Penile Frenuloplasty: A Comprehensive Review of Energy-Based and Non-energy-Based Surgical Techniques, Clinical Outcomes, Complications, and Future Directions

Penile frenuloplasty is an established surgical procedure performed to lengthen or reconstruct the penile frenulum in cases of frenulum breve (short frenulum), frenular chordee, recurrent tearing, dyspareunia, or premature ejaculation (PE) attributed to an anatomically constrained frenulum.While the procedure is widely practiced, there is no current consensus on the optimal surgical technique.Broadly, techniques are classified into non-energy (cold/mechanical) methods, which rely on scalpel incision and suture-based tissue rearrangement, and energy-based approaches, which employ diathermy (electrosurgery) or laser technology to incise, coagulate, and remodel the frenular tissue.This narrative literature review aims to systematically appraise, organize, and critically evaluate all available published research on both energy-based and non-energy-based penile frenuloplasty techniques, encompassing anatomy, indications, procedural descriptions, surgical outcomes, patient-reported outcomes, complications, and future research directions.A comprehensive search of PubMed/MEDLINE, Embase, Scopus, and Google Scholar was performed using the terms: frenuloplasty, frenulectomy, frenulum breve, penile frenulum surgery, CO 2 laser frenuloplasty, electrosurgery frenulum, pull-and-burn frenuloplasty, V-Y plasty frenulum, Z-plasty frenulum, and PE frenulectomy.All English-language publications meeting relevance criteria were included.Studies pertaining exclusively to the lingual, labial, or other non-penile frenula were excluded.A total of 12 primary studies and reports were identified and reviewed, in addition to anatomical references, guideline documents, and related commentaries.Non-energy (cold) techniques, including simple transverse incision with longitudinal closure, V-Y plasty, Z-plasty, and frenular grafting, demonstrate overall patient satisfaction rates of 89-97%, with subsequent circumcision rates of 8-20% and minor complication rates of approximately 8%.Energy-based techniques, including the electrosurgical pull-and-burn method and CO 2 laser frenuloplasty, offer sutureless, bloodless outpatient alternatives.The pull-and-burn method has been validated in a 15-year, 236-patient retrospective series with favorable safety data.CO 2 laser frenuloplasty has demonstrated statistically significant improvement in Short Form Health Survey (SF-12) Physical Component Summary (PCS) and Mental Component Summary (MCS) scores (p < 0.001), with complete tissue healing in two weeks.Frenulectomy in patients with a short frenulum and lifelong PE resulted in a statistically significant increase in intravaginal ejaculatory latency time (IELT) from a mean of 1.65 to 4.11 minutes (p < 0.0001).All reviewed techniques demonstrate acceptable safety and efficacy; however, the overall evidence base consists primarily of case series and retrospective cohorts at Level 3-4 evidence.No high-quality randomized controlled trial (RCT) directly comparing energy-based and non-energy-based frenuloplasty techniques has been published to date.The choice of technique should be individualized based on clinical anatomy, surgeon expertise, and patient preference.Future prospective comparative RCTs with standardized selection criteria and outcome measures are needed to establish a definitive evidence hierarchy.