title: Frenulum Sparing Circumcision: Step-By-Step Approach of a Novel Technique.
abstract: OBJECTIVE
  Circumcision, by most conventional methodologies, involves division of the frenulum and excision of the entire foreskin covering the glans. This seemingly simple procedure is occasionally associated with dreadful and devastating complications. We describe a new frenulum-sparing technique that circumvents some of the potential complications of conventional techniques and could also potentially help preserve preputial role in sexual function.
  
  
  METHODS
  An initial dorsal slit, three fourths of the way up to the corona is extended laterally and obliquely on either side, to meet the preputial edge, 3-4 mm from the frenulum. A broad sleeve of sub-coronal mucosa is thus preserved. The frenulum is left untouched, leaving a wide skin bridge connecting the mucosal sleeve with the shaft skin. The raw area is closed with interrupted, synthetic absorbable sutures. Over a three year period, 42 patients were circumcised using this technique.
  
  
  RESULTS
  No significant complications like frenular bleed, painful postoperative erections, chordee, meatal stenosis, or urethra-cutaneous fistula were observed in any patient. The cosmetic results were pleasing.
  
  
  CONCLUSIONS
  The frenulum-sparing technique of circumcision is a promising modification to the various existing techniques. The method described is technically easier to perform than conventional frenulum-dividing procedures and has an acceptable cosmesis. Further randomised controlled studies on larger cohorts are necessary to establish the true benefits of this technique over established procedures.
authors.affiliation: Head, Department of Urology, A J Institute of Medical Sciences & Research Centre , Mangaluru, Karnataka, India .
authors.forename: Sunil Purshotham
authors.initials: SP
authors.lastname: Shenoy
authors.affiliation: Professor, Department of Urology, A J Institute of Medical Sciences & Research Centre , Mangaluru, Karnataka, India .
authors.forename: Prashanth Kallaje
authors.initials: PK
authors.lastname: Marla
authors.affiliation: Assistant Professor, Department of Urology, A J Institute of Medical Sciences & Research Centre , Mangaluru, Karnataka, India .
authors.forename: Pritham
authors.initials: P
authors.lastname: Sharma
authors.affiliation: Professor, Department of Paediatric Surgery, A J Institute of Medical Sciences & Research Centre , Mangaluru, Karnataka, India .
authors.forename: Narayana
authors.initials: N
authors.lastname: Bhat
authors.affiliation: Consultant Urological Surgeon, Wexham Park Hospital , Wexham, Royal County of Berkshire, SL2 4HL, UK .
authors.forename: Amrith Raj
authors.initials: AR
authors.lastname: Rao
keywords: Complications; Frenular artery; Phimosis; Prepuce
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