Doctors Perform World’s First Successful Penis And Scrotum Transplant On US Veteran

The same Johns Hopkins surgical team also performed the country's first bilateral arm transplant in a wounded warrior. From left to right: Richard Redett, Trinity Bivalacqua, Brandacher Gerald, Arthur Burnett, and Andrew Lee. Johns Hopkins Medicine 

Madison Dapcevich 24 Apr 2018, 11:03

A team of reconstructive surgeons at Johns Hopkins Hospital has performed the world’s first penis and scrotum transplant to repair a US military veteran’s battle wounds sustained in Afghanistan. Better yet, it’s likely the patient will regain both urinary and sexual function.

“We are hopeful that this transplant will help restore near-normal urinary and sexual functions for this young man,” said Professor W. P. Andrew Lee in a statement.

Nine plastic surgeons and two urological surgeons performed the 14-hour surgery on March 26, transplanting the entire penis, scrotum (without testicles), and partial abdominal wall from a deceased donor. Surgeons also connected three arteries, four veins, and two nerves to provide blood flow and sensation, reports USA Today

“It’s a real mind-boggling injury to suffer, it is not an easy one to accept,” said the recipient, who chooses to remain anonymous. “When I first woke up, I felt finally more normal… [with] a level of confidence as well. Confidence… like finally I’m okay now.”

A diagram of the penile transplant shows a portion of the abdominal wall also successfully transferred. Devon Stuart/Johns Hopkins Medicine 

Vascularized composite allotransplantation (VCA) is an emerging field of transplant innovation where a body part or tissue is transferred from one individual to another. Surgery involves transplanting multiple tissues such as muscle, bone, nerve, skin, tendons, and blood vessels. 

It’s possible to reconstruct a penis using tissue from other parts of the body, but Lee said a prosthesis implant would be needed to achieve an erection and that comes with a high risk of infection. Plus, servicemen don’t typically have enough viable tissue from other parts of their bodies because of other injuries.

Between 2001 and 2013, more than 1,300 men in the United States military suffered injuries to their genitals or urinary tract in Iraq or Afghanistan, mostly from bomb blasts. Nearly three-quarters of these injuries involved external genitals – although fewer than five lost the penis – with 94 percent of cases occurring in men 35 or younger.

Three other successful penis transplants have been performed; two in South Africa in 2014 and 2017, and another at the Massachusetts General Hospital in 2016. This, however, is the first procedure involving the entire penis and scrotum. The testicles were not transferred from the donor in order to avoid ethical issues. They would have contained sperm from the anonymous donor, which could have led to ethical issues if the recipient had children.

The patient is currently on a regimen of immunosuppressive drugs to prevent tissue rejection. Doctors say he has recovered from surgery and is expected to be discharged later this week.

An animation of the procedure. Devon Stuart for Johns Hopkins Medicine 

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