Frenulum Sparing Circumcision: Step-By-Step Approach of a Novel Technique
Identifieur interne : 000667 ( Pmc/Corpus ); précédent : 000666; suivant : 000668Frenulum Sparing Circumcision: Step-By-Step Approach of a Novel Technique
Auteurs : Sunil Purshotham Shenoy ; Prashanth Kallaje Marla ; Pritham Sharma ; Narayana Bhat ; Amrith Raj RaoSource :
- Journal of Clinical and Diagnostic Research : JCDR [ 2249-782X ] ; 2015.
Abstract
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.
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.
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.
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.
Url:
DOI: 10.7860/JCDR/2015/14972.6860
PubMed: 26816940
PubMed Central: 4717729
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PMC:4717729Le document en format XML
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<author><name sortKey="Shenoy, Sunil Purshotham" sort="Shenoy, Sunil Purshotham" uniqKey="Shenoy S" first="Sunil Purshotham" last="Shenoy">Sunil Purshotham Shenoy</name>
<affiliation><nlm:aff id="aff1"> Head, Department of Urology,<institution>A J Institute of Medical Sciences & Research Centre</institution>
,<addr-line>Mangaluru, Karnataka, India</addr-line>
.</nlm:aff>
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</author>
<author><name sortKey="Marla, Prashanth Kallaje" sort="Marla, Prashanth Kallaje" uniqKey="Marla P" first="Prashanth Kallaje" last="Marla">Prashanth Kallaje Marla</name>
<affiliation><nlm:aff id="aff2"> Professor, Department of Urology,<institution>A J Institute of Medical Sciences & Research Centre</institution>
,<addr-line>Mangaluru, Karnataka, India</addr-line>
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<author><name sortKey="Sharma, Pritham" sort="Sharma, Pritham" uniqKey="Sharma P" first="Pritham" last="Sharma">Pritham Sharma</name>
<affiliation><nlm:aff id="aff3"> Assistant Professor, Department of Urology,<institution>A J Institute of Medical Sciences & Research Centre</institution>
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<author><name sortKey="Bhat, Narayana" sort="Bhat, Narayana" uniqKey="Bhat N" first="Narayana" last="Bhat">Narayana Bhat</name>
<affiliation><nlm:aff id="aff4"> Professor, Department of Paediatric Surgery,<institution>A J Institute of Medical Sciences & Research Centre</institution>
,<addr-line>Mangaluru, Karnataka, India</addr-line>
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<author><name sortKey="Rao, Amrith Raj" sort="Rao, Amrith Raj" uniqKey="Rao A" first="Amrith Raj" last="Rao">Amrith Raj Rao</name>
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<sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Frenulum Sparing Circumcision: Step-By-Step Approach of a Novel Technique</title>
<author><name sortKey="Shenoy, Sunil Purshotham" sort="Shenoy, Sunil Purshotham" uniqKey="Shenoy S" first="Sunil Purshotham" last="Shenoy">Sunil Purshotham Shenoy</name>
<affiliation><nlm:aff id="aff1"> Head, Department of Urology,<institution>A J Institute of Medical Sciences & Research Centre</institution>
,<addr-line>Mangaluru, Karnataka, India</addr-line>
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<author><name sortKey="Marla, Prashanth Kallaje" sort="Marla, Prashanth Kallaje" uniqKey="Marla P" first="Prashanth Kallaje" last="Marla">Prashanth Kallaje Marla</name>
<affiliation><nlm:aff id="aff2"> Professor, Department of Urology,<institution>A J Institute of Medical Sciences & Research Centre</institution>
,<addr-line>Mangaluru, Karnataka, India</addr-line>
.</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Sharma, Pritham" sort="Sharma, Pritham" uniqKey="Sharma P" first="Pritham" last="Sharma">Pritham Sharma</name>
<affiliation><nlm:aff id="aff3"> Assistant Professor, Department of Urology,<institution>A J Institute of Medical Sciences & Research Centre</institution>
,<addr-line>Mangaluru, Karnataka, India</addr-line>
.</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Bhat, Narayana" sort="Bhat, Narayana" uniqKey="Bhat N" first="Narayana" last="Bhat">Narayana Bhat</name>
<affiliation><nlm:aff id="aff4"> Professor, Department of Paediatric Surgery,<institution>A J Institute of Medical Sciences & Research Centre</institution>
,<addr-line>Mangaluru, Karnataka, India</addr-line>
.</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Rao, Amrith Raj" sort="Rao, Amrith Raj" uniqKey="Rao A" first="Amrith Raj" last="Rao">Amrith Raj Rao</name>
<affiliation><nlm:aff id="aff5"> Consultant Urological Surgeon,<institution>Wexham Park Hospital</institution>
,<addr-line>Wexham, Royal County of Berkshire, SL2 4HL, UK</addr-line>
.</nlm:aff>
</affiliation>
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<series><title level="j">Journal of Clinical and Diagnostic Research : JCDR</title>
<idno type="ISSN">2249-782X</idno>
<idno type="eISSN">0973-709X</idno>
<imprint><date when="2015">2015</date>
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<front><div type="abstract" xml:lang="en"><sec><title>Objective</title>
<p>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.</p>
</sec>
<sec><title>Materials and Methods</title>
<p>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.</p>
</sec>
<sec><title>Results</title>
<p>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.</p>
</sec>
<sec><title>Conclusion</title>
<p>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.</p>
</sec>
</div>
</front>
</TEI>
<pmc article-type="research-article"><pmc-comment>The publisher of this article does not allow downloading of the full text in XML form.</pmc-comment>
<front><journal-meta><journal-id journal-id-type="nlm-ta">J Clin Diagn Res</journal-id>
<journal-id journal-id-type="iso-abbrev">J Clin Diagn Res</journal-id>
<journal-id journal-id-type="hwp">Journal of Clinical and Diagnostic Research</journal-id>
<journal-id journal-id-type="publisher-id">JCDR</journal-id>
<journal-title-group><journal-title>Journal of Clinical and Diagnostic Research : JCDR</journal-title>
</journal-title-group>
<issn pub-type="ppub">2249-782X</issn>
<issn pub-type="epub">0973-709X</issn>
<publisher><publisher-name>JCDR Research and Publications (P) Limited</publisher-name>
<publisher-loc>Delhi, India</publisher-loc>
</publisher>
</journal-meta>
<article-meta><article-id pub-id-type="pmid">26816940</article-id>
<article-id pub-id-type="pmc">4717729</article-id>
<article-id pub-id-type="doi">10.7860/JCDR/2015/14972.6860</article-id>
<article-categories><subj-group subj-group-type="heading"><subject>Surgery Section</subject>
<subj-group subj-group-type="heading"><subject>Original Article</subject>
</subj-group>
</subj-group>
</article-categories>
<title-group><article-title>Frenulum Sparing Circumcision: Step-By-Step Approach of a Novel Technique</article-title>
</title-group>
<contrib-group><contrib contrib-type="author" corresp="yes"><name><surname>Shenoy</surname>
<given-names>Sunil Purshotham</given-names>
</name>
<xref ref-type="aff" rid="aff1">1</xref>
<xref ref-type="corresp" rid="cor1"></xref>
</contrib>
<contrib contrib-type="author"><name><surname>Marla</surname>
<given-names>Prashanth Kallaje</given-names>
</name>
<xref ref-type="aff" rid="aff2">2</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Sharma</surname>
<given-names>Pritham</given-names>
</name>
<xref ref-type="aff" rid="aff3">3</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Bhat</surname>
<given-names>Narayana</given-names>
</name>
<xref ref-type="aff" rid="aff4">4</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Rao</surname>
<given-names>Amrith Raj</given-names>
</name>
<xref ref-type="aff" rid="aff5">5</xref>
</contrib>
</contrib-group>
<aff id="aff1"><label>1</label>
Head, Department of Urology,<institution>A J Institute of Medical Sciences & Research Centre</institution>
,<addr-line>Mangaluru, Karnataka, India</addr-line>
.</aff>
<aff id="aff2"><label>2</label>
Professor, Department of Urology,<institution>A J Institute of Medical Sciences & Research Centre</institution>
,<addr-line>Mangaluru, Karnataka, India</addr-line>
.</aff>
<aff id="aff3"><label>3</label>
Assistant Professor, Department of Urology,<institution>A J Institute of Medical Sciences & Research Centre</institution>
,<addr-line>Mangaluru, Karnataka, India</addr-line>
.</aff>
<aff id="aff4"><label>4</label>
Professor, Department of Paediatric Surgery,<institution>A J Institute of Medical Sciences & Research Centre</institution>
,<addr-line>Mangaluru, Karnataka, India</addr-line>
.</aff>
<aff id="aff5"><label>5</label>
Consultant Urological Surgeon,<institution>Wexham Park Hospital</institution>
,<addr-line>Wexham, Royal County of Berkshire, SL2 4HL, UK</addr-line>
.</aff>
<author-notes><corresp id="cor1">NAME, ADDRESS, E-MAIL ID OF THE CORRESPONDING AUTHOR: Dr. Sunil P. Shenoy, Head, Department of Urology, A.J. Institute of Medical Sciences & Research Centre, Mangaluru-575003, Karnataka, India. E-mail: <email>drsunilpshenoy@gmail.com</email>
</corresp>
</author-notes>
<pub-date pub-type="ppub"><month>12</month>
<year>2015</year>
</pub-date>
<pub-date pub-type="epub"><day>01</day>
<month>12</month>
<year>2015</year>
</pub-date>
<volume>9</volume>
<issue>12</issue>
<fpage>PC01</fpage>
<lpage>PC03</lpage>
<history><date date-type="received"><day>22</day>
<month>5</month>
<year>2015</year>
</date>
<date date-type="rev-request"><day>08</day>
<month>9</month>
<year>2015</year>
</date>
<date date-type="accepted"><day>15</day>
<month>10</month>
<year>2015</year>
</date>
</history>
<permissions><copyright-statement>© 2015 Journal of Clinical and Diagnostic Research</copyright-statement>
<copyright-year>2015</copyright-year>
</permissions>
<abstract><sec><title>Objective</title>
<p>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.</p>
</sec>
<sec><title>Materials and Methods</title>
<p>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.</p>
</sec>
<sec><title>Results</title>
<p>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.</p>
</sec>
<sec><title>Conclusion</title>
<p>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.</p>
</sec>
</abstract>
<kwd-group><kwd>Complications</kwd>
<kwd>Frenular artery</kwd>
<kwd>Prepuce</kwd>
<kwd>Phimosis</kwd>
</kwd-group>
</article-meta>
</front>
</pmc>
</record>
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