August 12th, 2016
The very first penis transplantation or “gentitourinary vascularized composite allograft” (GUVCA), has been successfully performed in the United States on a 65 year old male, Thomas Manning from Massachusetts.
Here is a brief account of this huge milestone in the field of genital surgery.
In the year 2012, Manning underwent a penile amputation due to an overly aggressive cancer of penis. After amputation, Manning was left with a small (about 1-inch) stump. The surgery left a huge void in his life and enticed him to continue to explore revolutionary options until 2016 when he was offered the penis transplantation procedure by surgeons of Massachusetts General Hospital.
The complex 15 hours lengthy transplantation was performed by a team of 50 healthcare professionals (including urologists, nurses and anesthesiologists) at the Massachusetts General Hospital. In this surgical procedure, microscopic, complex vascular and nerve structures were extracted from the donor organ (penis) and are connected to the recipient’s tissues.
On his latest follow-up visit, doctors explained that the complex transplantation procedure has successfully reassembled the genitalia and it is hoped that soon Manning will be able to resume his normal urinary and sexual functions with the transplanted penis. The healing period has been uneventful so far and there has been no signs of infection, bleeding or graft rejection.
As the name suggests, penis transplantation involves transplanting the penile tissue from a dead donor to an otherwise healthy recipient. The first penis transplantation in the history was performed about 10 years ago in China. The 44-year old male lost most of his penis in a major accident and received the penis graft from a 22-year old male who was brain-dead. However, due to miscellaneous reasons, the procedure had to be reversed just after 15 days (2).
The first major successful penis transplantation procedure was performed in the South Africa on a young male, who lost his penis to a botched circumcision 3 years prior to the transplantation. The 21-year old patient underwent a nine-hour surgery during which a team of highly qualified professionals connected nerves and vessels with the donor tissue. The results of the surgery were excellent and on one-year follow-up, patient reported fully-functional penis that is capable of erection, orgasm, ejaculation and urination. Based on latest reports, patient has also successfully impregnated his partner (3).
The outcome of procedure is generally positive based on the limited number of surgeries performed this far. Currently investigators are carrying out studies to create a synthetic penile tissue that can be used in such procedures. Based on statistically significant data, laboratory experimentation on rabbits has delivered promising results. The rabbits were not only able to mate after the transplantation but were also able to impregnate their partners successfully. Although, no such surgery has ever been attempted in human subjects so far, investigators from Johns Hopkins School of Medicine are planning to initiate a series of experimental penile transplant surgeries for war veterans.
It is imperative to mention that the procedure is definitely complex. Moreover, since no long term data is available, it is too early to predict the quality of results in the long term. Besides procedure related risks such as hemorrhage, transplant rejection, anesthesia related complications, infection and other related complications, there is always a huge risk of developing adverse effects due to immunosuppressant drugs. The transplant recipients require immunosuppressant therapy for life in order to minimize the risk of tissue rejection. Also, immunosuppression has its own risks and concerns. But overall, the penile transplant surgery has given a hope to so many people who have gone through catastrophic injuries and accidents of genital region and were living in agony.
1. Reed-Maldonado, A. B., & Lue, T. F. (2016). Learning Penile Anatomy to Improve Function. The Journal of Urology.
2. Hu, Weilie, Jun Lu, Lichao Zhang, Wen Wu, Haibo Nie, Yunsong Zhu, Zhixiong Deng et al. “A preliminary report of penile transplantation.” European urology 50, no. 4 (2006): 851-853.
3. Bateman, C. (2015). World’s first successful penis transplant at Tygerberg Hospital. SAMJ: South African Medical Journal, 105(4), 251-252.
4. Kuehn, B. M. (2016). US Hospitals Prepare for Penis Transplants. JAMA, 315(13), 1322-1324.
5. Sopko, N. A., Matsui, H., Lough, D. M., Miller, D., Harris, K., Kates, M., … & Brandacher, G. (2016). Ex Vivo Model of Human Penile Transplantation and Rejection: Implications for Erectile Tissue Physiology. European Urology.