{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,8]],"date-time":"2026-04-08T16:10:48Z","timestamp":1775664648266,"version":"3.50.1"},"reference-count":32,"publisher":"Springer Science and Business Media LLC","issue":"8","license":[{"start":{"date-parts":[[2024,1,29]],"date-time":"2024-01-29T00:00:00Z","timestamp":1706486400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2024,1,29]],"date-time":"2024-01-29T00:00:00Z","timestamp":1706486400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"Gabinete de Apoio \u00e0 Investiga\u00e7\u00e3o Cient\u00edfica, Tecnol\u00f3gica e Inova\u00e7\u00e3o da Faculdade de Medicina da Universidade de Lisboa","award":["20210020"],"award-info":[{"award-number":["20210020"]}]},{"DOI":"10.13039\/501100005765","name":"Universidade de Lisboa","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100005765","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Aesth Plast Surg"],"published-print":{"date-parts":[[2024,4]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Introduction<\/jats:title>\n                <jats:p>Division of the suspensory ligament of the penis has emerged as a popular surgical approach for penile lengthening, but accurate preoperative predictions of lengthening outcomes remain elusive. This study aimed to identify readily measurable anatomical parameters associated with post-ligamentolysis penile length gain, facilitating more reliable preoperative estimations.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>An experimental cross-sectional study was performed on 16 adult cadavers. Data collected before dissection included: age at death, ethnicity, height, length of the penis before dissection and width of the suspensory ligament of penis. Following the complete dissection of the suspensory ligament of penis, the depth of the pubic symphysis and the penile length after the procedure were measured. The absolute and relative length differences pre- and post-ligamentolysis were calculated. Correlation coefficients were used to study relations between these variables.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>Penile length increased uniformly after complete division of the suspensory ligament (average gain: 26.38\u00a0mm, SD = 14.83\u00a0mm; range 4\u201360\u00a0mm). Pearson correlation revealed a significant negative correlation between pre-ligamentolysis penile length and post-ligamentolysis increase (<jats:italic>r<\/jats:italic> = \u2212 0.601; <jats:italic>p<\/jats:italic> = 0.014), suggesting greater gains in individuals with shorter pre-ligamentolysis lengths. Age, ligament width, and pubic arch depth showed no significant correlations. Ethnicity did not impact post-ligamentolysis length increase (<jats:italic>t<\/jats:italic> = \u2212 0.135; <jats:italic>p<\/jats:italic> = 0.894).<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>This study highlights the potential to predict penile length gain post-ligamentolysis through measurable anatomical parameters. The ability to anticipate the outcome of this procedure could empower surgeons to provide informed counseling, potentially elevating patient satisfaction.<jats:list list-type=\"bullet\">\n                  <jats:list-item>\n                    <jats:p>An experimental cross-sectional study was performed to investigate the outcomes of penile lengthening surgery<\/jats:p>\n                  <\/jats:list-item>\n                  <jats:list-item>\n                    <jats:p>Penile lengthening was achieved in all subjects via complete dissection of the suspensory ligament of the penis<\/jats:p>\n                  <\/jats:list-item>\n                  <jats:list-item>\n                    <jats:p>Penile length increase may be predicted preoperatively using easily measurable anatomical parameters<\/jats:p>\n                  <\/jats:list-item>\n                <\/jats:list><\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>No Level Assigned<\/jats:title>\n                <jats:p>This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"http:\/\/www.springer.com\/00266\">www.springer.com\/00266<\/jats:ext-link><\/jats:p>\n              <\/jats:sec>","DOI":"10.1007\/s00266-023-03837-7","type":"journal-article","created":{"date-parts":[[2024,1,29]],"date-time":"2024-01-29T19:02:41Z","timestamp":1706554961000},"page":"1635-1643","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Morphometric Predictors of Penile Length Increase After Division of its Suspensory Ligament"],"prefix":"10.1007","volume":"48","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2075-6625","authenticated-orcid":false,"given":"M\u00e1rcio","family":"Ramos","sequence":"first","affiliation":[]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2822-5650","authenticated-orcid":false,"given":"Alice","family":"Varanda Pereira","sequence":"additional","affiliation":[]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8977-3768","authenticated-orcid":false,"given":"Leonardo","family":"Silva","sequence":"additional","affiliation":[]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9965-1326","authenticated-orcid":false,"given":"Ana Rita","family":"In\u00e1cio","sequence":"additional","affiliation":[]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4473-4076","authenticated-orcid":false,"given":"Ivo","family":"\u00c1lvares Furtado","sequence":"additional","affiliation":[]}],"member":"297","published-online":{"date-parts":[[2024,1,29]]},"reference":[{"key":"3837_CR1","doi-asserted-by":"publisher","first-page":"114","DOI":"10.1038\/ncpuro0120","volume":"2","author":"Y Vardi","year":"2005","unstructured":"Vardi Y, Lowenstein L (2005) Penile enlargement surgery\u2014fact or illusion? Nat Clin Pract Urol 2:114\u2013115. https:\/\/doi.org\/10.1038\/ncpuro0120","journal-title":"Nat Clin Pract Urol"},{"key":"3837_CR2","doi-asserted-by":"publisher","first-page":"609","DOI":"10.1016\/j.eururo.2005.12.053","volume":"49","author":"Y Vardi","year":"2006","unstructured":"Vardi Y (2006) Is penile enlargement an ethical procedure for patients with a normal-sized penis? Eur Urol 49:609\u2013611. https:\/\/doi.org\/10.1016\/j.eururo.2005.12.053","journal-title":"Eur Urol"},{"key":"3837_CR3","doi-asserted-by":"publisher","first-page":"519","DOI":"10.1038\/ijir.2008.14","volume":"20","author":"BE Dillon","year":"2008","unstructured":"Dillon BE, Chama NB, Honig SC (2008) Penile size and penile enlargement surgery: a review. Int J Impot Res 20:519\u2013529. https:\/\/doi.org\/10.1038\/ijir.2008.14","journal-title":"Int J Impot Res"},{"key":"3837_CR4","doi-asserted-by":"publisher","first-page":"1042","DOI":"10.1016\/j.eururo.2008.07.080","volume":"54","author":"Y Vardi","year":"2008","unstructured":"Vardi Y, Harshai Y, Gil T, Gruenwald I (2008) A critical analysis of penile enhancement procedures for patients with normal penile size: surgical techniques, success, and complications. Eur Urol 54:1042\u20131050. https:\/\/doi.org\/10.1016\/j.eururo.2008.07.080","journal-title":"Eur Urol"},{"key":"3837_CR5","doi-asserted-by":"publisher","first-page":"601","DOI":"10.1097\/MOU.0b013e3283318f31","volume":"16","author":"Y Vardi","year":"2009","unstructured":"Vardi Y, Gruenwald I (2009) The status of penile enhancement procedures. Curr Opin Urol 16:601\u2013605. https:\/\/doi.org\/10.1097\/MOU.0b013e3283318f31","journal-title":"Curr Opin Urol"},{"key":"3837_CR6","doi-asserted-by":"publisher","first-page":"819","DOI":"10.1038\/aja.2013.58","volume":"15","author":"N Mertziotis","year":"2013","unstructured":"Mertziotis N, Kozyrakis D, Bogris E (2013) Is V-Y plasty necessary for penile lengthening? Girth enhancement and increased length solely through circumcision: description of a novel technique. Asian J Androl 15:819\u2013823. https:\/\/doi.org\/10.1038\/aja.2013.58","journal-title":"Asian J Androl"},{"key":"3837_CR7","first-page":"94","volume":"4","author":"MR Bizic","year":"2016","unstructured":"Bizic MR, Djordjevic ML (2016) Penile enhancement surgery: an overview. Eur Med J Urol 4:94\u2013100","journal-title":"Eur Med J Urol"},{"key":"3837_CR8","doi-asserted-by":"publisher","first-page":"133","DOI":"10.1007\/978-3-662-46753-4_17","volume-title":"Penile augmentation","author":"WS Chung","year":"2016","unstructured":"Chung WS, Kim JY (2016) Penile lengthening with ligament release and V-Y advancement flap. Penile augmentation. Springer, Berlin, Heidelberg, pp 133\u2013140"},{"key":"3837_CR9","doi-asserted-by":"publisher","first-page":"245","DOI":"10.1016\/S0302-2838(02)00264-6","volume":"42","author":"E Austoni","year":"2002","unstructured":"Austoni E, Guarneri A, Cazzaniga A (2002) A new technique for augmentation phalloplasty: albugineal surgery with bilateral saphenous grafts\u2014three years of experience. Eur Urol 42:245\u2013253. https:\/\/doi.org\/10.1016\/S0302-2838(02)00264-6","journal-title":"Eur Urol"},{"key":"3837_CR10","doi-asserted-by":"publisher","first-page":"121","DOI":"10.1016\/j.eururo.2005.02.021","volume":"48","author":"E Spyropoulos","year":"2005","unstructured":"Spyropoulos E, Christoforidis C, Borousas D et al (2005) Augmentation phalloplasty surgery for penile dysmorphophobia in young adults: considerations regarding patient selection, outcome evaluation and techniques applied. Eur Urol 48:121\u2013128. https:\/\/doi.org\/10.1016\/j.eururo.2005.02.021","journal-title":"Eur Urol"},{"issue":"3","key":"3837_CR11","doi-asserted-by":"publisher","first-page":"129","DOI":"10.1037\/1524-9220.7.3.129","volume":"7","author":"J Lever","year":"2006","unstructured":"Lever J, Frederick DA, Peplau LA (2006) Does size matter? Men\u2019s and women\u2019s views on penis size across the lifespan. Psychol Men Masc 7(3):129","journal-title":"Psychol Men Masc"},{"key":"3837_CR12","doi-asserted-by":"publisher","first-page":"6323","DOI":"10.1038\/s41598-019-41652-w","volume":"9","author":"A Littara","year":"2019","unstructured":"Littara A, Melone R, Morales-Medina JC et al (2019) Cosmetic penile enhancement surgery: a 3-year single-centre retrospective clinical evaluation of 355 cases. Sci Rep 9:6323. https:\/\/doi.org\/10.1038\/s41598-019-41652-w","journal-title":"Sci Rep"},{"key":"3837_CR13","doi-asserted-by":"publisher","first-page":"81","DOI":"10.1046\/j.1464-410x.1998.00672.x","volume":"82","author":"MF Van Driel","year":"1998","unstructured":"Van Driel MF, Schultz WC, Van de Wiel HB, Mensink HJ (1998) Surgical lengthening of the penis. Br J Urol 82:81\u201385. https:\/\/doi.org\/10.1046\/j.1464-410x.1998.00672.x","journal-title":"Br J Urol"},{"key":"3837_CR14","doi-asserted-by":"publisher","first-page":"283","DOI":"10.1038\/sj.ijir.3900887","volume":"14","author":"N Mondaini","year":"2002","unstructured":"Mondaini N, Ponchietti R, Gontero P et al (2002) Penile length is normal in most men seeking penile lengthening procedures. Int J Impot Res 14:283\u2013286. https:\/\/doi.org\/10.1038\/sj.ijir.3900887","journal-title":"Int J Impot Res"},{"key":"3837_CR15","doi-asserted-by":"publisher","first-page":"1449","DOI":"10.1111\/j.1464-410X.2007.06806.x","volume":"99","author":"KR Wylie","year":"2007","unstructured":"Wylie KR, Eardley I (2007) Penile size and the \u201csmall penis syndrome.\u201d BJU Int 99:1449\u20131455. https:\/\/doi.org\/10.1111\/j.1464-410X.2007.06806.x","journal-title":"BJU Int"},{"key":"3837_CR16","doi-asserted-by":"publisher","first-page":"225","DOI":"10.1037\/a0033264","volume":"15","author":"L Johnston","year":"2014","unstructured":"Johnston L, McLellan T, McKinlay A (2014) (Perceived) size really does matter: male dissatisfaction with penis size. Psychol Men Masc 15:225\u2013228. https:\/\/doi.org\/10.1037\/a0033264","journal-title":"Psychol Men Masc"},{"key":"3837_CR17","doi-asserted-by":"publisher","first-page":"e0133079","DOI":"10.1371\/journal.pone.0133079","volume":"10","author":"N Prause","year":"2015","unstructured":"Prause N, Park J, Leung S, Miller G (2015) Women\u2019s preferences for penis size: a new research method using selection among 3D models. PLoS ONE 10:e0133079. https:\/\/doi.org\/10.1371\/journal.pone.0133079","journal-title":"PLoS ONE"},{"key":"3837_CR18","doi-asserted-by":"publisher","first-page":"645","DOI":"10.1016\/0022-3468(71)90391-5","volume":"6","author":"JH Kelley","year":"1971","unstructured":"Kelley JH, Eraklis AJ (1971) A procedure for lengthening the phallus in boys with exstrophy of the bladder. J Pediatr Surg 6:645\u2013649. https:\/\/doi.org\/10.1016\/0022-3468(71)90391-5","journal-title":"J Pediatr Surg"},{"key":"3837_CR19","doi-asserted-by":"publisher","first-page":"729","DOI":"10.1016\/j.eururo.2006.01.020","volume":"49","author":"C-Y Li","year":"2006","unstructured":"Li C-Y, Kayes O, Kell PD et al (2006) Penile suspensory ligament division for penile augmentation: indications and results. Eur Urol 49:729\u2013733. https:\/\/doi.org\/10.1016\/j.eururo.2006.01.020","journal-title":"Eur Urol"},{"key":"3837_CR20","doi-asserted-by":"publisher","first-page":"183","DOI":"10.1007\/s00266-004-0153-y","volume":"30","author":"DE Panfilov","year":"2006","unstructured":"Panfilov DE (2006) Augmentative phalloplasty. Aesthet Plast Surg 30:183\u2013197. https:\/\/doi.org\/10.1007\/s00266-004-0153-y","journal-title":"Aesthet Plast Surg"},{"key":"3837_CR21","doi-asserted-by":"publisher","first-page":"118","DOI":"10.1080\/00926230903554453","volume":"36","author":"HM Nugteren","year":"2010","unstructured":"Nugteren HM, Balkema GT, Pascal AL et al (2010) Penile enlargement: from medication to surgery. J Sex Marital Ther 36:118\u2013123. https:\/\/doi.org\/10.1080\/00926230903554453","journal-title":"J Sex Marital Ther"},{"key":"3837_CR22","doi-asserted-by":"publisher","first-page":"189","DOI":"10.1055\/s-0031-1281488","volume":"25","author":"G Alter","year":"2011","unstructured":"Alter G, Salgado C, Chim H (2011) Aesthetic surgery of the male genitalia. Semin Plast Surg 25:189\u2013195. https:\/\/doi.org\/10.1055\/s-0031-1281488","journal-title":"Semin Plast Surg"},{"key":"3837_CR23","doi-asserted-by":"publisher","first-page":"499","DOI":"10.1038\/nrurol.2012.150","volume":"9","author":"O Kayes","year":"2012","unstructured":"Kayes O, Shabbir M, Ralph D, Minhas S (2012) Therapeutic strategies for patients with micropenis or penile dysmorphic disorder. Nat Rev Urol 9:499\u2013507. https:\/\/doi.org\/10.1038\/nrurol.2012.150","journal-title":"Nat Rev Urol"},{"key":"3837_CR24","doi-asserted-by":"publisher","first-page":"413","DOI":"10.1007\/BF01653133","volume":"20","author":"A Hoznek","year":"1998","unstructured":"Hoznek A, Rahmouni A, Abbou C et al (1998) The suspensory ligament of the penis: an anatomic and radiologic description. Surg Radiol Anat 20:413\u2013417. https:\/\/doi.org\/10.1007\/BF01653133","journal-title":"Surg Radiol Anat"},{"key":"3837_CR25","first-page":"199","volume":"82","author":"V Protogerou","year":"2011","unstructured":"Protogerou V, Anagnostopolou S, Venierates D et al (2011) Penis ligaments: their use in \u201cincreasing\u201d the size of the penis in penile augmentation procedures. Anatomical description in human cadavers and clinical results of a phalloplasty series. Ann Ital Chir 82:199\u2013204","journal-title":"Ann Ital Chir"},{"key":"3837_CR26","doi-asserted-by":"publisher","first-page":"2436","DOI":"10.12659\/MSM.901926","volume":"23","author":"X Chen","year":"2017","unstructured":"Chen X, Wu Y, Tao L et al (2017) Visualization of penile suspensory ligamentous system based on visible human data sets. Med Sci Monit 23:2436\u20132444. https:\/\/doi.org\/10.12659\/MSM.901926","journal-title":"Med Sci Monit"},{"key":"3837_CR27","doi-asserted-by":"publisher","first-page":"530","DOI":"10.1016\/S0090-4295(94)80052-9","volume":"44","author":"MS Steiner","year":"1994","unstructured":"Steiner MS (1994) The puboprostatic ligament and the male urethral suspensory mechanism: an anatomic study. Urology 44:530\u2013534. https:\/\/doi.org\/10.1016\/S0090-4295(94)80052-9","journal-title":"Urology"},{"key":"3837_CR28","unstructured":"Klein R (1999) Penile augmentation surgery. Electron J Hum Sex. http:\/\/www.ejhs.org\/volume2\/klein\/penistoc.htm"},{"key":"3837_CR29","doi-asserted-by":"publisher","first-page":"596","DOI":"10.1097\/00006534-200002000-00018","volume":"105","author":"L Shirong","year":"2000","unstructured":"Shirong L, Xuan Z, Zhengxiang W et al (2000) Modified penis lengthening surgery: review of 52 cases. Plast Reconstr Surg 105:596\u2013599. https:\/\/doi.org\/10.1097\/00006534-200002000-00018","journal-title":"Plast Reconstr Surg"},{"key":"3837_CR30","doi-asserted-by":"publisher","first-page":"621","DOI":"10.1097\/00006534-198604000-00019","volume":"77","author":"SA Kramer","year":"1986","unstructured":"Kramer SA, Jackson IT (1986) Bilateral rhomboid flaps for reconstruction of the external genitalia in epispadias-exstrophy. Plast Reconstr Surg 77:621\u2013629. https:\/\/doi.org\/10.1097\/00006534-198604000-00019","journal-title":"Plast Reconstr Surg"},{"key":"3837_CR31","doi-asserted-by":"publisher","first-page":"69","DOI":"10.21037\/tau.2016.11.19","volume":"6","author":"J Campbell","year":"2017","unstructured":"Campbell J, Gillis J (2017) A review of penile elongation surgery. Transl Androl Urol 6:69\u201378. https:\/\/doi.org\/10.21037\/tau.2016.11.19","journal-title":"Transl Androl Urol"},{"key":"3837_CR32","doi-asserted-by":"publisher","first-page":"1811","DOI":"10.1016\/j.jsxm.2018.10.007","volume":"15","author":"J Furr","year":"2018","unstructured":"Furr J, Hebert K, Wisenbaugh E, Gelman J (2018) Complications of genital enlargement surgery. J Sex Med 15:1811\u20131817. https:\/\/doi.org\/10.1016\/j.jsxm.2018.10.007","journal-title":"J Sex Med"}],"container-title":["Aesthetic Plastic Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00266-023-03837-7.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00266-023-03837-7\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00266-023-03837-7.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,9,18]],"date-time":"2024-09-18T18:02:41Z","timestamp":1726682561000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00266-023-03837-7"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,1,29]]},"references-count":32,"journal-issue":{"issue":"8","published-print":{"date-parts":[[2024,4]]}},"alternative-id":["3837"],"URL":"https:\/\/doi.org\/10.1007\/s00266-023-03837-7","relation":{},"ISSN":["0364-216X","1432-5241"],"issn-type":[{"value":"0364-216X","type":"print"},{"value":"1432-5241","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,1,29]]},"assertion":[{"value":"3 August 2023","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"22 December 2023","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"29 January 2024","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare that they have no conflict of interest.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and\/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical Standards"}}]}}