The Johns Hopkins University medical team that performed arm and hand transplants hopes to perform the first penile transplant in the United States in the coming months.
The team led by Dr. W.P. Andrew Lee hopes to help returning servicemen with an often-hidden wound of war. Modern warfare in Afghanistan and Iraq has put more troops on the streets with dismounted patrols and increased exposure to improvised explosive devices. That has led to a new kind of trauma: genitourinary, known as GU trauma, which includes the genitals, bladder, urinary tract and kidney systems.
About 5% of the 16,323 trauma admissions between 2001 and 2008 involved GU injuries, according to data from the Department of Defense Trauma Registry. More than 60% of those injuries resulted from explosions. The Defense Department found the average age of injury was 24.
Carisa Cooney, assistant professor of plastic and reconstructive surgery at Johns Hopkins, said the university began investigating the possibility of penile transplants after getting requests back in 2012.
“You put into context that these are usually young men who perhaps haven’t had a chance to start a family. A lot of time masculinity has a lot to do with the perception of themselves. And to have injury to the genitalia can be devastating to their identity and to their relationships back home,” Cooney said.
According to the Bob Woodruff Foundation, an organization devoted to helping returning service members, one of the questions doctors hear immediately after a serviceman is injured is “How’s my junk?”
Under the scalpel
Lee said John Hopkins has a potential patient lined up but is awaiting a donor. Lee and his team have performed 11 hand and arm transplants in seven patients, and said the process of transplanting a penis is not much different from transplanting a hand. “Other than the fact that this is a different anatomic part, there are a great deal of similarities,” he said.
To attach the donor penis to the patient, Lee and his colleagues will connect a four small arteries and two veins under the microscope. In addition, he said, a minimum of two nerves will also be connected to provide sensation.
Immediate recovery of the wounds to heal will take about four to six weeks, but function might not be regained for some months afterward. “Normally, in the hand or anywhere else, we need to reconnect the nerves. The nerves need to grow until the end of the organs, and that’s a process that can take months,” Lee said. In arms, he said, it can take more than a year.
Success will be determined both by patient satisfaction as well as clinical measures, including the ability to urinate and participate in sexual activity.
Impact on fertility
South African doctors performed the first successful penis transplant in December 2014, and in June, doctors reported that the transplant recipient’s girlfriend had become pregnant.
Lee emphasized the Johns Hopkins team is working on transplanting the penis, not the testicles, where the sperm line is generated. So, as long as a patient’s testicles are functional, he would be able to father his biological children. But the penis transplant would not have any bearing on fertility.
According to Cooney, the procedure is estimated to cost $200,000 to $400,000 in addition to donated surgical time. Johns Hopkins has volunteered to pay for the first transplant.