A team from Stellenbosch University (SU) and the Tygerberg Academic Hospital recently performed a second penis transplant, making it the first medical centre in the world to successfully perform this procedure twice, reports Health24. This comes after the world’s first successful penis transplant was done in December 2014 at the same facility.
Professor André van der Merwe, head of the division of urology at SU’s faculty of medicine and health sciences (FMHS), led the marathon operation of nine and a half hours performed on 21 April.
The recipient was a 40-year-old male who had lost his penis 17 years ago due to complications after a traditional circumcision. His identity is being protected for ethical reasons. “He is certainly one of the happiest patients we have seen in our ward. He is doing remarkably well,” says van der Merwe. “There are no signs of rejection and all the reconnected structures seem to be healing well.”
The report says the patient is expected to regain all urinary and reproductive functions of the organ within six months of the transplant. A colour discrepancy between the recipient and the donor organ will be corrected with medical tattooing between six to eight months after the operation.
Western Cape Health Minister Dr Nomafrench Mbombo called the procedure ground-breaking. “This is a remarkable procedure. Traditional circumcision has claimed many young lives in South Africa. For this patient, life will never be the same again,” Mbombo said.
The entire penis was carefully dissected from the donor to keep blood vessels, nerves and other connecting structures intact. These were marked and connected to the recipient’s correlating tissue during the transplant.
The surgeons connected: three blood vessels (each between 1 and 2mm in diameter) to ensure sufficient blood flow to the transplanted organ; two dorsal nerves (also between 1 and 2mm in diameter) to restore sensation; the urethra, which enables the recipient to urinate through the penis; as well as the corpus cavernosum (cavernous body of the penis), which will allow the patient to obtain an erection.
“The diverse presentation of the blood vessels and nerves makes the operation very challenging and means each case is unique,” says one of the team members Dr Alexander Zühlke. “All these structures need to be treated with the utmost delicacy and respect in order to be connected perfectly to ensure good circulation and function in the long term.”
The team consisted of van der Merwe‚ Zühlke‚ who heads the FMHS’ division of plastic and reconstructive Surgery‚ Professor Rafique Moosa‚ head of the FMHS’ department of medicine‚ Zarrabi and Dr Zamira Keyser of Tygerberg Hospital, reports The Times. They were assisted by transplant coordinators‚ anaesthetists‚ theatre nurses‚ a psychologist‚ an ethicist and other support staff.
It is thought that up 250 partial or complete penile amputations take place a year in South Africa due to botched traditional circumcisions. “At Stellenbosch University and Tygerberg Hospital we are committed to finding cost-effective solutions to help these men‚” says van der Merwe. The procedure was part of a proof of concept study to develop a cost-effective penile transplant procedure that could be performed in a typical theatre setting in a South African public sector hospital‚ he said.
The costs of the second procedure was much less than the first.
The report says the biggest challenge to rolling out this procedure is the shortage of organs. “I think the lack of penis transplants across the world since we performed the first one in 2014‚ is mostly due to a lack of donors. It might be easier to donate organs that you cannot see‚ like a kidney‚ than something like a hand or a penis‚” said van der Merwe. “We are extremely grateful to the donor’s family who so generously donated not only the penis‚ but also the kidneys‚ skin and corneas of their beloved son. Through this donation they are changing the lives of many patients.
The report says the patient had counselling over two years to explain and ensure he understood the operation is not a tried and tested treatment‚ but is still an experimental procedure with many risks.