PAST SUCCESSES:

A South African surgical team announced the world’s first successful penile transplant. On December 11, 2014, a young man received a donor’s penis during a nine-hour procedure performed at Tygerberg Hospital in Cape Town. Now, three months after, the transplanted organ is fully functioning — for sex and for urination — though full sensation may take a bit longer. “Our goal was that he would be fully functional at two years and we are very surprised by his rapid recovery,” team leader Andre van der Merwe of Stellenbosch University says in a statement.

The sexually active 21-year-old recipient will now be able to have children if he chooses to. Three years ago, he lost all but one centimeter of his penis when complications arose during a ritual circumcision — which members of the Xhosa group often undergo. “There is a greater need in South Africa for this type of procedure than elsewhere in the world,” Van der Merwe adds, “as many young men lose their penises every year due to complications from traditional circumcision.” According to previous estimates, as many as 250 penile amputations occur across the country every year.

Researchers initially struggled to obtain a donated penis, but they finally received one after fashioning a replacement out of skin to be buried with the donor. “The family is much happier to send the body to the grave with something resembling a penis,” Van der Merwe tells Bloomberg.

ONGOING:

In late 2017, surgeons from Johns Hopkins University are going to perform 60 penis transplants, a type of operation which has never been conducted before in the U.S. The first will be an unnamed patient injured in Afghanistan.

The recipients will be veterans who have suffered a genitourinary injury, having lost all or part of their penis and testicles. The organ will come from a recently deceased donor, and the medical team expects it to start working within months, developing sensation and urinary function, then eventually acquiring the ability to have sex.

The surgery takes 12 hours, during which the doctors will connect two to six nerves and six or seven arteries and veins. The patients should be able to urinate autonomously within a few weeks, but other functions might take longer to return. For sexual functions to develop, the nerves of the patient have to grow in the donor organ and timing depend on the extent of the injury, as nerves grow at about 2.5 centimeters (1 inch) per month.

Once the transplant is successful the men will be put on anti-rejection medication, which stops the immune system attacking the new organ. These types of medicine have side effects, and people taking them have an increased risk of contracting infections and developing cancer.

The surgery is considered highly experimental. There have only been two other penis transplants: a failed one in China in 2006 and a successful one in South Africa in 2014. Johns Hopkins University has given permission to perform 60 transplants and it will monitor the results closely. If they are positive, it will consider making this surgery a standard treatment.

During the recent conflicts in Afghanistan and Iraq, 12 percent of war injuries were genitourinary ones. According to the Department of Defense Trauma Registry, 1,367 men in military service during those conflicts suffered a genital wound.

“These genitourinary injuries are not things we hear about or read about very often,” Dr W. P. Andrew Lee, the chairman of plastic and reconstructive surgery at Johns Hopkins, told The New York Times. “I think one would agree it is as devastating as anything that our wounded warriors suffer, for a young man to come home in his early 20s with the pelvic area completely destroyed.”

[H/T: The New York Times]

This operation was part of a pilot study to develop a penile transplant procedure that could feasibly be performed in typical South African hospital theater settings. The team used techniques developed for the first facial transplant, including microscopic surgery to connect small blood vessels and nerves. While blood vessels in the kidney can be a centimeter wide, for example, the ones they’re working with here are about 1.5 millimeters wide, BBC reports.

“It’s a massive breakthrough,” Frank Graewe of Stellenbosch University says. “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.” Nine more patients will be receiving penile transplants as part of this study.

This is at least the second time a surgery like this was attempted, and the first time it was successful. In 2006, a patient in China asked doctors to remove his new organ just 10 days after surgery. While the transplant was physically successful, Washington Post explains, the psychological trauma may have been too much.

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