The world's first total penis and scrotum transplant was performed about a month ago on a US soldier who was injured in Afghanistan, doctors say.
"We are hopeful that this transplant will help restore near-normal urinary and sexual functions for this young man," said surgical team member Dr W.P. Andrew Lee. He's professor and director of plastic and reconstructive surgery at Johns Hopkins University School of Medicine, in Baltimore.
Not easy to accept
According to a Hopkins news release, nine plastic surgeons and two urological surgeons conducted the 14-hour surgery on 26 March. The transplant from a deceased donor included the entire penis, scrotum (without testicles) and partial abdominal wall.
The world's first penile transplant was done at Tygerberg Hospital in Cape Town on 11 December 2014, but this did not not include the scrotum.
The US surgery involved transplanting skin, muscles, tendons, nerves, bone and blood vessels.
"It's a real mind-boggling injury to suffer; it is not an easy one to accept," said the recipient, who wishes 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 OK now," he said in the news release.
The man has recovered from the transplant surgery and is expected to leave the hospital this week.
Speaking to The New York Times, the veteran described his anguish from his injuries, which occurred after he stepped on a hidden bomb. He lost both legs above the knee, but the genital injury was even more devastating.
"That injury, I felt like it banished me from a relationship," he told the Times last week. "Like, that's it, you're done, you're by yourself for the rest of your life. I struggled with even viewing myself as a man for a long time."
Testes not transplanted
He asked that his name not be published due to stigma surrounding genital injuries.
Lee told the newspaper, "We're hopeful we can restore sexual function in terms of spontaneous erection and orgasm."
However, the transplant recipient did not receive the donor's testes as part of the transplant. Receiving those organs might have enabled the patient to go on to father children with the donor's sperm, something deemed medically unethical.
The patient is currently receiving testosterone to compensate for the lack of testes, as well as the erectile dysfunction drug Cialis, to encourage erectile function.
As with any transplant surgery, rejection of the patient's transplanted tissue is a concern, so he is also receiving immune system-suppressing drugs to reduce the risk of rejection.
It's possible to reconstruct a penis using tissue from other parts of the body, but an implant is necessary to enable erections, which poses a much higher risk of infection, Lee explained.
Tough times emotionally
Lee also noted that due to other injuries, soldiers often don't have enough usable tissue from other parts of their bodies for penis reconstruction, so transplant was the only good option. The veteran in this case waited more than a year for a viable donor. The surgery is estimated to have cost between $300 000 (R3.7 million) to $400 000 (R4.9 million), but in this case Hopkins paid the bill and the surgical team worked for free, the Times said.
The exact need for these types of surgeries remains unclear, but the newspaper said that Department of Defense data shows that more than 1 300 men have sustained genitourinary injuries in Iraq or Afghanistan, with close to one-third of injuries involving the penis.
The patient said he went through tough times emotionally after the injury, and kept the loss of his genitalia a secret from all but a few.
"There were times you'd be hanging out and guys would be talking about getting hurt, and that's one of the first things when they get blown up, to check down there, and they would say things like, 'If I lost mine I'd just kill myself,'" he told the Times. "And I'm sitting there. They didn't know, and I know they didn't mean any offence, but it kind of hits you in the gut."
Future looks brighter now
Thoughts of suicide crossed his mind, he said, but "when I would actually think about killing myself, I would think, 'Am I really just gonna kill myself over a penis?'"
So, he underwent physical therapy, learned to walk on prosthetic legs, and even earned a college degree in the years after the injury. He is now making plans to attend medical school.
But intimate relationships seemed out of the question, because he feared disclosing his injury.
However, the future looks brighter now, the man told the Times.
His goals? "To do well in school, to go to medical school and follow my career as a doctor, find my niche in the field and just excel at it. Maybe settle down and maybe eventually find someone, and get into a relationship, maybe. Just that normal stuff."
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