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Friday, 8 November 2019

The world's first penis and scrotum transplant is fully functional one year after surgery

X-ray performed before the patient's operation. | Redett et al./NEJM

It is more than a year after this particular operation, that the recipient of the very first penis and scrotum transplant in the world, is recovering well. He is a veteran of the US Armed Forces, who lost most of his lower body during an explosion.

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The man in question (who wishes to remain anonymous), was on patrol with his squad in Afghanistan when Taliban fighters ambushed them: while he was going to give the first aid to another soldier, he walked on a explosive device hidden on the road. The explosion took away much of the lower half of his body ... " I remember that everything seemed to have stopped and I was upside down,  " said the man. "  I remember thinking very quickly, 'It's not good,'  " he added.

And indeed, it was not good. During this explosion, the soldier lost almost all of his legs, his genitals and part of his abdomen. The tragedy took place in 2010.

At the time, there was only one total penis transplant, performed in 2006 on a patient in Guangzhou, China. And the results were not really promising ... complications soon appeared and the man's body started to reject the organ, which showed signs of necrosis, probably because of insufficient blood supply. Not to mention psychological issues, including objections from the patient's wife. What remained of the transplant was removed only a fortnight later.

Nevertheless, reconstructive surgery specialists at Johns Hopkins Hospital were convinced that their patient soldier, whom he had met for the first time in 2013, would be a good candidate for transplant surgery: although it took five years of preparation (including extensive experimentation on cadavers) before this can be attempted once a suitable deceased donor organ is finally available.

The patient decided to remain anonymous. Credits: Andrew Mangum / The New York Times

During this long waiting period, three successful penis transplants were performed: two in South Africa (both on patients with penile loss due to circumcision infections) and another involving a man in the United States, who underwent surgery after a partial penectomy following penile cancer.

Yet none of these patients had lost as many elements as this soldier. As a result, his operation was particularly ambitious, involving the transplantation of a single piece of tissue including the penis, scrotum and lower abdominal wall: what the doctors had never tried before!

In total, the entire graft weighed more than two kilograms and was approximately 25 centimeters. Despite the challenges of assembling hundreds of small blood vessels a millimeter or two wide under a powerful microscope, the 14-hour operation, performed by 11 different surgeons, was a success.

The veteran who received a penis transplant also had to undergo physical therapy to regain his strength. Credits: Andrew Mangum / The New York Times


And more importantly, more than a year after this first transplant, the medical team is happy to have been able to announce that the patient was recovering well, and that the organ and its restored nerve connections were functioning as well as they would have done. could have hoped.

" He has almost normal erections and the ability to reach orgasm,  " the researchers write in their case report. "  He has normal sensations in the stem and tip of the transplanted penis and can pinpoint the sensation of touch ... The patient is urinating upright, without effort, without increased frequency or urgency, the urine being discharged in a powerful jet.  They add.


Although the operation required scrotal transplantation, the researchers chose not to transplant the testes from the donor after consulting with bioethicists. " If we had included the testicles, the recipient could have fathered a child with the donor's DNA ," said one of the team members, plastic surgeon and reconstructor. "  This young man has no children, but was happy with the decision. He's not in a relationship, but I'm sure he's considering it now  . "

Another unique decision in this patient's case was a bone marrow infusion from the donor, which reduces the soldier's need for immunosuppression medication (which helps the body to accept the new organ).

Currently, it should only take one tablet a day and the team hopes that with the progress of medicine, it will be able to completely do without the drug "in the next five to ten years". We do not know if this will be possible or not, but what is perfectly clear is that this incredible procedure has greatly improved the life of this young man.

The doctors explained that he is now back in school full time and he lives and walks independently thanks to his leg prostheses. " He announced that he had a better image of him and that he was feeling 'whole again'. He says he is very satisfied with the transplant and its implications for its future, "they explained.

" I do not regret it. It's one of the best decisions I've ever made, "said the young man. This case represents a great victory (and advanced) for doctors, and of course, especially for the patient, who admitted that formerly he even had trouble "to consider himself a man".

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