The Johns Hopkins University School of Medicine had successfully performed the first total penis and scrotum transplant in the world.

The 14-hour surgery was done on 26 March 2018. The reconstructive surgery team, composed of nine plastic surgeons and two urological surgeons, transplanted the entire penis, scrotum (without testicles) and partial abdominal wall from a deceased donor to a veteran soldier who was wounded in Afghanistan.

Vascularized composite allotransplantation

A diagram of the procedure. Photo credit: Devon Stuart of Johns Hopkins Medicine.
A diagram of the procedure. Photo credit: Devon Stuart of Johns Hopkins Medicine.

The procedure performed by the reconstructive surgery team was called vascularized composite allotransplantation. It overcomes some of the limitations of reconstructing the penis from other parts of the body. According to Professor WP Andrew Lee, the Director of Plastic and Reconstructive Surgery, reconstructing the penis from other parts of the body also requires a prosthesis implant, in order for the patient to achieve an erection. However, this comes with a much higher rate of infection. Furthermore, sometimes patients may sustain injuries that result in inadequate viable tissue from other parts of the body for use in penis reconstruction.

Prior to the surgery, the donor’s testicles were removed so the patient will not be able to ejaculate or reproduce. This was done to avoid ethical issues that can arise from the donor siring children with another man’s genetic material.

“We just felt there were too many unanswered ethical questions with that kind of transplant,” said Dr Damon Cooney, an Assistant Professor of Plastic and Reconstructive Surgery.

To reduce the risk of infection, the team had developed an immune modulation protocol to minimize the number of immunosuppressive drugs needed by the patient.

Future outlook

The patient had thus far recovered and claimed to be feeling confident about his recovery. However, the extent of his sexual function will not be known until six months later.

"We are hopeful that this transplant will help restore near-normal urinary and sexual functions for this young man," said Lee.

Previously, doctors have succeeded at transplanting only the penis, performed at hospitals in China, South Africa and Massachusetts. MIMS

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