Since 2014, three men have entered hospitals in the U.S. and South Africa without fully functioning genitalia. At least two departed with transplanted penises that allowed urination, erectile function, and—in at least one case—the capacity for intercourse.
A variety of hurdles remain before penile transplants become anything near routine. But the trio of cases has provided urologists and their teams with something valuable: experience and a track record of sorts.
“Things are moving slowly by all accounts. But it’s more than just a phenomenon that happened once and is fading,” said Arthur L. Burnett II, MD, MBA, professor of urology and director of the Basic Science Laboratory in Neurourology at Johns Hopkins Medical Institutions, Baltimore, in an interview with Urology Times.
“There have been challenges on different levels,” said Dr. Burnett, whose institution plans to offer penile transplants. “But I think it’s going to gain momentum.”
8-year gap from failure to success
The initial penis transplant, which took place in China in 2006, was unsuccessful. The 44-year-old recipient had suffered a recent traumatic penile injury and was matched with a brain-dead 22-year-old donor.
The donor penis was not rejected, surgeons said in a case report, and the man was able to urinate standing up after just 10 days. However, in their published report, the surgeons wrote: “At day 14 postoperatively because of a severe psychological problem of the recipient and his wife, the transplanted penis regretfully had to be cut off” (Eur Urol 2006; 50:851-3).
The first successful case came 8 years later, in late 2014, in South Africa. This time, the patient was an unidentified 21-year-old man who’d suffered penile loss as a result of complications of a ritual circumcision. In 2017, researchers published a 24-months follow-up case report about the 9-hour procedure (Lancet 2017; 390:1038-47).
Immediate complications included an arterial thrombus, an infected hematoma, and an area of proximal skin necrosis. Other complications included acute kidney injury at 7 months, which was reversed via lowering the dose of an immunosuppressant.
At discharge at 1 month post-operation, the patient was advised to wait to have sexual intercourse. The patient, however, did not wait. According to the new report, the patient began having sex 1 week after discharge, and began regular sexual intercourse at 3 months postoperatively.
Six months after the procedure, surgeon and lead author Andre van der Merwe, MD, professor and head of urology at Cape Town’s Stellenbosch University, told the BBC that the patient’s wife had become pregnant. It’s not clear if the wife went on to have a child or if paternity was confirmed.
The 2017 case report says questionnaires showed that the patient’s quality of life improved dramatically after the operation, and both maximum urine flow rate and International Index of Erectile Function scores reached normal levels.