Wounded US veteran receives first penis and scrotum transplant

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A young US serviceman injured in Afghanistan was the recipient of the world’s first successful total penis and scrotum transplant, completed at Johns Hopkins Hospital on March 26, according to a news release.

This surgery was performed by Johns Hopkins doctors during a complex 14-hour surgery.

The Johns Hopkins team consisted of nine plastic surgeons and two urological surgeons (some members of the same surgical team were responsible for a rare double-arm transplant in 2012 for a soldier wounded in Iraq).

Members of the medical team who performed the first successful penis and scrotum transplant at Johns Hopkins Hospital in Baltimore.

 

The transplant recipient, who wished to remain anonymous, is a young US serviceman who sustained injuries to his lower pelvis, lower abdominal wall and lower extremities in an improvised explosive device blast while serving in Afghanistan.

Surgeons in South Africa performed the first successful penis transplant in 2014. A man who lost his penis to cancer became the first US penis transplant recipient in 2016. The Johns Hopkins operation is ground-breaking for also involving the transplant of the scrotum.

“We are hopeful we can restore sexual function in terms of spontaneous erection and orgasm,” Dr. Lee said.

An illustration of how the transplant was performed

 

For most men, that means regaining the ability to urinate while standing up and to have sex. Dr. Lee thinks transplantation can make both possible, though healing and nerve regeneration will take time. Urination is expected first, within a few months. Nerves grow from the recipient into the transplant at the rate of about an inch a month.

How many men might need this type of transplant is not known. Data from the Defence Department show that more than 1,300 men sustained so-called genitourinary injuries in Iraq and Afghanistan, and that 31 percent of those injuries involved the penis.

About 20 percent of the penile injuries were considered severe but how many might warrant a transplant is not clear. Women in the military have also suffered genitourinary and reproductive injuries, but they are less common.

According to Lee, the Comprehensive Transplant Center at Johns Hopkins has been a pioneer in many of the recent advancements in VCA procedures.

“Just over five years ago, the first quadruple amputee survivor in Iraq, US Army Sgt. Brendan Marrocco, received a double arm transplant at Johns Hopkins,” Lee said. “And just over five months ago, our team transplanted two new arms into Army National Guard Sgt. Eric Lund, who lost both arms just below his shoulders from a roadside bomb in Afghanistan.”

Nearly one month after the procedure, the penis transplant recipient appears to be recovering well and is expected to be discharged later this week, according to Redett.

“Our patient is recovering from the transplant well. He is up walking, and the graft shows no signs of infection or rejection,” Redett said. “It is our hope that such a life-enhancing transplant will allow him to regain urinary and sexual function and lead a more normal life.”

The patient is expected to regain full sexual and urinary function in the coming months, though he will not be able to produce sperm, according to Brandacher.

“All the research that we have done and all the experience that we have from our urology colleagues clearly indicates that he will regain full function of the penis with regard to urination … to have an erection and to have intercourse,” Brandacher said.

After the announcement of the surgery, the donor’s family, which also was not mentioned by name, released a statement thanking the recipient for his service: “We are all very proud that our loved one was able to help a young man that served this country. We are so thankful to say that our loved one would be proud and honored to know he provided such a special gift to you. As a family, we are very supportive of all the men and women who serve our country and grateful for the job you did for this nation.”

 

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