DOCTORS IN THE US have performed the world’s first total penis and scrotum transplant on a military serviceman who was wounded in Afghanistan.

The 14-hour operation took place at Johns Hopkins University in Baltimore, Maryland, on 26 March. It was performed by a team of nine plastic surgeons and two urologic surgeons.

“We are hopeful that this transplant will help restore near-normal urinary and sexual functions for this young man,” WP Andrew Lee, professor and director of plastic and reconstructive surgery at the Johns Hopkins University School of Medicine, said.

The patient was severely injured by a blast from an improvised explosive device in Afghanistan several years ago, Lee said.

The entire penis, scrotum (without testicles) and partial abdominal wall came from a deceased donor.

“It’s a real mind-boggling injury to suffer, it is not an easy one to accept,” a statement from the recipient, who has asked to remain anonymous, said.

“When I first woke up, I felt finally more normal … [with] a level of confidence as well … like finally I’m okay now,” he added.

Fertility

The man is now up and walking around, and is expected to be released from hospital this week. He lost his testicles in the explosion and did not get them restored as part of his transplant.

“The testicles were not transplanted because we had made a decision early in the programme to not transplant germline tissue … tissue that generates sperm, because this would raise a number of ethical questions,” plastic surgeon Damon Cooney said.

“In particular, the ability of the recipient of the transplant to have children would result in genetic material being transmitted from the donor of the transplanted tissue to the recipient’s offspring,” Cooney added.

And we just felt there were too many unanswered ethical questions with that.

Doctors are hopeful the man will be able to urinate with his penis in the coming weeks.

The patient retained his prostate gland in the blast but, as he lost his testicles, he will not be able to ejaculate. The extent of his sexual function will not be known for about six months, doctors said.

While it is possible to reconstruct a penis using tissue from other parts of the body, Lee said, a prosthesis implant would be necessary to achieve an erection, and that comes with a much higher rate of infection. Additionally, due to other injuries, servicemen often don’t have enough viable tissue from other parts of their bodies to work with.

Tissue rejection 

This type of transplant, where a body part or tissue is transferred from one individual to another, is called vascularised composite allotransplantation. The surgery involves transplanting skin, muscles and tendons, nerves, bone and blood vessels.

As with any transplant surgery, tissue rejection is a concern. The patient is put on a regimen of immunosuppressive drugs to prevent rejection. Lee’s team has developed an immune modulation protocol aimed at minimising the number of these drugs needed to prevent rejection.

The first penis transplant in the world took place in China in 2006, but it was later removed due to “a severe psychological problem of the recipient and his wife”, doctors said.

Only four penis transplants have ever been done successfully, including the one announced yesterday, doctors said.

Two have been done in South Africa, the nation that achieved the first such successful surgery in 2015. The United States performed its first successful penis transplant in 2016.

Contains reporting from - © AFP 2018