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Lysis of frenum
SURGEON’S
WORKSHOP
LYSIS OF FRENUM
BRADFORD
B. SCHWARTZ,
M.D.
From the Department of Urology, Naval Regional Medical Center, Philadelphia, Pennsylvania
Patients requesting circumcision frequently do so because of pain associated with stretching and tearing of the frenum during coitus. These patients attribute their symptoms to the presence of a redundant prepuce. However, the prepuce itself is not usually the cause of their pain. A tight frenum and its tethering effect during penile erection and penetration can be the basis for their complaints. Circumcision in these patients may not be necessary.
anesthetic configuration. A disposable batteryoperated cautery device has been found to be useful and efficient for the lysis. The frenum, while on tension, is incised with the glowing tip of the cautery (Fig. 1B). Small superficial vessels and bleeding points may be immediately coagulated. With care, an incision deeper than that required to divide the frenum is avoided. The sides of the incision may be approximated with fine absorbable suture creating a suture line
FIGURE 1. (A) With retraction of prepuce, tight frenum is brought into sharp relief. (B) Incision with cautey divides frenum. (C) Completed lysis; note lack of tethering with retraction of prepuce.
Lysis of the frenum may be utilized. The procedure is rapid, precise, and specific and spares the patient the morbidity and complications of a formal circumcision. Technique The prepuce is retracted and placed on the stretch creating tension in the tight frenum (Fig. 1A). Using aproximately 0.5 ml. of a local anesthetic, the frenum is infiltrated. The resulting bullous swelling is then reduced by firm pressure, returning the frenum to its pre-
UROLOGY
/ FEBRUARY
1979 !
VOLUME
XIII,
NUMBER 2
without tension and removing the tether of the frenum (Fig. 1C). A small piece of Vaseline impregnated gauze is placed on the suture line and the retracted prepuce is brought forward. The patient is advised to maintain the gauze in place until the following day and then fully retract the prepuce and gently cleanse the area twice daily until healing occurs. Postoperative discomfort is minimal. Philadelphia,
Pennsylvania 19145 (DR. SCHWARTZ)
195
WORKSHOP
LYSIS OF FRENUM
BRADFORD
B. SCHWARTZ,
M.D.
From the Department of Urology, Naval Regional Medical Center, Philadelphia, Pennsylvania
Patients requesting circumcision frequently do so because of pain associated with stretching and tearing of the frenum during coitus. These patients attribute their symptoms to the presence of a redundant prepuce. However, the prepuce itself is not usually the cause of their pain. A tight frenum and its tethering effect during penile erection and penetration can be the basis for their complaints. Circumcision in these patients may not be necessary.
anesthetic configuration. A disposable batteryoperated cautery device has been found to be useful and efficient for the lysis. The frenum, while on tension, is incised with the glowing tip of the cautery (Fig. 1B). Small superficial vessels and bleeding points may be immediately coagulated. With care, an incision deeper than that required to divide the frenum is avoided. The sides of the incision may be approximated with fine absorbable suture creating a suture line
FIGURE 1. (A) With retraction of prepuce, tight frenum is brought into sharp relief. (B) Incision with cautey divides frenum. (C) Completed lysis; note lack of tethering with retraction of prepuce.
Lysis of the frenum may be utilized. The procedure is rapid, precise, and specific and spares the patient the morbidity and complications of a formal circumcision. Technique The prepuce is retracted and placed on the stretch creating tension in the tight frenum (Fig. 1A). Using aproximately 0.5 ml. of a local anesthetic, the frenum is infiltrated. The resulting bullous swelling is then reduced by firm pressure, returning the frenum to its pre-
UROLOGY
/ FEBRUARY
1979 !
VOLUME
XIII,
NUMBER 2
without tension and removing the tether of the frenum (Fig. 1C). A small piece of Vaseline impregnated gauze is placed on the suture line and the retracted prepuce is brought forward. The patient is advised to maintain the gauze in place until the following day and then fully retract the prepuce and gently cleanse the area twice daily until healing occurs. Postoperative discomfort is minimal. Philadelphia,
Pennsylvania 19145 (DR. SCHWARTZ)
195