MP30-01 PENIS TRANSPLANTATION: FIRST U.S. EXPERIENCE

Abstract

You have accessJournal of UrologyTransplantation & Vascular Surgery: Renal Transplantation & Vascular Surgery II1 Apr 2017MP30-01 PENIS TRANSPLANTATION: FIRST U.S. EXPERIENCE Dicken Ko, Kai Li, Harry Salinas, Ilse Schol, Branko Bojovic, Kyle Eberlin, Jonathan Winograd, Jeffrey Lee, Garry Choy, Raymond Liu, Ivy Rosales, Michael Grant, Francis McGovern, Adam Feldman, Cigdem (Cori) Tanrikut, Robert Colvin, and Curtis Cetrulo Dicken KoDicken Ko More articles by this author , Kai LiKai Li More articles by this author , Harry SalinasHarry Salinas More articles by this author , Ilse ScholIlse Schol More articles by this author , Branko BojovicBranko Bojovic More articles by this author , Kyle EberlinKyle Eberlin More articles by this author , Jonathan WinogradJonathan Winograd More articles by this author , Jeffrey LeeJeffrey Lee More articles by this author , Garry ChoyGarry Choy More articles by this author , Raymond LiuRaymond Liu More articles by this author , Ivy RosalesIvy Rosales More articles by this author , Michael GrantMichael Grant More articles by this author , Francis McGovernFrancis McGovern More articles by this author , Adam FeldmanAdam Feldman More articles by this author , Cigdem (Cori) TanrikutCigdem (Cori) Tanrikut More articles by this author , Robert ColvinRobert Colvin More articles by this author , and Curtis CetruloCurtis Cetrulo More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.934AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES 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. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e389 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Dicken Ko More articles by this author Kai Li More articles by this author Harry Salinas More articles by this author Ilse Schol More articles by this author Branko Bojovic More articles by this author Kyle Eberlin More articles by this author Jonathan Winograd More articles by this author Jeffrey Lee More articles by this author Garry Choy More articles by this author Raymond Liu More articles by this author Ivy Rosales More articles by this author Michael Grant More articles by this author Francis McGovern More articles by this author Adam Feldman More articles by this author Cigdem (Cori) Tanrikut More articles by this author Robert Colvin More articles by this author Curtis Cetrulo More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...