Arterial insufficiency \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">43 (38.4) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Veno-occlusive dysfunction \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">22 (19.6) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Mixed dysfunction \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">15 (13.4) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1978078.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Results of the penile Doppler ultrasound." ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:25 [ 0 => array:3 [ "identificador" => "bib0130" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "EAU-ESTRO-SIOG guidelines on prostate cancer. Part 1: screening, diagnosis, and local treatment with curative intent" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "N. Mottet" 1 => "J. Bellmunt" 2 => "M. Bolla" 3 => "E. Briers" 4 => "M.G. Cumberbatch" 5 => "M. De Santis" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.eururo.2016.08.003" "Revista" => array:6 [ "tituloSerie" => "Eur Urol" "fecha" => "2017" "volumen" => "71" "paginaInicial" => "618" "paginaFinal" => "629" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27568654" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0135" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Urinary incontinence and erectile dysfunction after robotic versus open radical prostatectomy: a prospective, controlled, nonrandomised trial" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "E. 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Impact of the baseline study with penile doppler ultrasound in patients with prostate cancer before radical prostatectomy

Impacto del estudio basal con ecografía doppler en pacientes con cáncer de próstata previo a prostatectomía radical

J. Muñoz-Rodrígueza,

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jesusmunozrguez@hotmail.com

Corresponding author.

, N. Hannaouia, A. Domíngueza, C. Centenoa, V. Parejoa, M.A. Rosadoa, J. Pratsa, S. Navarrob

a Servicio de Urología, Hospital Universitari Parc Taulí, Universitat Autònoma de Barcelona, Sabadell, Barcelona, Spain

b Servicio de Cirugía General y Digestiva, Hospital Universitari Parc Taulí, Universitat Autònoma de Barcelona, Sabadell, Barcelona, Spain

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of the population between 40 and 70 years&#44;<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">4</span></a> it is important to have a baseline examination of patients before undergoing a radical prostatectomy in order to assess realistic expectations regarding their recovery&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Material and methods</span><p id="par0015" class="elsevierStylePara elsevierViewall">A prospective study was conducted from February 2012 to August 2016 to evaluate sexual function prior to laparoscopic radical prostatectomy in patients with prostate cancer willing to preserve their erectile function &#40;EF&#41;&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Before surgery&#44; patients responded to validated ED and sexual questionnaires&#58; the EF Domain &#40;questions 1&#8211;5 and 15&#41; of the International Index of Erectile Function &#40;IIEF&#41;<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">5</span></a> and Erection Hardness Score &#40;EHS&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">6</span></a> According to the IIEF test&#44; 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&#62;30<span class="elsevierStyleHsp" style=""></span>cm&#47;s&#44; and an end-diastolic velocity &#40;EDV&#41; &#60;5<span class="elsevierStyleHsp" style=""></span>cm&#47;s were taken as normal values&#46; In this way&#44; a study was considered normal with a PSV &#62;30<span class="elsevierStyleHsp" style=""></span>cm&#47;s and a EDV &#60;5<span class="elsevierStyleHsp" style=""></span>cm&#47;s&#46; Arterial insufficiency was considered when &#60;30<span class="elsevierStyleHsp" style=""></span>cm&#47;s PSV and &#60;5<span class="elsevierStyleHsp" style=""></span>cm&#47;s EDV&#46; Corporal veno-occlusive dysfunction &#40;CVOD&#41; was considered with a &#62;30<span class="elsevierStyleHsp" style=""></span>cm&#47;s PSV and a &#62;5<span class="elsevierStyleHsp" style=""></span>cm&#47;s EDV&#44; When both parameters were altered&#44;<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">9</span></a> we considered it as combined dysfunction&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Comorbidities&#44; the Charlson Comorbidity Index &#40;CCI&#41;<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">10</span></a> and drugs that could influence the patients&#8217; EF were collected&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">After surgery&#44; penile rehabilitation with daily use of vardenafil 5<span class="elsevierStyleHsp" style=""></span>mg was recommended to patients&#46; Apparently&#44; an early use of these drug could improve the intracavernous smooth muscle preservation&#46;<a class="elsevierStyleCrossRefs" href="#bib0180"><span class="elsevierStyleSup">11&#44;12</span></a></p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Statistical study</span><p id="par0050" class="elsevierStylePara elsevierViewall">The items of the EORTC QLQ C-30 and PR-25 questionnaires were scaled according to the scoring manual&#46;<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">13</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">The description of the qualitative variables has been made by their absolute and relative frequencies&#46; The description of the quantitative variables&#44; by the mean and the standard deviation &#40;with normal distribution&#41; or by the median and the interquartile range &#40;with non-normal distribution&#41;&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">A univariate study has been performed using the Chi-squared test for qualitative variables&#46; The Student&#39;s <span class="elsevierStyleItalic">t</span> test has been used for quantitative variables with normal distribution&#46; The Mann&#8211;Whitney <span class="elsevierStyleItalic">U</span> test for those with non-normal distributions&#44; and the Student&#39;s <span class="elsevierStyleItalic">t</span> test has been used for paired data to compare the variables of the quality of life questionnaires&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">The statistical significance will be established as <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;05 in all inferential tests&#46;</p></span></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Results</span><p id="par0070" class="elsevierStylePara elsevierViewall">A total of 112 patients whose characteristics are described in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#44; have been included in the study&#46; Due to the fact that it is a cohort of patients who are candidates for surgery&#44; we found little comorbidity&#44; with 78&#46;6&#37; presenting a CCI<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>2&#46; There is only 14&#46;3&#37; of diabetes&#44; 2&#46;7&#37; of ischaemic heart disease&#44; 35&#46;7&#37; of hypertension and 32&#46;1&#37; of dyslipidemia&#46; 43&#46;8&#37; of the patients are non-smokers&#46; Only 5&#46;4&#37; take beta blockers&#44; 14&#46;3&#37; diuretics&#44; 26&#46;8&#37; angiotensin-converting enzyme inhibitors and 25&#46;9&#37; statins&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0075" class="elsevierStylePara elsevierViewall">Quality of life scores from the QLQ C-30 and PR-25 questionnaires are shown in <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#46; We should note that&#58; 32 patients reported urinary incontinence prior to surgery&#44; although with little repercussion in their quality of life &#40;all scored 0&#41;&#44; and 14 patients did not score in the sexual function scale&#44; for they did not maintain sexual activity in the previous 4 weeks&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0080" class="elsevierStylePara elsevierViewall">The EF assessed with the IIEF and the EHS is shown in <a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#46; As occurred with the quality of life test&#44; 14 patients could not be evaluated by the IIEF&#44; due to the absence of sexual intercourse in the last 4 weeks&#46; According to the IIEF questionnaire&#44; 50&#46;9&#37; of the population had a normal EF&#46; The rest of the patients already presented some degree of ED&#46; In contrast&#44; up to 75&#46;9&#37; had a grade 3&#8211;4 erection in the EHS&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0085" class="elsevierStylePara elsevierViewall">Taking into account the patient&#39;s age&#44; the CCI and the IIEF score&#44; Briganti et al&#46;<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">14</span></a> categorised the patients into prognostic groups for the loss of EF after surgery with preservation of the neurovascular bundles&#46; The study population shows a similar distribution in all 3 risk categories&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a> shows the results of the EF evaluated with PDU&#46; Only 28&#46;6&#37; of the patients presented values within normality&#46; 51&#46;8&#37; showed some degree of arterial insufficiency &#40;pure and associated with CVOD&#41;&#46; These results are reflected in the medians of the PSV&#44; which are very close to the cutoff value considered as normal&#46;</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia><p id="par0095" class="elsevierStylePara elsevierViewall">5&#46;4&#37; &#40;6 patients&#41; were taking PDE5 inhibitors before surgery&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">We found a significant association &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;0001&#41; between the categorised EF-IIEF &#40;normal&#44; mild&#47;moderate&#47;severe&#41; and the EHS value&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">The relation between the presence of PDU &#40;normal vs&#46; pathological&#41; and the EHS &#40;3&#8211;4 vs&#46; 1&#8211;2&#41;&#44; was found as statistically significant association &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;005&#41;&#46; We found that 92&#46;6&#37; of the patients with EHS 1&#8211;2 presented a pathologic ultrasound&#46; In contrast&#44; in patients with a 3&#8211;4 EHS&#44; only 35&#46;3&#37; had a normal ultrasound&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">We evaluated the association between the EF assessed in the PDU &#40;normal vs&#46; pathologic&#41; and FE according to the IIEF &#40;&#8805;26 vs&#46; &#60;26&#41;&#46; A statistically significant association was found &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;043&#41;&#46; We have seen that 80&#37; of the patients with an IIEF &#60;26 had a pathologic ultrasound&#46; However&#44; only 36&#46;6&#37; of the patients with an IIEF &#8805;26 had a normal ultrasound&#46; In the group of patients with &#60;26 IIEF and pathologic PDU we found&#58; 42&#46;8&#37; of arterial insufficiency&#44; 28&#46;5&#37; CVOD and another 28&#46;5&#37; combined dysfunction&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">With the IIEF test used as reference test for normal vs&#46; pathologic EF classification of the patients&#44; we have seen PDU was a positive predictive value in 48&#46;5&#37; and a negative predictive value in 73&#37; of the cases&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">We have not found a statistically significant association between ED valued with EHS and the IIEF or PDU and the presence of the following&#58; diabetes&#44; ischaemic heart disease&#44; smoking&#44; hypertension&#44; dyslipidemia with CHF and taking beta-blockers&#44; diuretics&#44; angiotensin-converting enzyme inhibitors or statins&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">We have not found significant association between the existence of ED and the Gleason of the biopsy&#44; nor with the piece or the local stadium&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">We have studied the relationship between age and BMI and ED according to EHS&#44; IIEF and PDU&#46; Thus&#44; we find that the age is associated with the presence of ED evaluated with IIEF &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;004&#41; and PDU &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;029&#41;&#46; We found no association with EHS &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;346&#41;&#46; We found no relationship between BMI and IIEF &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;519&#41;&#44; ED &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;566&#41; or EHS &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;669&#41;&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">When we selected the 14 patients who had not had sexual activity in the previous month &#40;their score in the IIEF was not assessable&#41; we found that only 2 of them had a normal penile ultrasound&#46; There were ten patients with arterial insufficiency and 2 with CVOD&#46; In addition to the 5 patients presenting an EHS grade 3&#44; 80&#37; had a pathologic ultrasound&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">Regarding quality of life questionnaires&#44; we found that patients with IIEF &#60;26 present a lower score both in the sexual function item &#40;60&#46;64 vs&#46; 40&#46;5&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;0001&#41; as in the sexual activity item &#40;58&#46;68 vs&#46; 39&#46;12&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41; of the EORTC PR-25&#46; When assessing patients with EHS &#8804;2&#44; we found the same low score in erectile function &#40;55&#46;28 vs&#46; 32&#46;98&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;01&#41; and sexual activity &#40;47&#46;65 vs&#46; 30&#46;44&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;14&#41;&#46; In contrast&#44; no differences were found in these items between patients with normal ED vs&#46; pathologic&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">Regarding the remaining functions&#44; it is important to note that the emotional scored less than the rest of the function items&#46; Regarding symptoms&#44; insomnia scored significantly higher &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;0001&#41;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Discussion</span><p id="par0150" class="elsevierStylePara elsevierViewall">It is very important to carry out a baseline study of quality of life before applying treatments that can affect it&#44; as happens with radical prostatectomy&#46; In addition&#44; it is crucial to assess baseline EF&#44; as it is one of the items of quality of life that may be highly affected&#46;</p><p id="par0155" class="elsevierStylePara elsevierViewall">EF before radical surgery has been studied in every aspect&#46; We have not found EF-risk factors in our population in any of the diagnostic tests performed &#40;EHS&#44; IIEF&#44; PDU&#41;&#46; In contrast to other series&#8217; results&#44;<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">11</span></a> the presence of a higher comorbidity valued with the CCI has not appeared as a risk factor&#46; Cardiovascular disease &#40;diabetes mellitus&#44; dyslipidemia&#44; hypertension&#44; smoking&#41; risk factors have shown to be ED risk factors as well&#46; In spite of sharing common aspects for endothelial dysfunction&#44;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">15</span></a> a previous history of ischaemic heart disease was not associated with the presence of ischaemic heart disease&#46; Recent studies have shown that poor glycemic control in type 2 diabetic patients and the presence of a high BMI are also risk factors&#46;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">16</span></a> We have probably not found an association due to the selection bias of patients who are candidates for surgical treatment and&#44; therefore&#44; have a low rate of comorbidities&#46; This is shown by the fact that the majority of patients had a CCI<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>2&#46; Only 2&#46;7&#37; were affected by ischaemic heart disease and 14&#46;3&#37; were diabetic&#46; Moreover&#44; as our patients had been selected for surgery&#44; we did not find many patients with obesity criteria &#40;as shown in the BMI median&#41;&#46;</p><p id="par0160" class="elsevierStylePara elsevierViewall">In contrast to what other authors have mentioned &#40;they have even found that this relationship depends on the dose<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">17</span></a>&#41;&#44; we have not found association between ED and smoking&#46;</p><p id="par0165" class="elsevierStylePara elsevierViewall">Treatment with beta-blockers or diuretics in hypertensive patients has been associated with a worse EF&#46;<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">18</span></a> Hypertensive patients were mainly treated with angiotensin-converting enzyme inhibitors&#46; The use of beta-blockers or diuretics was very low&#46; This may explain the absence of association between these drugs and a worse EF&#46;</p><p id="par0170" class="elsevierStylePara elsevierViewall">Both the performance of prostate biopsies and the diagnosis of prostate cancer have an impact on EF&#46; Murray et al&#46; found that 34&#37; of the patients with normal EF presented a decreased IIEF one week later&#46; They also found that the diagnosis of prostate cancer was a factor for the decrease in the IIEF<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">19</span></a> score&#46;</p><p id="par0175" class="elsevierStylePara elsevierViewall">Anxiety towards the probability of having cancer also plays an important role in the EF of patients undergoing prostate biopsy&#46;<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">20</span></a> Moreover&#44; Helfand et al&#46; found that patients with a prostate cancer diagnosis have worse IIEF than patients with negative prostate biopsy&#46;<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">21</span></a></p><p id="par0180" class="elsevierStylePara elsevierViewall">This would explain why 14 patients had not had sexual intercourse during the previous 4 weeks&#46; The systematic use of a questionnaire like IIEF to evaluate EF may not be the best option in patients diagnosed with prostate cancer&#46; It would be advisable to carry out a more complete evaluation of the EF in order to achieve a more realistic approach&#44; not only based on questionnaires&#46; This way&#44; we would be able to know the real expectations we could have on the recovery of this function after surgery&#46;</p><p id="par0185" class="elsevierStylePara elsevierViewall">In addition&#44; this anxiety would show why our population had the emotional function more altered than the rest of the functions&#44; as well as having insomnia as the highest symptom&#46; All this could be due to the recent diagnosis of prostate cancer&#46;</p><p id="par0190" class="elsevierStylePara elsevierViewall">As far as we know&#44; there has only been one study evaluating EF through PDU&#46; Kawanishi et al&#46;<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">22</span></a> performed one previous PDU with a second performance 4&#8211;6 weeks post-surgery&#44; only in cases where EF was preserved&#46; They only reveal the PSV&#44; which is slightly higher than the one obtained in our series &#40;36&#46;1 and 37&#46;7<span class="elsevierStyleHsp" style=""></span>cm&#47;s for the right and left sides&#44; respectively&#41;&#46; They did not find changes in the PSV in the subsequent control&#46; We ignore long-term changes&#44; and evolution in the PDU of patients with ED&#44; as 4&#8211;6 weeks is a short period for the EF recovery&#46;</p><p id="par0195" class="elsevierStylePara elsevierViewall">We believe that it is important to assess the EF with all the tools available&#44; with subjective data &#40;IIEF and the EHS&#41;&#44; as well as objective data &#40;PDU&#41; which can provide information on the aetiology of EF&#46; Blander et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">23</span></a> have already doubted whether the questionnaires could replace the EF test&#46; They concluded that the IIEF is a good starting point that should probably be complemented with objective techniques&#44; especially to assess the efficacy of treatments&#46; In our series&#44; PDV has been very useful to evaluate the EF in those patients who had not had sexual intercourse during the last 4 weeks&#44; since the IIEF did not provide information in these cases&#46;</p><p id="par0200" class="elsevierStylePara elsevierViewall">Ultrasound has also been very useful in the group of patients with IIEF &#8805;26&#46; 61&#46;4&#37; of the cases had a pathologic ultrasound&#44; and this could be the first indication of an underlying ED and would probably have an impact on the EF recovery after surgery&#46; This would explain why the positive predictive value of the PDU was only of 48&#46;5&#37;&#46; PDU is convenient when results are normal&#44; since in most cases the patient will present a IIEF &#8805;26&#44; due to the high negative predictive value&#46;</p><p id="par0205" class="elsevierStylePara elsevierViewall">Regarding quality of life&#44; we found association between the self-administered tests IIEF and EHS and the EORTC PR-25 test when it grades function and sexual activity&#46; As logical as it seems&#44; we found the same results in our patients using the same method with different questions&#46; However&#44; we did not obtain differences in the results of patients with normal and with pathological PDU&#46; This is why we believe there is a group of patients in which the pathological PDU is the first sign of a possible underlying ED&#46;</p><p id="par0210" class="elsevierStylePara elsevierViewall">In relation to the remaining quality of life items&#44; Pompe et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">24</span></a> conducted a baseline study using the QoL item of the EORTC QLQ C-30&#44; with a mean of 74&#44; much lower than that of our series&#46;</p><p id="par0215" class="elsevierStylePara elsevierViewall">Lennern&#228;s et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">25</span></a> also used the EORTC QLQ C-30 in patients who were undergoing radical prostatectomy&#46; Their scores on the functional scale were similar to ours&#44; but our patients scored lower in relation to fatigue and pain &#40;the mean was 14 and 7&#44; respectively&#41;&#46; The scale of financial difficulties &#40;mean 8&#41; is also lower&#44; which could be due to differences between Sweden and Spain&#39;s National Health Systems&#46;</p><p id="par0220" class="elsevierStylePara elsevierViewall">The main limitation of our study is having a small patient cohort&#46; Our study provides an assessment of the overall situation of the patient in terms of their general health condition and those aspects that may be harmed by surgical treatment&#46; In particular&#44; it presents an important assessment of the EF in all its aspects&#44; with the aid of subjective&#44; validated questionnaires&#44; as well as with objective explorations&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Conclusions</span><p id="par0225" class="elsevierStylePara elsevierViewall">It is very important to perform a baseline assessment of every aspect concerning the patient&#39;s quality of life that may be affected by radical prostatectomy&#46; In particular&#44; it is important to carry out a global analysis of the EF &#40;not only through IIEF&#41; in order to assess its recovery expectations after surgery&#46; PDU can play a very significant role in this evaluation&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Conflict of interests</span><p id="par0230" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflict of interests&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introduction</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Given the high prevalence of erectile dysfunction in male population between 40 and 70 years old and the effect of radical prostatectomy on this domain&#44; it is important to perform a baseline study&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Material and methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Prior radical prostatectomy&#44; erectile function has been assessed prospectively in 112 prostate cancer patients using the erectile function &#40;EF&#41; domain of the International Index of Erectile Function &#40;EF-IIEF&#41;&#44; Erectile Hardness Score &#40;EHS&#41; and a penile doppler ultrasound &#40;PDUS&#41;&#46; Comorbidities and Charlson index were collected&#46; The EORTC QLQ C-30 and PR-25 tests were administered&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">According to EF-IIEF questionnaire&#44; 50&#46;9&#37; of patients showed normal EF and EHS grade 3&#8211;4 erection was achieved in the 75&#46;9&#37;&#46; PDUS was normal only in 28&#46;6&#37; of patients and 51&#46;8&#37; showed arterial insufficiency&#46; We found a significant association &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0001&#41; between categorised EF-IIEF &#40;normal&#44; mild&#47;moderate&#47;severe&#41; and the EHS value&#46; Between PDUS &#40;normal vs&#46; pathologic&#41; and EHS &#40;3&#8211;4 vs&#46; 1&#8211;2&#41; statistically significant association &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;005&#41; was found&#46; Just 35&#46;3&#37; of patients with EHS 3&#8211;4 showed normal PDUS&#46; Correlation between the PDUS and the EF-IIEF &#40;&#8805;26 vs&#46; 26&#41; was statistically significant &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;043&#41;&#46; Moreover&#44; only 38&#46;6&#37; of patients with EF-IIEF<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>26 had a normal PDUS&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">In order to predict EF recovery after surgery&#44; global assessment is required&#46; Solely self-administered tests are not enough&#46; In this baseline study&#44; PDUS can play an important role&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0005"
            "titulo" => "Introduction"
          ]
          1 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "Material and methods"
          ]
          2 => array:2 [
            "identificador" => "abst0015"
            "titulo" => "Results"
          ]
          3 => array:2 [
            "identificador" => "abst0020"
            "titulo" => "Conclusions"
          ]
        ]
      ]
      "es" => array:3 [
        "titulo" => "Resumen"
        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introducci&#243;n</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">La disfunci&#243;n er&#233;ctil peneana tiene una prevalencia alta entre los 40-70 a&#241;os&#44; por lo que es importante su valoraci&#243;n basal antes de la prostatectom&#237;a radical&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Material y m&#233;todos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Se ha evaluado la funci&#243;n er&#233;ctil &#40;FE&#41; de 112 pacientes con c&#225;ncer de pr&#243;stata previamente a la prostatectom&#237;a radical&#44; mediante el dominio de la FE del &#205;ndice Internacional de Funci&#243;n Er&#233;ctil &#40;IIEF&#41;&#44; el test Erectile Hardness Score &#40;EHS&#41; y una ecograf&#237;a doppler de pene &#40;EDP&#41;&#46; Se recogieron comorbilidades&#44; el &#237;ndice de Charlson y se administr&#243; el test de calidad de vida de la EORTC QLQ <span class="elsevierStyleSmallCaps">C</span>-30 y PR-25&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Un 50&#44;9&#37; de la poblaci&#243;n ten&#237;an una FE normal usando el cuestionario IIEF y un 75&#44;9&#37; consegu&#237;an una erecci&#243;n grado 3-4 en el EHS&#46; &#218;nicamente el 28&#44;6&#37; presentaban una EDP normal&#44; y el 51&#44;8&#37; mostraron insuficiencia arterial&#46; Encontramos una asociaci&#243;n significativa &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;0001&#41; entre el IIEF categorizado y el valor de EHS&#46; Se encontr&#243; una asociaci&#243;n significativa &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;005&#41; entre la presencia en la EDP &#40;normal vs&#46; patol&#243;gico&#41; y el EHS &#40;3-4 vs&#46; 1-2&#41;&#46; Solo el 35&#44;3&#37; de los pacientes con un EHS de 3-4 ten&#237;an una EDP normal&#46; Tambi&#233;n encontramos una asociaci&#243;n significativa &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;043&#41; entre la EDP y la FE valorada seg&#250;n el IIEF &#40;&#8805;26 vs&#46; 26&#41;&#46; &#218;nicamente ten&#237;an una EDP normal el 38&#44;6&#37; de los pacientes con IIEF<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>26&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Es importante una valoraci&#243;n global de la FE para poder valorar las expectativas de recuperaci&#243;n de dicha funci&#243;n tras la cirug&#237;a y no reducirla &#250;nicamente a test autoadministrados&#44; pudiendo jugar un papel importante la EDP&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0025"
            "titulo" => "Introducci&#243;n"
          ]
          1 => array:2 [
            "identificador" => "abst0030"
            "titulo" => "Material y m&#233;todos"
          ]
          2 => array:2 [
            "identificador" => "abst0035"
            "titulo" => "Resultados"
          ]
          3 => array:2 [
            "identificador" => "abst0040"
            "titulo" => "Conclusiones"
          ]
        ]
      ]
    ]
    "NotaPie" => array:1 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0015">Please cite this article as&#58; Mu&#241;oz-Rodr&#237;guez J&#44; Hannaoui N&#44; Dom&#237;nguez A&#44; Centeno C&#44; Parejo V&#44; Rosado MA&#44; et al&#46; Impacto del estudio basal con ecograf&#237;a doppler en pacientes con c&#225;ncer de pr&#243;stata previo a prostatectom&#237;a radical&#46; Actas Urol Esp&#46; 2019&#59;43&#58;84&#8211;90&#46;</p>"
      ]
    ]
    "multimedia" => array:4 [
      0 => array:8 [
        "identificador" => "tbl0005"
        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at1"
            "detalle" => "Table "
            "rol" => "short"
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        "tabla" => array:2 [
          "leyenda" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">SD&#58; standard deviation&#59; IQR&#58; interquartile range&#46;</p>"
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                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Age &#40;years&#41;&#44; mean &#40;SD&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">61&#46;77 &#40;5&#46;90&#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="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Body mass index &#40;kg&#47;m</span><span class="elsevierStyleSup"><span class="elsevierStyleItalic">2</span></span><span class="elsevierStyleItalic">&#41;&#44; mean &#40;SD&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">27&#46;76 &#40;3&#46;29&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Charlson comorbidity index&#44; n &#40;&#37;&#41;</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">53 &#40;47&#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="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">35 &#40;31&#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="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">15 &#40;13&#46;4&#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="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>&#62;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9 &#40;8&#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="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Prostate-specific antigen &#40;ng&#47;ml&#41;&#44; median &#40;IQR&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6&#46;33 &#40;5&#46;29&#8211;9&#46;33&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Biopsy Gleason&#44; n &#40;&#37;&#41;</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>&#8804;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">55 &#40;49&#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="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">51 &#40;45&#46;5&#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="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>&#8805;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6 &#40;5&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Pathological stage&#44; n &#40;&#37;&#41;</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>pT2a-b&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">31 &#40;28&#46;57&#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="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>pT2c&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">66 &#40;58&#46;92&#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="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>pT3a-b&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">14 &#40;12&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Pathological Gleason&#44; n &#40;&#37;&#41;</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>&#8804;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">43 &#40;38&#46;39&#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="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">66 &#40;58&#46;92&#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="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>&#8805;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3 &#40;2&#46;67&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Neurovascular bundles&#8217; preservation&#44; n &#40;&#37;&#41;</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>No preservation&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">30 &#40;26&#46;78&#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="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Unilateral&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">26 &#40;23&#46;21&#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="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Bilateral&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">56 &#40;50&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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        "descripcion" => array:1 [
          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Patient and tumour characteristics&#46;</p>"
        ]
      ]
      1 => array:8 [
        "identificador" => "tbl0010"
        "etiqueta" => "Table 2"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at2"
            "detalle" => "Table "
            "rol" => "short"
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        ]
        "tabla" => array:3 [
          "leyenda" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">SD&#58; standard deviation&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <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="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Mean &#40;SD&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">QLQ C-30 functioning</span><a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Physical functioning&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">96&#46;9 &#40;0&#46;67&#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="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Role functioning&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">97&#46;91 &#40;0&#46;73&#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="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Emotional functioning&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">78&#46;71 &#40;1&#46;91&#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="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Cognitive functioning&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">93&#46;52 &#40;1&#46;07&#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="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Social functioning&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">94&#46;19 &#40;1&#46;49&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">QLQ C-30 symptoms</span><a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Fatigue&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6&#46;94 &#40;1&#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="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Nausea and vomiting&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;44 &#40;0&#46;33&#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="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Pain&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7&#46;88 &#40;1&#46;43&#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="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Dyspnoea&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&#46;35 &#40;1&#46;23&#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="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Insomnia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">17&#46;85 &#40;2&#46;19&#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="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Appetite loss&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&#46;46 &#40;1&#46;23&#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="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Constipation&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6&#46;54 &#40;1&#46;39&#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="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Diarrhoea&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&#46;57 &#40;0&#46;97&#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="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Financial difficulties&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#46;38 &#40;0&#46;91&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">QLQ C-30 quality of life</span><a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Quality of life&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">81&#46;26 &#40;1&#46;69&#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="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>QLQ Summary Score&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">92&#46;58 &#40;0&#46;66&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">EORTC PR-25 functioning and symptoms</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Sexual activity <a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">51&#46;04 &#40;2&#46;55&#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="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Sexual functioning<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">77&#46;81 &#40;2&#46;21&#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="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Urinary symptoms<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">15&#46;65 &#40;1&#46;24&#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="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Bowel symptoms<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&#46;01 &#40;0&#46;63&#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="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Hormonal treatment side-effects<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&#46;21 &#40;0&#46;54&#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="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Urinary incontinence symptoms<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0 &#40;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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              "identificador" => "tblfn0005"
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              "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Functioning scales go from 0 to 100&#44; with higher scores representing better functioning&#46;</p>"
            ]
            1 => array:3 [
              "identificador" => "tblfn0010"
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              "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Symptom scales go from 0 to 100&#44; with lower scores representing less symptoms&#46;</p>"
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          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Results of the EORT QLQ C-30 and PR-25 questionnaires&#46;</p>"
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      ]
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        "etiqueta" => "Table 3"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
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            "identificador" => "at3"
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                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Erectile Hardness Score&#44; n &#40;&#37;&#41;</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>I&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6 &#40;5&#46;4&#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="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>II&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">21 &#40;18&#46;8&#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="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>III&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">68 &#40;60&#46;7&#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="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>IV&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">17 &#40;15&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Erectile function domain of the International Index of Erectile Function&#44; n &#40;&#37;&#41;</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Normal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">57 &#40;50&#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="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Mild&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">24 &#40;21&#46;4&#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="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Moderate&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">13 &#40;11&#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="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Severe&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4 &#40;3&#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="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>No sexual activity&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">14 &#40;12&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Risk groups for the recovery of sexual functioning&#44; n &#40;&#37;&#41;</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Low risk&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">34 &#40;30&#46;4&#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="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Intermediate risk&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">38 &#40;33&#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="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>High risk&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">40 &#40;35&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Erectile Hardness Score&#44; International Index of Erectile Function and Briganti risk groups&#46;</p>"
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        "identificador" => "tbl0020"
        "etiqueta" => "Table 4"
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            "identificador" => "at4"
            "detalle" => "Table "
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        "tabla" => array:2 [
          "leyenda" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">IQR&#58; interquartile range&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Right cavernosal artery diameter &#40;mm&#41;&#44; median &#40;IQR&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;70 &#40;0&#46;59&#8211;0&#46;81&#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="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Left cavernosal artery diameter &#40;mm&#41; median &#40;IQR&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;69 &#40;0&#46;62&#8211;0&#46;81&#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="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Peak systolic velocity of the right cavernosal artery &#40;cm&#47;s&#41;&#44; median &#40;IQR&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">30&#46;63 &#40;21&#46;72&#8211;39&#46;97&#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="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Peak systolic velocity of the left cavernosal artery &#40;cm&#47;s&#41;&#44; median &#40;IQR&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">30&#46;07 &#40;20&#46;22&#8211;39&#46;27&#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="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">End-diastolic velocity of the right cavernosal artery &#40;cm&#47;s&#41;&#44; median &#40;IQR&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&#46;34 &#40;2&#46;52&#8211;8&#46;0&#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="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">End-diastolic velocity of the left cavernosal artery &#40;cm&#47;s&#41;&#44; median &#40;IQR&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&#46;03 &#40;2&#46;32&#8211;7&#46;67&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Doppler ultrasound result&#44; n &#40;&#37;&#41;</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Normal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">32 &#40;28&#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="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Arterial insufficiency&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">43 &#40;38&#46;4&#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="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Veno-occlusive dysfunction&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">22 &#40;19&#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="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Mixed dysfunction&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">15 &#40;13&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "en" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Results of the penile Doppler ultrasound&#46;</p>"
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