Penile Frenulectomy - Procedure, Side Effect and Recovery

The scrotum and penis are the external male genitals, and the internal reproductive organs include the testicles. Penis has the following parts:

1. Shaft: It extends from the tip or head of the penis to the lower belly and looks like a tube. The shaft is outside the urethra.
2. Glans: The tip or head of the penis and the urethra open here. The urine, semen, and pre-ejaculation come out from the glans. 
3. Foreskin: It is a skin patch that protects and covers the glans.
4. Frenulum: the underside of the penis where the foreskin meets is the frenulum. The appearance of the frenulum is a slight V just below the head.

Individuals who are having issues such as:

1. Frenulum breve
2. Premature ejaculation

The procedure of penile frenulectomy involves the following point. The doctor does the following to the patient:

1. Apply lidocaine-prilocaine anaesthetic cream over the frenulum one hour before the surgery.
2. If required, a dose of 2% lidocaine will be injected at the level of the frenulum.
3. Pass a deep Vycril (synthetic, absorbable suture) stitch at the base of the frenulum to prevent bleeding and provide suspension of the penis. 
4. Cut the midportion of the frenulum using an iris scissor.
5. Then the scissor is moved in a horizontal way parallel to the penile shaft.
6. Finally, the stitches are placed.

Before the Surgery

1. You must inform the doctor If they have a joint replacement, stent, heart valve, pacemaker, or blood vessel graft.
2. If you have or had methicillin-resistant staphylococcus aureus MRSA infection
3. If you take blood-thinning medicines like aspirin, warfarin, dabigatran, clopidogrel, and rivaroxaban.

The doctor will:

1. Do a pre-anaesthetic check-up
2. Evaluate the medical history 
3. Ask you not to eat or drink for eight hours
4. Ask you to stop smoking
5. Tell you to stop taking erectile dysfunction medicine for at least one day before the surgery
6. Ask you to take some medicines like blood pressure medicine with a sip of water
7. Tell you to stop taking a herbal supplement for one or two weeks before the surgery 

On the Day of Surgery

You can expect the following on the day of surgery:

1. You will be told to sign the consent form to let the doctor proceed with the surgery. 
2. The healthcare staff will note the following information:
3. The time of your last meal and fluids
4. Medical history, current symptoms and allergies
5. Vital signs like body temperature, blood pressure and heart rate
6. The healthcare staff will trim the hair on the surgical site if needed
7. They will place a soft, thin tube called an intravenous line into a vein in the hand or arm to give medicines directly into the blood vessel.

During the Surgery

1. Position during the surgery: For penile frenulectomy, you will be kept in a supine position. 
2. Cleaning and draping: Proper draping and cleaning will be done to prevent infection and protect your privacy and comfort.
3. Anaesthesia: Local cream anaesthesia will be applied to you.

The recovery process in the hospital

After the surgery, you will be moved from the operating room to the recovery room (also called the post-operative room), where: 

1. You will receive painkillers and antibiotics for post-surgical pain and prevent any infection.
2. The healthcare staff will closely monitor your condition for a few hours.
3. If you have had outpatient surgery, you will be sent home on the same day after you are stable on monitoring.

The recovery process/expectation after discharge

The doctor will tell the following things to the you: 

1. There will be bruising and swelling of the penis that will fade in some days.
2. Prescribe pain-relieving medicines such as paracetamol
3. Dress in loose-fitting clothes for two to three days.
4. Remove the dressing within 24 hours. Remove the dressing if it is soaked with urine.
5. Keep the area dry for one to two days.
6. Avoid soaking in a bath.
7. Avoid swimming for one or two weeks.
8. There should be no pain in passing the urine.
9. Keep the wound dry and clean after urination.
10. Not to have sexual intercourse for up to four weeks.

First Follow up Appointment

1. The follow-up will be scheduled after three months of the surgery to check the recovery.

The benefit of the surgery include:

1. Permanent, safe, and effective treatment
2. Reduced anxiety and fear caused by tearing and bleeding
3. Increased pleasure and sensation
4. Quick and lasting solution to penile bleeding and pain during sexual activity.

Possible side effects that can normally occur after the surgery are:

1. Pain at the surgical site.
2. Allergic reaction to the medicines, materials, or equipment

Risks/complications of the surgery:

1. Decreased sensation of the glans
2. Swelling in the penis
3. Scar tenderness at the surgical site
4. Bleeding from the surgical area
5. Sequelae of infection: Infection at the surgical area

The cost of Penile Frenulectomy ranges from ₹20,000 to ₹50,000. The cost varies based on the following factors:

1. Type of Penile Frenulectomy surgery
2. Age of the patient
3. The medical condition of the patient
4. The type of hospital facility availed - individual room or shared.