Doctors in South Africa have performed the world's third successful penile transplant, after a nearly 10-hour-long surgical procedure.
The team, led by Prof André van der Merwe, Head of the Division of Urology at Stellenbosch University's Faculty of Medicine and Health Sciences, had already performed a successful transplant in 2014, on a 21-year-old who had been amputated at the age of 18 – the first successful penis transplant ever. A second successful penis transplant was performed last year in the US, at the Massachusetts General Hospital in Boston.
This third patient was a 40-year-old man who has lost is penis 17 years ago due to complications after a traditional circumcision.
Penis mutilation is thought to occur commonly in South Africa during circumcisions performed as part of a traditional rites of passage in some communities. Although there are no official figures, some estimations have put the number of penile amputations at 55 cases of a year, in the Eastern Cape alone.
Regaining sexual function
The transplant procedure involved taking the entire penis of a donor to keep blood vessels, nerves and other connecting structures intact. Transplanting it on the recipient is a complex matter, as different types of body tissue (nerves, blood vessels, muscle) have to be connected between the recipient and the donor organ – a procedure known as a composite tissue transplant.
The procedure is all the more delicate that doctors have to connect together tiny blood vessels (between 1 and 2mm in diameter). In fact this second transplant took longer than the one performed in 2014, because establishing the connections between blood vessels to ensure blood flow to the transplanted organ was particularly challenging.
"The diverse presentation of the blood vessels and nerves makes the operation very challenging and means each case is unique. All these structures need to be treated with the utmost delicacy and respect in order to be connected perfectly to ensure good circulation and function in the long term," explained Dr Alexander Zühlke, a member of the medical team and the head of the FMHS's Division of Plastic and Reconstructive Surgery.
According to his doctors, the patient is doing well, a month on after receiving the transplant. He is in a good state of mind.
"When he saw his penis for the first time, he was quite emotional. He is certainly one of the happiest patients we have seen in our ward. He is doing remarkably well. There are no signs of rejection and all the reconnected structures seem to be healing well," Van der Merwe said.
They estimate that he will be able to recover all urinary, reproductive and orgasmic functions within six months of the transplant. Normal erections should happen within three months.
On the long term, he is expected to make full recovery, just like the recipient of the first transplant. "Our first patient doing extremely well, both physically and mentally", says Van der Merwe. "He is living a normal life. His urinary and sexual functions have returned to normal, and he has virtually forgotten that he had a transplant."
That being said, both men will have to take immunosuppression medication for the rest of their lives – even if they have made a full recovery. Their bodies would naturally recognise the donor's penis as a foreign object and reject it without these drugs.
The reason the second procedure was only performed three years after the first is that doctors were confronted to the challenge of finding a donor. "I think the lack of penis transplants across the world since we performed the first one in 2014, is mostly due to a lack of donors. It might be easier to donate organs that you cannot see, like a kidney, than something like a hand or a penis," Van der Merwe concluded.