THE COMPLETE FRENULUM STUDIES

Part One:
Introduction (Grewel)
Basic Human Studies
Part Two:
Modern Treatment (Z plasty etc.)
Ancient treatment (Bryk, Luo Rites)
The Animal Studies

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PART TWO
Modern Treatment

Z plasty for frenulum breve was first reported in 1954

Drs. Jack Davis y Rufino J. Flores-Belaunde Frenillo de Pene. Plastica con "Z" (Spanish text) Frenulum of the Prepuce; "Z" shaped plastic surgery Rev. argent. urol 23:144-145 Mar-Ap 54 S

In figure 1 the principles of plastic surgery are outlined. The movement of two areas of healthy skin formed by two isocoleses triangles. One is designated with spots the other with stripes. By moving the free extremety of point B to point B', at the same time the other extremity A automatically moves to A' As a result of this transposition the skin areas obtain a greater vertical diameter and a zig zag scar.

Figure 2 shows the geometrical application on an area of skin whose folds run transversally, where a scar line (CICATRIZ) cuts them perpendicularly. To correct this scar line it is necessary to divide and divert this straight vertical line. The most effective way of doing this is the "Z" as described above.

Applying this method to the frenulum of the penis has given excellant results (figures 3 and 4) without any cases being unsuccessful or needing to be repeated. Notice that in figure 4 the vertical cut is hidden in the preputial fold and that the slanting cuts lie independantly on the glans and prepuce.

VR. Chitale, MS, FICS, Z Plasty for Short Frenum of Prepuce of Penis Ann Plast Surg 1991 Feb;26(2):196-7

"Z plasty for short scarred frenum of prepuce of penis is presented as a useful new technique."
"Previously we used to perform circumcision or frenoplasty with a transverse incision sutured vertically to treat this condition. Circumcision, however, was thought to be too big a procedure for this condition, and transverse incision sutured vertically did not give a satisfactory result. Hence a Z plasty was performed on the patient presented."

"The two triangles slid very easily, and suturing was done with 6-0 chromic catgut. The result was very satisfactory. The patient had satisfactory sexual intercourse 15 days after operation."

Bradford B. Schwartz, M.D. Lysis of frenum Urology 1979 Feb;13(2):195

"Lysis of the frenum may be utilised. ... ... A disposable battery-operated 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. Small superficial vessels and bleeding points may be immediately coagulated. ... The sides of the incision may be approximated with fine absorbable suture ... "

Hernaez Manrique, et al, Elongación del frenillo balanoprepucial con una técnica muy sencilla - (Spanish text) Elongation of the balano-preputial frenulum using a very simple technique Arch Esp Urol 1990 Jan-Feb;43(1):78-9

"Abstract - A new technique to achieve, elongation of frenulum is described. The procedure is simple, exsanguine, and can be performed quickly. The results obtained with this procedure is similar to those obtained with traditional techniques."

"1. Anaesthetic injection at the base of the frenulum. 2. The placement of two vascular clips as shown in figure 1." (one under the glans, the second parallel near the foreskin. 3. Section of the frenulum as in figure 2 and pulling the end of the clips away from each other) "4. When the frenulum is stretched as shown in figure 3, it is covered with a dressing for twenty four hours."

"The operation took place without bleeding and in no case took longer than five minutes. The clips released spontaneously after three or four days."

Campbell's Urology Edited by Patrick C. Walsh (et al.), Part XIV Chapter 107: Surgery of the Penis and Urethra Gerald H. Jordan, M.D., et al, Seventh Edition London W B Saunders 1998 Page 3333

During a description on a possible preparatory step for circumcision: ... "a second incision is marked, following the outlines of the corona and the V of the frenulum on the ventral side. The frenulum usually retracts into a V. In some cases, the frenulum can be lengthened by closing the edges of the V in a longitudinal orientation for a short length (frenuloplasty). If frenoplasty is done, the proximal incision does not need to follow the V of the retracted frenulum in that the ventral skin is straight"

Brough, Betts and Payne EMLA cream anaesthesia for frenuloplasty Br J Urol 1995 Nov;76(5):653-4

"Abstract - Objective: To evaluate the use of a eutectic mixture of local anaesthetics (EMLA) cream as the sole anaesthetic for frenuloplasty. Patients and Methods: Fifteen patients . were given topical EMLA cream 30 min before frenuloplasty; a Tegaderm dressing was applied to keep the anaesthetic in place. The level of anaesthesia was assessed on arrival in theatre using pin-prick testing and the patients were asked to grade their level of pain ...
Results: Fourteen patients had pain scores of zero and were fully anaesthetized during the procedure. One patient's Tegaderm dressing was displaced soon after application and he was inadequately anaesthetized on testing, ... and required infiltrative lignocaine ...
Conclusions: EMLA cream is a well-tolerated and reliable anaesthetic for frenuloplasty. Using a condom to keep the cream in place would reduce the small failure rate associated with the displacement of the Tegaderm dressing."

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Sensitivity

Four studies refer to the sensitivity in the area of the frenulum.
They largely discuss vibratory stimulation for impotence

Everaert and Oosterlinck Diagnosis and treatment of psychosocial induced anejaculation or anorgasm by vibratory stimulation Acta Urol Belg 1997 Mar;65(1):59-61

JL. Pryor et al. Vibratory stimulation for treatment of anejaculation in quadriplegic men (Arch Phys Med Rehabil 1995 Jan;76(1):59-64)

Sarkarati, Rossier and Fam Experience in vibratory and electro-ejaculation techniques in spinal cord injury patients: a preliminary report J Urol 1987 Jul;138(1):59-62

Paick JS, Jeong H, Park MS Penile sensitivity in men with premature ejaculation. Int J Impot Res 1998 Dec;10(4):247-50

Studies 18 men suffering premature ejaculation, none had frenulum breve.

Two studies on neuroanatomy.

Halata and Munger The neuroanatomical basis for the protopathic sensibility of the human glans penis Brain Res 1986 Apr 23;371(2):205-30

"Genital end bulbs are present throughout the glans, but are most numerous in the corona and near the frenulum."

Yang CC, Bradley WE Innervation of the human glans penis. J Urol 1999 Jan;161(1):97-102

"The penile dorsal nerve innervates the glans penis except for the area of the frenulum, which is innervated by the penile dorsal nerve and a branch of the perineal nerve."