Friday, March 20, 2015

SOUTH AFRICA: Successful (?) penis penis transplant after botch

The Guardian
March 13, 2015

Man gets world's first successful penis transplant after botched circumcision

by David Smith in Johannesburg

A 21-year-old man in South Africa has received the world’s first successful penis transplant and accepts the organ as his own, doctors said on Friday.

The operation took a team of surgeons nine hours and has allowed the patient to become sexually active.

The man’s penis was amputated three years ago after a circumcision went wrong at a traditional initiation ceremony. The patient, who has not been named, received the new organ from a deceased donor on 11 December and has regained all functions.

Professor Andre van der Merwe, head of the urology division at Stellenbosch University, whose staff carried out the operation at Tygerberg hospital in Cape Town, said the recipient is doing “extremely well” both physically and psychologically.

“The patient accepted the penis as his own,” he told the eNews Channel Africa (eNCA). “He told me in no uncertain terms that the fact it belonged to somebody else is completely out of his mind and he’s moved on with this as his own penis. That’s absolutely the way we want it.”


“We repaired a small hole in his urethra, the pee pipe, last week so we could remove his catheter and just that induced an erection on the operating table. We were so surprised at that erection that he certainly is getting very good results for his transplant.”

Van der Merwe described the groundbreaking operation as “very, very difficult”. He told eNCA: “What we did was to manage the small blood vessels in the penis, which are really only a little bit more than a millimetre wide, to existing blood vessels in the abdomen that has come down, and we could connect that up.

“So many things could have gone wrong. Actually one of the blood vessels did clot up for a few hours. We could relieve the clot, thankfully.”

Immediately after the operation there was an “oozing” that led to bleeding, he continued. “We were dealing with infection and clot formation and bleeding. That was the most difficult thing initially.”

But the patient is “a very fit young man” and making “a good recovery”.

...the South African man and his partner are coping well, according to Van der Merwe. “Huge psychological effects. If you add an organ you make a ripple effect on somebody’s ego, you can even induce psychosis …

... bogus surgeons are blamed every year for numerous deaths and injuries, including gangrene caused by unsterilised blades. Experts estimate that around 250 lose their penises each year to medical complications.

“There is a greater need in South Africa for this type of procedure than elsewhere in the world,” Van der Merwe said in a statement. “For a young man of 18 or 19 years, the loss of his penis can be deeply traumatic. He doesn’t necessarily have the psychological capability to process this. There are even reports of suicide among these young men.” ...

But not so fast:

March 13, 2015

The Penis Transplant Is Not A Breakthrough Yet

by Benjamin Davis

The news of the first penile transplantation washed across Twitter  feeds this morning and the usual casually assertive statements were made. One of the surgeons involved in the operation even trumpeted the results as “a massive breakthrough” in a press release from his institution.

Allow me to deflate the party somewhat on this “breakthrough.” As described, the surgeons sewed very small nerves and vessels together. This is done every day, in every hospital in the US (think vasectomy reversal). There is nothing surgically novel about sewing two ends of a urethra together or really small blood vessels either for that matter (remember that John Wayne Bobbitt’s severed penis was sewn back on relatively quickly).

But long-term function is a different — and major –  issue. The penis in question has only been functioning for a few months. It is the long-term function that is important, particularly in light of the fact that rejection of transplanted organs often takes years, not months. Would the headlines be different if the patient loses his penis next month? Or if he develops a post-transplant lymphoproliferative disorder, which is commonly deadly?

The good news: The patient appears to be doing well and has erections. ...  One media misconception laid to rest: If he had a 1 cm penis to begin with (as described) then his ability to orgasm and ejaculate were already preserved. It is the erection and urinary ability that is new.

But similar, albeit perhaps more strident sentiments, were expressed when the first double-hand transplant and face transplant patients were announced. And how is that going? Well, I would say extremely slowly but with some limited success....

My larger concern for these patients is that most of these young men whom the operation could be helpful for are not living in medically accessible regions. As outlined by reports from the CRL Commission in South Africa, over 500,000 men were hospitalized from ritual circumcisions.

Transplanting the penis was the easy part. Taking care of it will be the really hard part. Transplant patients need constant blood work, medication changes, biopsies, and exams (remember the first hand transplant patient refused to take his meds – and his hand was removed). For patient’s who live in remote areas of the world with limited medical care a penis transplant is not going to help and unlikely to be a common procedure in the future. Sorry. I wish I thought differently.

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