Introduction

Penis transplantation represents a new paradigm in restoring anatomic appearance, urine conduit, and sexual function following genitourinary tissue loss. Genitourinary injuries and diseases that result in partial or complete penile loss have devastating functional and emotional consequences for patients leading to significant mental health sequelae, including depression and suicide. To date, only two penis transplants have been performed worldwide. We describe the 6 month follow up of the first successful penis transplant in the United States in a patient with a history of subtotal penectomy for penile cancer.

Methods

Following Institutional Review Board approval, extensive medical, surgical, and radiological evaluations of the patient were performed. His candidacy was reviewed by an multidisciplinary team of surgeons, physicians, psychiatrists, social workers, and nurse coordinators. After an appropriate donor was identified by United Network for Organ Donation, allograft procurement and recipient preparation took place concurrently. Anastomoses of the urethra, corpora, cavernosal and dorsal arteries, dorsal vein, and dorsal nerves were performed as well as inclusion of a donor skin pedicle as the composite allograft. Immunosuppression consisted of antithymocyte globulin induction, mycophenolate mofetil, and methylprednisolone, and tacrolimus.

Results

Postoperatively, the allograft had an excellent capillary refill and strong Doppler signals. Operative interventions on postoperative days 2 and 13 were required for hematoma evacuation and debridement of maturing skin eschar. At 3 weeks, no anastomotic leaks were detected on peri-catheter urethrogram and the catheter was removed. The patient developed one episode of steroid-resistant rejection (Banff III) which required a repeat course of methylprednisolone and antithymocyte globulin. At 6 months, the patient has recovered partial sensation of the penile shaft and has spontaneous penile tumescence. Our patient reports increased overall health satisfaction, dramatic improvement of self-image, and optimism for the future.

Conclusions

We have shown that it is feasible to perform penile transplantation with excellent results. Furthermore, this experience demonstrates that penile transplantation can be successfully performed with conventional immunosuppression. We propose that our penile transplantation pilot experience with encouraging short-term results represents a proof of concept that establishes a new and emerging field in reconstructive transplantation.

Funding

Massachusetts General Hospital