After Failure in 2006, Scientists Score First Successful Penis Transplant

Urologists at Stellenbosch University (SU) and Tygerberg Hospital have erected a happy new milestone along the trails of medical research.  In a nine hour surgery last December, a team of doctors performed only the second attempt in history at a penis transplant.  

And unlike the first attempt, this time everything is looking good with the patient regaining full function — including sensation, urinary function, and sexual function — within five weeks of the operation (by February).  Now, with more than three months past and nothing but positive reports, researchers are finally able to conclude their hard work yielded a breakthrough success.

I. A Pressing Gap in Treatment

Unwanted loss of the male penis can result from a number of causes including accident, assault, and disease-related penectomies (surgical amputations due to disease complications such as botched amputations or penile cancers).  Such losses are belived to affect thousands, if not tens of thousands of men worldwide, leading to deep psychology and sexual problems.

Aside from botched circumcisions (typically performed in non-sterile environment), many men lose their penises annually to penile cancers. [Image Source: HowCancerKills]
In 2006 a team of Chinese doctors attempted a controversial attempt at harvesting and transplanting a penis of a 22-year-old brain-dead male onto a 44-year-old male who had losts his sexual appendage due to an undisclosed accident.  Performed at a military hospital in Guangzhou, China, the procedure at first appeared to be a success.  But in a devastating development it had to be reversed 15 days later.  The entire saga was reported [paper] in the journal European Urology that same year.

After the 2006 failure and the firestorm of criticism that followed it, few were eager to risk becoming the next to try their hand at the risky procedure.  But starting in 2010 the head of urology at SU, Prof André van der Merwe became convinced that his team could pull it off.  It would take him and his fellow surgical researchers four years to get a chance to put that believe to the test, but when they got the opportunity, they made the best of the rare trial.

When it comes to penile transplants it is perhaps only fitting that South Africa would rise to the occasion.

South Africa has a rich history in the field of organ transplantation.  It was there from the very start, in fact.  The first heart transplant was performed in 1967 at Groote Schuur Hospital in Cape Town, less than a half hour drive away from Tygerberg Hospital.

The first successful transplant of any human organ was a heart transplant performed in South Africa in 1967. [Image Source: TIME]
South Africa also has once of the most severe needs for a penis transplant procedure as each year hundreds of its men lose their penises.  Most of these losses occur due to botched circumcisions.

Multiple studies [abstracts] have shown circumcision to significantly reduce the risk of contracting HIV (Human immunodeficiency virus), particularly when the male is participating in heterosexual sexual contact.  South Africa is home to the world’s worst HIV epidemic, so there’s a lot of pressure to circumcize.  It is estimated that 6.1 million people are living with HIV in South Africa, and 240,000 die annually from complications resulting from AIDS (acquired immunodeficiency syndrome) [source — 2012].  (AIDS is caused by the HIV virus and manifests as a weakening of the immune system.)

HIV infections are extremely pervasive in South Africa, increasing the need for circumcision.
[Image Source: Glogster.com]
However, tribal superstitions compel many South African men to wait until their 20s or later ot get circumcized.  Circumcisions in newborns in controlled surgical settings have a low 1.5 percent rate of mishaps, and mishaps serious enough to require amputation are exceedingly rare.  But circumcisions of adults has much higher risks — as high as 6 percent or more [abstract] in a surgical setting.  Also, the severity of complications increases.  In the non-sterile environment of tribal medicine — where crude, possibly contaminated instruments are used — complications are frequent.

The SU press release reveals these alarming statistics, writing:
Although there are no formal records on the number of penile amputations per year due to traditional circumcision, one study reported up to 55 cases in the Eastern Cape alone, and experts estimate as many as 250 amputations per year across the country.
Men who lost their penises in botched circumcisions had a hard road ahead, with seemingly no hope at a normal sex life.  But the gaping hole in treatments for those who lost their penises would soon come a bit closer to being filled, thanks to the intrepid team of researchers at SU.

II. Driving in Dark: The Road to the First Successful Penile Transplant

Dr. Van der Merwe was moved by the plight of these young men.  He states:
There is a greater need in South Africa for this type of procedure than elsewhere in the world, as many young men lose their penises every year due to complications from traditional circumcision.  This is a very serious situation. For a young man of 18 or 19 years the loss of his penis can be deeply traumatic. He doesn’t necessarily have the psychological capability to process this. There are even reports of suicide among these young men.

Dr. Van der Merwe (left) and Dr. Rafique Moosa discuss their historic attempt. [Image Source: AFP/Getty Images]
Despite his determined efforts it would take four years to get the proper permits, plan the procedure, and find a willing donor.  The latter would prove one of the most thorny subjects, as many family members nixed the idea of letting their love ones’ penises go to science.  Dr. Van der Merwe finally employed a clever compromise to convince one family to reconsider.  He told Bloomberg in an interview, that he finally recruited one family to donate by surgically creating a faux organ out of the donor’s skin flap, to replace the removed penis on the cadaver.  He describes:
In South Africa, the law is even if you are an organ donor, you’re not allowed to harvest any organs from that patient unless the family consents.  The family is much happier to send the body to the grave with something resembling a penis.
By the time he solved the problem of finding a donor.  The transplant recipient had also been selected.  The transplant recipient had been just 21-years-old when they lost their penis to a botched traditional circumcision in 2011.  Now 24-years-old, the patient was in good health but continue to struggle from the devastating psychological impact of that mishap.

The transplant team celebrates their historic trial. [Image Source: SU]
The surgery was carried out on Dec. 11 with additional assistance from “Prof Frank Graewe, head of the Division of Plastic Reconstructive Surgery at SU FMHS, Prof Rafique Moosa, head of the FMHS Department of Medicine, transplant coordinators, anaesthetists, theatre nurses, a psychologist, an ethicist and other support staff.”

The team had to painstakingly reconnect the major vasculature of the organ — including the dorsal vein, dorsal artery, and pudendal artery.  They also had to reconnect the pair of dorsal nerves (which would allow the recipient to eventually “feel” the new organ and get an erection) and the urethra.

[Image Source: Dr. Graewe via Daily Mail UK]
The surgery was daunting and required great skill.  Comments Dr. Merwe:
What we did was to manage the small blood vessels in the penis, which are really only a little bit more than a millimetre wide, to existing blood vessels in the abdomen that has come down, and we could connect that up.  So many things could have gone wrong. Actually one of the blood vessels did clot up for a few hours. We could relieve the clot, thankfully.
As a result of these difficulties the procedure took an exhausting nine hours.

III. A Triumph of Man

But it was worth it.

Left to recover on anti-rejection drugs, the recipient exhibited a remarkable recovery.  Dr. Van der Merwe cheers, “Our goal was that he would be fully functional at two years and we are very surprised by his rapid recovery.”

Within five weeks the patient was able to get an erection and have sex with his girlfriend, according to an interview with the UK’s Daily Mail.  A recent followup operation allowed the merged urethra to finish healing and for the patient to urinate out of their new penis.  Describes Dr. Merwe to eNews Channel Africa (eNCA):
Cosmetically we’ve got a very good match for color.  We obviously transplanted a good normal penis and the erections that the patient gets are very good.  We repaired a small hole in his urethra, the pee pipe, last week so we could remove his catheter and just that induced an erection on the operating table. We were so surprised at that erection that he certainly is getting very good results for his transplant.

Since then there’s been nothing but good news, with no signs of trouble.  

One piece of particularly good news is that unlike the Chinese implant, where psychological factors contributed to the need to amputate, the South African recipient appears to have embraced their new organ.  Comments Dr. Merwe:
The patient accepted the penis as his own.  He told me in no uncertain terms that the fact it belonged to somebody else is completely out of his mind and he’s moved on with this as his own penis. That’s absolutely the way we want it.
While the patient has to take anti-rejection drugs, they continue to recover and enjoy the perks of a new sex life.  They’re planning a circumcision in months to come — but this time in a carefully controlled medical setting.

A paper on the work is pending.  And the research team have nine pending transplant requests they hope to fill over the next several years.

Dr. Grawe summarizes:
It’s a massive breakthrough. We’ve proved that it can be done – we can give someone an organ that is just as good as the one that he had.  It was a privilege to be part of this first successful penis transplant in the world.
It took decades for surgery to penetrate what once appeared to be insurmountable technical obstacles to a penile transplant.  But with the path to transplantation clear at last, in years to come thousands of men who lost their sex organs in assaults, accidents, botched circumcisions, or battles with penile cancer may come to enjoy the perks of getting a second chance at life with a penis.

Meanwhile, work to grow penises in a lab remains ongoing.  Dr. Anthony Atala, M.D.’s team at Wake Forest Univ. has succcessfully completed trials in rabbits and will next look to grow penises in a clinical trial for humans, or perhaps a closer relative like pigs.  If successful, this work would supplement the transplant efforts, by eliminating the need for a donor.

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