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| CASE REPORT |
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| Year : 2020 | Volume
: 18
| Issue : 4 | Page : 332-333 |
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Double-penile frenulum: An unusual developmental anomaly
Suresh Kumar Goyal1, Shifali Gupta2, Suman Gupta3
1 Department of Urology, Guru Gobind Singh Medical College, Faridkot, Punjab, India
2 Department of Pediatrics, Guru Gobind Singh Medical College, Faridkot, Punjab, India
3 Department of Pediatrics, Adesh institute Medical Sciences and Research, Bathinda, Punjab, India
| Date of Submission | 05-Jun-2020 |
| Date of Decision | 28-Jun-2020 |
| Date of Acceptance | 29-Jul-2020 |
| Date of Web Publication | 19-Oct-2020 |
Correspondence Address:
Dr. Shifali Gupta
Department of Pediatrics, Guru Gobind Singh Medical College, Faridkot - 151 203, Punjab
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/cmi.cmi_99_20
Double frenulum is a rare penile developmental anomaly. This anomaly may remain unnoticed before presenting in sexually active males with complaints of dyspareunia. This may be an ncidental finding in patients for unrelated complaints. We present a case of an adolescent sexually inactive male who came with complaints of unusual appearance of the penis.
Keywords: Dorsal frenulum, double frenulum, dyspareunia
How to cite this article:
Goyal SK, Gupta S, Gupta S. Double-penile frenulum: An unusual developmental anomaly. Curr Med Issues 2020;18:332-3 |
| Introduction | |  |
Double frenulum is a rare penile developmental anomaly. Previously reported cases describe sexually active males with complaints of dyspareunia or incidental finding in patients for unrelated complaints.[1],[2],[3] We present a case of an adolescent male who came with complaints of unusual appearance of the penis.
| Case Report | | |
A 17-year-old, sexually inactive adolescent male presented with complaints of an unusual appearance of his penis. He had no past history of dysuria, balanoposthitis, trauma, surgery, or any penile lesion (ulcer or wart etc.). There was a history of occasional painful, spontaneous nocturnal penile erections, severe enough to wake him from sleep. On examination, the external urethral and penile shafts were normal. A normal ventral frenulum was present in addition to a band of tissue between the dorsolateral aspect of the glans and prepuce at 10 o'clock position [Figure 1]. The ventral midline raphe was normal. A diagnosis of double frenulum was made. Other medical causes of painful penile erection were ruled out. The patient underwent a frenuloplasty of the aberrant frenulum. The patient was satisfied with cosmetic appearance of the penis and was asymptomatic on follow-up. | Figure 1: Retracted prepuce showing the accessory frenulum at the dorsolateral aspect of the glans at 10 o'clock position.
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| Discussion | | |
The prepuce constitutes the normal anatomical covering of the glans. The embryologic development of frenulum is related to that of the prepuce. At 8 weeks postconception, the ectoderm begins to develop into the penile skin and prepuce.[4] The prepuce in particular is formed by reduplication of the distal penile ectoderm in the 3rd month of intrauterine life. The preputial sac is then formed as a result of separation of the prepuce from the glans. The frenulum is formed from the persistent residual adhesions of ectoderm on the ventral aspect of the penis between the inner prepuce and glans penis.[1],[4] Congenital torsion of penis may result in shifting of frenulum along with external meatus (clockwise or counterclockwise). In this case, external meatus and frenulum were placed normally on the ventral aspect. There was an accessory frenulum on the dorsolateral aspect of the glans at 10 o'clock position [Figure 1].
In previously reported cases, two patients presented with dyspareunia, and one case was an incidental finding in a polytrauma patient.[1],[2],[3] In this case, the patient had complaints of unusual appearance of the penis and occasional painful nocturnal penile erections.
In one of the cases reported in past, the patient had only a dorsal frenulum and the normal ventral frenulum was absent; the second and third reported cases had both a dorsal and ventral frenulums.[1],[2],[3] Our case had an accessory frenulum on the right dorsolateral aspect of the glans apart from normal ventral prepuce.
Patients who presented with dyspareunia were managed with frenuloplasty, which relieved their symptoms.[1],[2] The patient who was incidentally diagnosed to have double frenulum was asymptomatic. Our patient underwent frenuloplasty with a satisfactory cosmetic outcome. The patient was relieved of painful spontaneous erections.
Singla et al. described the embryological development of the preputial sac and postulated that the prepuce separated from the glans on all sides except on the dorsal side. The residual adhesions on the dorsal side then formed the dorsal frenulum.[1] In the present case, during embryological development, there is a possibility of residual adhesions between the prepuce and glans on the right dorsolateral aspect apart from the normal ventral frenulum, resulting in double frenulum.
Thus, double frenulum is a rare congenital anomaly of penis. Symptomatic patients can be promptly diagnosed and treated appropriately.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given his consent for his images and other clinical information to be reported in the journal. The patient understands that his name and initial will not be published, and due efforts will be made to conceal identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| References | | |
| 1. | Singla SL, Garg P, Bishnoi PK, Singh B. Dorsal penile frenulum. Urol Int 1997;59:55-6.  |
| 2. | Arora B. Dorsal penile frenulum: A rare developmental abnormality. Int J Case Rep Imag 2016;7:311-3. |
| 3. | Mukendi AM, Doherty SW. Dorsal penile frenulum: A rare congenital abnormality. Afr J Urol 2019;25:1-3. |
| 4. | Yiee JH, Baskin LS. Penile embryology and anatomy. ScientificWorldJournal 2010;10:1174-9. |
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