Penis transplantation

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Penis transplantation
ICD-9-CM 64.98

Penis transplantation is a surgical transplant procedure in which a penis is transplanted to a patient. The penis may be an allograft from a human donor, or it may be grown artificially, though the latter has not yet been transplanted onto a human.

Contents

Cases

2006 allotransplant procedure

The first such procedure was performed in September 2006 at a military hospital in Guangzhou, China. The patient, a 44-year-old male, had sustained the loss of most of his penis in an accident. The transplanted penis came from a brain-dead 22-year-old male. Although a surgical success, the patient and his wife developed psychological trauma as a result of the procedure, and had the surgery reversed 15 days later. [1] [2] Following this, Jean-Michel Dubernard, who performed the world's first face transplant, wrote that the case "raises many questions and has some critics". He alluded to a double standard, writing:

I cannot imagine what would have been the reactions of the medical profession, ethics specialists, and the media if a European surgical team had performed the same operation. [3]

An example of a critic is Piet Hoebeke, a reconstructive urologist in Belgium, who wrote a letter that raised the question of whether or not ethics committees were involved, and criticized the group for the follow-up time of only 15 days. Hoebeke asserted that successful voiding at two weeks is not predictive of long-term outcomes, and even that inadequate arterial anastomoses might not manifest themselves in this time. [4] The hospital that performed the first transplantation later issued a set of guidelines which, among other considerations, "recommended that the procedure be restricted to individuals with severe injuries who are unwilling to undergo traditional reconstructive surgery", according to a mini-review of the ethical issues surrounding penis transplantation published in the Asian Journal of Andrology . [5]

2014 procedure in South Africa

The first successful penis transplant was performed at Stellenbosch University in South Africa (medical campus pictured). Tygerberg from air.jpg
The first successful penis transplant was performed at Stellenbosch University in South Africa (medical campus pictured).

In December 2014, the first successful penis transplant was performed on a 21-year-old man by specialists led by urologist André van der Merwe from the University of Stellenbosch in South Africa. The surgical team consisted of urologist André van der Merwe and plastic surgeon Frank Graewe. The immunosuppression was conducted by Rafique Moosa. The nine-hour procedure used microsurgery to connect blood vessels and nerves. [6] The patient had lost his penis as a result of a botched circumcision procedure he underwent aged 18. As of 13 March 2015, the recipient was reported to have recovered function in the organ, including urination, erection, orgasm and ejaculation, but sensation was expected to take two years to return fully. [7] [8] The doctors who performed the transplant were surprised by this, as they had not expected the patient to recover fully until about December 2016. [6] Given that circumcisions are performed frequently in parts of South Africa to mark a boy's transition to adulthood, and these are often unsanitary procedures, frequently carried out by uncertified amateurs, doctors have said that South Africa has some of the greatest need for penis transplantations in the world. [8] In 2015, the recipient announced that he had successfully conceived a child. [9]

2016 Massachusetts General Hospital procedure

In May 2016 surgeons, co-led by Curtis L. Cetrulo Jr. and Dicken S. C. Ko at Massachusetts General Hospital, Harvard Medical School performed a transplant on a 64-year-old man from Halifax, Massachusetts. [10] The surgeons demonstrated that it was possible to perform penile transplantation using a new technique of genitourinary vascularized composite allografts (GUVCA) to replace lost tissue under conventional immunosuppressive medication. The clinical results of this pioneering procedure in reconstructive transplantation in the United States was published in Annals of Surgery, May 2017. [11]

In October 2020 doctors from Massachusetts General Hospital debated penis transplants in transgender patients. [12]

2017 procedure in South Africa

A surgical team from Stellenbosch University and the Tygerberg Academic Hospital performed a second penis transplant on 21 April 2017. [13] [14]

In a nine and a half hour procedure, André van der Merwe and his team successfully transplanted a penis onto a 40-year-old male who had lost his penis 17 years prior, in a botched traditional circumcision. The patient is set to receive medical skin darkening tattoos in order to correct skin tone differences, as the donor was white and the recipient black. The patients name was David Pansegrouw.

Stellenbosch University is the only medical center in the world to have successfully completed two penile transplants. [15]

Johns Hopkins program

In December 2015, The New York Times reported that surgeons from Johns Hopkins School of Medicine in Baltimore would soon be performing experimental penis transplantation surgeries on injured veterans, and were optimistic that such surgeries could result in sexual and reproductive function. [16]

In April 2018, The New York Times reported that surgeons from Johns Hopkins, led by Richard Redett, MD, had performed the first penis transplant performed on a combat survivor and the third successful penis transplant so far. This transplant also included the scrotum, but not the testicles, for ethical reasons. The patient's identity was not disclosed. [17]

Serbia

Miroslav Djordjevic is working on a research project that is exploring the feasibility of penile transplantation for the purpose of gender-affirming surgery. [18]

Laboratory-grown penises

In 2009, Anthony Atala and colleagues at the Wake Forest Institute for Regenerative Medicine in North Carolina transplanted bioengineered penises onto 12 rabbits. All of them mated and four produced offspring. It was a test for a concept he had been working on since 1992, with the aim of making human penises for transplant. He has since produced test versions of bioengineered human penises. While there have been multiple successful transplants of other bioengineered organs, including the urethra, transplantation of a complete bioengineered penis has not yet been attempted in humans. [19]

In fiction

The British science fiction comedies, Percy (1971) and Percy's Progress , also known as It's Not the Size That Counts (1974) depict the world's first penis transplant. Ralph Thomas directed both films, and the first was co-written by Michael Palin and featured music by The Kinks.[ citation needed ]

See also

Related Research Articles

<span class="mw-page-title-main">Penectomy</span> Medical removal of the penis

Penectomy is penis removal through surgery, generally for medical or personal reasons.

<span class="mw-page-title-main">Urology</span> Medical specialty

Urology, also known as genitourinary surgery, is the branch of medicine that focuses on surgical and medical diseases of the urinary-tract system and the reproductive organs. Organs under the domain of urology include the kidneys, adrenal glands, ureters, urinary bladder, urethra, and the male reproductive organs.

<span class="mw-page-title-main">Body modification</span> Deliberate alteration of the human anatomy with the consent of the altered

Body modification is the deliberate altering of the human anatomy or human physical appearance. In its broadest definition it includes skin tattooing, socially acceptable decoration, and religious rites of passage, as well as the modern primitive movement.

<span class="mw-page-title-main">Penis enlargement</span> Technique aimed to increase the size of a human penis

Penis enlargement, or male enhancement, is any technique aimed to increase the size of a human penis. Some methods aim to increase total length, others the shaft's girth, and yet others the glans size. Techniques include surgery, supplements, ointments, patches, and physical methods like pumping, jelqing, and traction.

<span class="mw-page-title-main">Paraphimosis</span> Medical condition

Paraphimosis is an uncommon medical condition in which the foreskin of a penis becomes trapped behind the glans penis, and cannot be reduced. If this condition persists for several hours or there is any sign of a lack of blood flow, paraphimosis should be treated as a medical emergency, as it can result in gangrene.

<span class="mw-page-title-main">Urethral stricture</span> Medical condition

A urethral stricture is a narrowing of the urethra, the tube connected to the bladder that allows the passing of urine. The narrowing reduces the flow of urine and makes it more difficult or even painful to empty the bladder.

<span class="mw-page-title-main">Hypospadias</span> Medical condition

Hypospadias is a common variation in fetal development of the penis in which the urethra does not open from its usual location on the head of the penis. It is the second-most common birth defect of the male reproductive system, affecting about one of every 250 males at birth. Roughly 90% of cases are the less serious distal hypospadias, in which the urethral opening is on or near the head of the penis (glans). The remainder have proximal hypospadias, in which the meatus is all the way back on the shaft of the penis, near or within the scrotum. Shiny tissue that typically forms the urethra instead extends from the meatus to the tip of the glans; this tissue is called the urethral plate.

Phalloplasty is the construction or reconstruction of a penis or the artificial modification of the penis by surgery. The term is also occasionally used to refer to penis enlargement.

Gender-affirming surgery for male-to-female transgender women or transfeminine non-binary people describes a variety of surgical procedures that alter the body to provide physical traits more comfortable and affirming to an individual's gender identity and overall functioning.

<span class="mw-page-title-main">Scrotoplasty</span> Type of surgery to create or repair the scrotum

Scrotoplasty, also known as oscheoplasty, is a type of surgery to create or repair the scrotum. The history of male genital plastic surgery is rooted in many cultures and dates back to ancient times. However, scientific research for male genital plastic surgery such as scrotoplasty began to develop in the early 1900s. The development of testicular implants began in 1940 made from materials outside of what is used today. Today, testicular implants are created from saline or gel filled silicone rubber. There are a variety of reasons why scrotoplasty is done. Some transgender men and intersex or non-binary people who were assigned female at birth may choose to have this surgery to create a scrotum, as part of their transition. Other reasons for this procedure include addressing issues with the scrotum due to birth defects, aging, or medical conditions such as infection. For newborn males with penoscrotal defects such as webbed penis, a condition in which the penile shaft is attached to the scrotum, scrotoplasty can be performed to restore normal appearance and function. For older male adults, the scrotum may extend with age. Scrotoplasty or scrotal lift can be performed to remove the loose, excess skin. Scrotoplasty can also be performed for males who undergo infection, necrosis, traumatic injury of the scrotum.

<span class="mw-page-title-main">Prostatectomy</span> Surgical removal of all or part of the prostate gland

Prostatectomy is the surgical removal of all or part of the prostate gland. This operation is done for benign conditions that cause urinary retention, as well as for prostate cancer and for other cancers of the pelvis.

A urethrotomy is an operation which involves incision of the urethra, especially for relief of a stricture. It is most often performed in the outpatient setting, with the patient (usually) being discharged from the hospital or surgery center within six hours from the procedure's inception.

<span class="mw-page-title-main">Penile implant</span> Medical device

A penile implant is an implanted device intended for the treatment of erectile dysfunction, Peyronie's disease, ischemic priapism, deformity and any traumatic injury of the penis, and for phalloplasty or metoidioplasty, including in gender-affirming surgery. Men also opt for penile implants for aesthetic purposes. Men's satisfaction and sexual function is influenced by discomfort over genital size which leads to seek surgical and non-surgical solutions for penis alteration. Although there are many distinct types of implants, most fall into one of two categories: malleable and inflatable transplants.

Urethroplasty is the surgical repair of an injury or defect within the walls of the urethra. Trauma, iatrogenic injury and infections are the most common causes of urethral injury/defect requiring repair. Urethroplasty is regarded as the gold standard treatment for urethral strictures and offers better outcomes in terms of recurrence rates than dilatations and urethrotomies. It is probably the only useful modality of treatment for long and complex strictures though recurrence rates are higher for this difficult treatment group.

In ancient civilizations, the removal of the human penis was sometimes used to demonstrate superiority or dominance over an enemy. Armies were sometimes known to sever the penises of their enemies to count the dead, as well as for trophies. The practice of castration sometimes involved the removal of all or part of the penis, generally with a tube inserted to keep the urethra open for urination. Castration has been used to create a class of servants or slaves called eunuchs in many different places and eras.

<span class="mw-page-title-main">Buried penis</span> Male congenital condition

Buried penis, also called hidden penis or retractile penis, is a congenital or acquired condition in which the penis is partially or completely hidden below the surface of the skin. A buried penis can lead to urinary difficulties, poor hygiene, infection, and inhibition of normal sexual function.

<span class="mw-page-title-main">Webbed penis</span> Medical condition

Webbed penis also known as buried or concealed penis is an acquired or congenital condition in which the scrotal skin extends onto the ventral penile shaft. The penile shaft is buried in the scrotum or tethered to the scrotal midline by a fold or web of skin. The urethra and erectile bodies are usually normal. Webbed penis is usually asymptomatic, but the cosmetic appearance is often unacceptable. This condition may be corrected by surgical techniques.

<span class="mw-page-title-main">Prokar Dasgupta</span>

Prokar Dasgupta is an Indian-born British surgeon and academic who is professor of surgery at the surgical academy at King's Health Partners, London, UK. Since 2002, he has been consultant urologist to Guy's Hospital, and in 2009 became the first professor of robotic surgery and urology at King's, and subsequently the chairman of the King's College-Vattikuti Institute of Robotic Surgery.

André van der Merwe is a South African urologist. He is currently head of urology at the University of Stellenbosch and an associate professor at Tygerberg Hospital. He is best known for conducting the world's first successful penis transplant in 2014. He also performed the first laparoscopic kidney removal in South Africa.

<span class="mw-page-title-main">Miroslav Djordjevic</span> Serbian genital surgeon

Miroslav L Djordjevic is a Serbian surgeon specializing in sex reassignment surgery, and an assistant professor of urology at the School of Medicine, University of Belgrade, Serbia.

References

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