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Frenuloplasty: from alpha to omega

International Journal of Impotence Research volume 34, pages 347–352 (2022)Cite this article

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Abstract

Frenuloplasty is a common surgical procedure performed on an outpatient basis either for the treatment of frenulum breve alone or as an additional intervention in patients undergoing circumcision. We aimed to provide tips and tricks on performing frenuloplasty, either alone or in combination with circumcision, and to generate a comprehensive review of the available literature on the matter. We suggest that the frenulum should be divided with a scalpel without the use of diathermy and reapproximated with interrupted 4-0 absorbable sutures. Moreover, the frenular artery should be maintained and any injury of the glans must be avoided to ensure optimal functional outcomes. After the procedure, a paraffin gauze filled with antibiotic paste followed by a light compression dressing for one day should be placed to maximize cosmetic results. Regarding the available literature, several methods of frenuloplasty have been described, varying from simple division of the frenulum to more sophisticated grafting or plasty techniques. Both the use of diathermy and the application of laser, with or without suturing of the released frenulum, seem to provide optimal functional and esthetic results. However, the findings of all available studies were mitigated by the relatively small number of included participants and low response rates. Additionally, comparative data or high-quality, long-term functional and cosmetic results on the matter are lacking. Therefore, until high-level evidence regarding frenuloplasty is available, individual clinical judgment should prevail.

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Fig. 1: Preoperative view of the penis.
Fig. 2: Frenuloplasty for frenulum breve.
Fig. 3: Frenuloplasty combined with circumcision.

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References

  1. Dwyer ME, Salgado CJ, Lightner DJ. Normal penile, scrotal, and perineal anatomy with reconstructive considerations. Semin Plast Surg. 2011;25:179–88.

    Article  Google Scholar 

  2. Yang CC, Bradley WE. Innervation of the human glans penis. J Urol. 1999;161:97–2.

    Article  CAS  Google Scholar 

  3. Halata Z, Munger BL. The neuroanatomical basis for the protopathic sensibility of the human glans penis. Brain Res. 1986;371:205–30.

    Article  CAS  Google Scholar 

  4. Whelan P. Male dyspareunia due to short frenulum: an indication for adult circumcision. Br Med J. 1977;2:1633–4.

    Article  CAS  Google Scholar 

  5. Gyftopoulos K. Male dyspareunia due to short frenulum: the suture-free, “pull and burn” method. J Sex Med. 2009;6:2611–4.

    Article  Google Scholar 

  6. Smith JA, Howards SS, Preminger GM, Dmochowski RR. Hinman’s Atlas of Urologic Surgery Revised Reprint. Philadelphia, PA: Elsevier Health Sciences; 2019. 1011.

  7. Cold CJ, Taylor JR. The prepuce. BJU Int. 1999;83:34–44.

    Article  Google Scholar 

  8. Sokolakis I, Pyrgidis N, Hatzichristodoulou G. The use of collagen fleece (TachoSil) as grafting material in the surgical treatment of Peyronie’s disease. A comprehensive narrative review. Int J Impot Res. 2021. https://doi.org/10.1038/s41443-020-00401-8. [epub ahead of print]

  9. Aird LNF, Bristol SG, Phang PT, Raval MJ, Brown CJ. Randomized double-blind trial comparing the cosmetic outcome of cutting diathermy versus scalpel for skin incisions. Br J Surg. 2015;102:489–94.

    Article  CAS  Google Scholar 

  10. Ly J, Mittal A, Windsor J. Systematic review and meta-analysis of cutting diathermy versus scalpel for skin incision. Br J Surg. 2012;99:613–20.

    Article  CAS  Google Scholar 

  11. Abdol-Mohammad K, Majid K, Mona A, Firouzeh H, Hamid A, Seyed-Mohammad M. 326 post circumcision meatal stenosis in the neonates due to meatal devascularisation: a comparison of franular artery sparing, plastibell and conventional technique. J Urol. 2011;185:e132–e132.

    Article  Google Scholar 

  12. Joudi M, Fathi M, Hiradfar M. Incidence of asymptomatic meatal stenosis in children following neonatal circumcision. J Pediatr Urol. 2011;7:526–8.

    Article  Google Scholar 

  13. Persad R, Sharma S, McTavish J, Imber C, Mouriquand PD. Clinical presentation and pathophysiology of meatal stenosis following circumcision. Br J Urol. 1995;75:91–3.

    Article  CAS  Google Scholar 

  14. Gallo L, Perdonà S, Gallo A. The role of short frenulum and the effects of frenulectomy on premature ejaculation. J Sex Med. 2010;7:1269–76.

    Article  Google Scholar 

  15. Gyftopoulos KI. Meatal stenosis after surgical correction of short frenulum: Is the “pull-and-burn” method the way to go? Urol Ann. 2018;10:354.

    Article  Google Scholar 

  16. Griffin AS, Kroovand RL. Frenular chordee: implications and treatment. Urology. 1990;35:133–4.

    Article  CAS  Google Scholar 

  17. Rajan P, McNeill SA, Turner KJ. Is frenuloplasty worthwhile? A 12-year experience. Ann R Coll Surg Engl. 2006;88:583–4.

    Article  Google Scholar 

  18. Duarte AF, Correia O. Laser CO2 frenuloplasty: a safe alternative treatment for a short frenulum. J Cosmet Laser Ther Publ Eur Soc Laser Dermatol. 2009;11:151–3.

    Article  Google Scholar 

  19. Kayes O, Li C-Y, Spillings A, Ralph D. Frenular grafting: an alternative to circumcision in men with a combination of tight frenulum and phimosis. J Sex Med. 2007;4:1070–3.

    Article  Google Scholar 

  20. Dockray J, Finlayson A, Muir GH. Penile frenuloplasty: a simple and effective treatment for frenular pain or scarring. BJU Int. 2012;109:1546–50.

    Article  Google Scholar 

  21. Gallo L, Perdonà S, Gallo A. Reply to Emmanuele A. Jannini’s Words of wisdom re: the role of short frenulum and the effects of frenulectomy on premature ejaculation [J Sex Med 2010;7:1269-76]. Eur Urol 2010;57:1119-20. Eur Urol. 2010;58:e49–50.

    Article  Google Scholar 

  22. Jannini EA. Words of wisdom. Re: the role of short frenulum and the effects of frenulectomy on premature ejaculation. Eur Urol. 2010;57:1119–20.

    Article  Google Scholar 

  23. Salonia A, Bettochi C, Carvalho J, Corona G, Jones TH, Kadioğlu A, et al. EAU Guidelines on Sexual and Reproductive Health 2020. In: European Association of Urology Guidelines 2020 Edition. Arnhem, The Netherlands: European Association of Urology Guidelines Office; 2020. https://uroweb.org/guideline/sexual-and-reproductive-health/.

  24. Hosseini SR, Mohseni MG, Salavati A, Yosefi R. Role of frenular web preservation on ejaculation latency time. Acta Med Iran. 2012;50:676–8.

    PubMed  Google Scholar 

Download references

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Authors and Affiliations

  1. Department of Urology, Martha-Maria Hospital Nuremberg, Nuremberg, Germany

    Nikolaos Pyrgidis, Ioannis Sokolakis & Georgios Hatzichristodoulou

  2. Department of Urology, Aristotle University of Thessaloniki, Thessaloniki, Greece

    Fotios Dimitriadis

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  1. Nikolaos Pyrgidis
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  2. Ioannis Sokolakis
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  3. Fotios Dimitriadis
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  4. Georgios Hatzichristodoulou
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All authors participated in the drafting, writing, and editing of the manuscript. All gave final approval and agree to be accountable for all aspects of work ensuring integrity and accuracy.

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Correspondence to Georgios Hatzichristodoulou.

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Pyrgidis, N., Sokolakis, I., Dimitriadis, F. et al. Frenuloplasty: from alpha to omega. Int J Impot Res 34, 347–352 (2022). https://doi.org/10.1038/s41443-021-00446-3

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