title: Penile frenuloplasty: a simple and effective treatment for frenular pain or scarring.
abstract: Study Type - Therapy (case series) Level of Evidence 4. What's known on the subject? and What does the study add? Frenuloplasty, using common plastic surgical techniques for scar lengthening, is a commonly performed operation amongst urologists for isolated frenular pathology. However, there is very little data in the urological literature regarding either technique or assessment. The only other published study was a questionnaire follow-up with a 23% response rate and the technique used was not clarified. Other studies describe expensive, rarely used procedures and are hampered by small patient numbers or short-term follow-up only. Our study validates the common practice of using plastic surgical techniques for scar lengthening. We have 100% clinical short-term follow-up (3 months) and 91% long-term follow-up (up to 10 years) showing high patient satisfaction scores and low complication and re-operation rates. This provides an evidence base from which to counsel patients who are keen for foreskin sparing surgery for frenular pathology. The extra addition of our grading system allows patients to be risk-stratified as to the risk of re-operation depending on their status at presentation and underlying pathology.
  
  
  OBJECTIVE
  To assess the long-term patient satisfaction and outcomes for penile frenuloplasty when offered as an alternative to circumcision for frenular pain and/or scarring.
  
  
  METHODS
  Data was prospectively collected over 10 years, for a total of 106 men. The nature of the frenular problem was graded. Techniques of V-Y plasty, Z-plasty or a combination of the two were used. All patients were reviewed at 3 months and contacted via questionnaire ≥ 1 year after surgery. The questionnaire assessed satisfaction, cosmetic appearance, pain on intercourse, need for subsequent surgery and if they would recommend the procedure to a friend.
  
  
  RESULTS
  Follow-up was 100% (106/106) at 3 months and 91% (96/106) ≥ 1 year. Patient satisfaction and cosmesis scores both averaged 8.9/10. Need for subsequent circumcision was 8% (9/96). There were minor complications (bruising/infection/partial dehiscence) in 8% (9/96) of patients. 97% (84/87) of patients would recommend the procedure to a friend.
  
  
  CONCLUSIONS
  Penile frenuloplasty is a safe alternative to circumcision. There are high patient satisfaction rates after surgery. Low numbers of patients require a completion circumcision after penile frenuloplasty.
authors.affiliation: King's College Hospital, Denmark Hill, London, UK. j.v.dockray@gmail.com
authors.forename: Judith
authors.initials: J
authors.lastname: Dockray
authors.forename: Alexander
authors.initials: A
authors.lastname: Finlayson
authors.forename: Gordon H
authors.initials: GH
authors.lastname: Muir
mesh_terms: D000328:Adult; D002921:Cicatrix / Q000209:etiology / Q000601:surgery*; D005500:Follow-Up Studies; D052816:Foreskin / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000209:etiology / Q000601:surgery*; D017060:Patient Satisfaction; D010409:Penile Diseases / Q000150:complications / Q000473:pathology / Q000601:surgery*; D010413:Penis / Q000601:surgery*; D019651:Plastic Surgery Procedures / Q000379:methods*; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome; D013521:Urologic Surgical Procedures, Male / Q000379:methods*; D055815:Young Adult