Penile Transplantation Research Articles

En Bloc Surgical Dissection for Penile Transplantation for Trans-Men: A Cadaveric Study.

Introduction The surgical techniques currently available for penile reconstruction for trans-men with gender dysphoria present with multiple drawbacks and often fail to meet patients' expectations. Literature reports three cases where penile transplantation has been performed for cis-men, with the last two cases being considered successful. Aim To determine whether an en bloc surgical dissection can be performed in a male cadaver, in order to include structures necessary for penile transplantation (from a deceased donor male) to a recipient with female genitalia in gender affirmation surgery. Method The study was conducted in the form of explorative dissections of the genital and pelvic regions of three male cadavers preserved in phenol-ethanol solution. Results The first two dissections failed to explant adequately all the relevant structures. The third dissection, which was performed along the pubic arch and through the perineum, succeeded in explanting the relevant structures: it, in fact, allowed for identification and adequate transection of urethra, vessels, dorsal nerves, crura of corpora cavernosa, and bulb of corpus spongiosum, in en bloc explantation of male genitalia. Conclusions It is possible to explant the penis and associated vessels, nerves, and urethra en bloc from a cadaver. This study suggests a surgical technique for en bloc explantation aiming for transplantation of the penis from a cadaveric donor male to a recipient with female genitalia.

Penile transplantation as an appropriate response to botched traditional circumcisions in South Africa: an argument against

Penile transplantation as an appropriate response to botched traditional circumcisions in South Africa: an argument against

Upper limb reconstructive transplantation in military recipients

AbstractLessons from conflict have contributed to military medical advances which have significantly improved the survivability of critically injured servicemen and women. However, survival following such severe combat polytrauma is often associated with devastating tissue loss and functional deficits that challenge conventional reconstruction. Despite recent advances, upper extremity prosthetic alternatives lack the fidelity to restore the complex intrinsic and sensory function of the human hand. Upper Limb Reconstructive Transplantation, or Vascularised Composite Allotransplantation (VCA), is currently an experimental procedure offering superior anatomical and functional outcomes compared to prostheses.Military candidates for VCA usually enjoy high pre-morbid fitness, mental health resilience and support, and relatively rich provision of rehabilitation. However, co-morbidities of polytrauma, such as traumatic brain injury and post-traumatic stress disorder, may have an impact on outcomes.Since 1998, over 120 upper limb transplants have been performed worldwide. Of these, six have been performed on servicemen and women across three continents. The morbidity and mortality associated with the requirement for lifelong immunosuppression, however, continues to skew the risk-benefit considerations of these promising procedures when compared to prostheses. Thus, although the technical surgical feasibility of upper limb and other VCA such as face, abdominal wall, uterus and penis transplants has been established over the past decade, these procedures remain restricted to recipients fulfilling stringent inclusion criteria.We review the current state of VCA in military recipients, and summarise ongoing collaborative VCA research conducted by British and American military medical teams.

New Frontiers in Transplantation and Stem Cell Technology: A Brief Synopsis

Since the first kidney transplant was performed in 1954 immense progress has been made in the world of transplantation. Modern immunosuppressive regimens have led to increasing graft and patient survival after solid organ transplantation. Furthermore, these advances have opened the door to new fields of transplantation such as composite tissue allotransplantation. These developments have made possible numerous types of transplantation including, but not limited to face, penile, and uterine transplantation. Moreover, innovations in genetic engineering and stem cell technology have contributed to rapid developments in the fields of xenotransplantation and the engineering of functional organs from induced pluripotent stem cells. As the prevalence of chronic diseases rises, so too will the necessity for organ transplantation. Thus, the transplant innovations of the modern era need to be expanded upon so as to continue to discover new ways to address organ shortages and the complications of transplantation.

Surgery in 2017: Moving towards successful penile transplantation programmes.

Surgery in 2017: Moving towards successful penile transplantation programmes.

Genitourinary vascularized composite allotransplantation.

Genitourinary vascularized allotransplantation (GUVCA) is gaining interest as a treatment option for patients with functional and aesthetic urogenital tissue loss. Only three cases have been done worldwide and research on the implementation and feasibility of this procedure is in an elementary state. The psychosocial impact and ethical considerations with GUVCA are remote, particularly because of the intimate and personal nature of genital tissue. Though two of the three penile transplantation cases are considered successful, various unexpected factors and complications have been described alongside these successes. Treatment outcome depends on a complex combination of immunological, technical, and psychosocial components that will be different per individual case. Multidisciplinary evaluation and treatment protocols should be established to ensure that the quality of life in GUVCA recipients can be increased in a safe and ethical way. Penile transplantation represents challenging new potential to improve phallus reconstruction in patients with severe genital tissue defects, but worldwide experience with GUVCA is limited. Controlled multicenter research is required to better define the risk/benefit ratio of this experimental yet promising treatment option.

Penile allotransplantation for penis amputation following ritual circumcision: a case report with 24 months of follow-up

Ritual circumcision complicated by gangrene is a leading cause of penile loss in young men in South Africa. This deeply rooted cultural tradition is unlikely to be abolished. Conventional reconstructive techniques using free vascularised tissue flaps with penile implants are undesirable in this often socioeconomically challenged group because donor site morbidity can hinder manual labour and vigorous sexual activity might lead to penile implant extrusion. The psychosociological effects of penile loss in a young man are devastating and replacing it with the same organ is likely to produce the maximum benefit. We first performed a cadaver-to-cadaver penile transplantation as preparation. After approval from the Human Research Ethics Committee was obtained, we recruited potential recipients. We screened the potential participants for both physical and psychological characteristics, including penile stump length, and emotional suitability for the procedure. A suitable donor became available and the penis was harvested. We surgically prepared the penile stump of the recipient and attached the penile graft. Immunosuppression treatment with antithymyocyte globulin, methylprednisolone, tacrolimus, mycophenolate mofetil, and prednisone were commenced. Tadalafil at 5 mg once per day was commenced after 1 week as penile rehabilitation and was continued for 3 months. We collected on quality-of-life scores (Short Form 36 version 2 [SF-36v2] questionnaires) before surgery and during follow-up and measured erectile function (International Index for Erectile Function [IIEF] score) and urine flow rates at 24 months post transplant. The warm ischaemia time for the graft after removal was 4 min and the cold ischaemia time was 16 h. The surgery lasted 9 h. An arterial thrombus required urgent revision 8 h after the operation. On post operative day 6, an infected haematoma and an area of proximal skin necrosis were surgically treated. The recipient was discharged after 1 month and first reported satisfactory sexual intercourse 1 week later (despite advice to the contrary). The recipient reported regular sexual intercourse from 3 months after the operation. An episode of acute kidney injury at 7 months was reversed by reducing the tacrolimus dose to 14 mg twice per day. At 8 months after surgery, the patient had a skin infection with phaeohyphomycosis due to Alternaria alternata, which we treated with topical antifungal medication. Quality-of-life scores improved substantially after the operation (SF-36v2 mental health scores improved from 25 preoperatively, to 57 at 6 months and 46 at 24 months post transplant; physical health scores improved from 37 at baseline to 60 at 6 months and 59 at 24 months post-transplant). At 24 months, measured maximum urine flow rate (16·3 mL/s from a volume voided of 109 mL) and IIEF score (overall satisfaction score of 8 from a maximum of 10) were normal, showing normal voiding and erectile function, respectively. Penile transplantation restored normal physiological functions in this transplant recipient without major complications in the first 24 months. Department of Health, Western Cape Government.

Penile transplantation is here

Penile transplantation is here

AB086. Penile transplantation: a long way to routine clinical practice

BackgroundThe aim of this review was to discuss the current issues in penile transplantation.MethodsPubMed, ISI Web of Science and Google Scholar databases (until April 2015) were searched for relevant publications on penile transplantation.ResultsPatients with penile carcinoma might be ideal possible patients who require transplantation. Penis deficiencies caused by surgery (e.g., traditional circumcision in some countries) might be an important resource for penile transplantation. Although penile reconstruction, penile replantation, and penile lengthening are other available options for penile defects, the following limitations should be considered: (I) no good substitute is available for erectile tissue in reconstructive surgery; (II) no excellent cosmetic result can be achieved in most cases; (III) multiple operations are needed; (IV) limited ischemic time and well-preserved amputated penis are required; and (V) occurrence of nerve/vascular damage.ConclusionsAt present, only two penile transplantations were reported but showed initial success. However, uncertainty of long-term erectile function, immunosuppression-related concerns, ethical issues, and even financial burden have limited the development of penile transplantations. Penile transplantation is still in the exploratory stage, and the operation will be performed only after strict preoperative evaluation, patient selection, full informed consent, and approval of the ethics committee. Only after all the above concerns are solved can penile transplantation be applied in routine practice.

AB002. Human penile allotransplantation: an emerging option for major genital loss

Reconstruction of complex functional structures is increasingly being performed with vascularized composite allotransplantation. This reconstructive approach has been used successfully to replace complex functional tissues including the face, hands and limbs. At this time, penile transplantation is under consideration for vascularized composite allotransplantation. Indications for penile transplantation include severe penile tissue loss and congenital penile malformations. Additionally, although traditionally not considered an indication for penile transplantation, its role in gender reassignment surgery has been increasingly considered. Penile transplantation offers an alternative to autogenous reconstruction, particularly when the latter option is disadvantageous on the basis of limited donor tissue availability as well as complexity of surgical revision that commonly is associated with autogenous reconstruction. It is recognized that phalloplasty techniques should achieve such goals as a normal appearing phallus, a mode for successful urinary transport and natural erection ability with sensation. Penile transplantation may offer an alternative for complex genitourinary reconstruction meeting objectives of phalloplasty. However, consideration must be given to various challenges, including ethical and psychosocial considerations as well as concerns of immunosuppression and surgical anatomical complexity. A multidisciplinary approach involving urologic and plastic surgeons, mental health specialists, bioethicists and perioperative clinical providers is essential for establishing a clinical program that offers this therapy.

Penile transplantation as an appropriate response to botched traditional circumcisions in South Africa: an argument against

Traditional male circumcision is a deeply entrenched cultural practice in South Africa. In recent times, there have been increasing numbers of botched circumcisions by untrained and unscrupulous practitioners, leading to...

PD63-01 SEVERE PENILE INJURIES SUSTAINED DURING OPERATIONS IRAQI AND ENDURING FREEDOM: EVALUATING THE TOUGH COHORT FOR PENILE TRANSPLANTATION

You have accessJournal of UrologyTrauma/Reconstruction/Diversion: External Genitalia Reconstruction and Urotrauma (including transgender surgery) II1 Apr 2017PD63-01 SEVERE PENILE INJURIES SUSTAINED DURING OPERATIONS IRAQI AND ENDURING FREEDOM: EVALUATING THE TOUGH COHORT FOR PENILE TRANSPLANTATION Steven Hudak, Judson Janak, Jean Orman, and Michael Davis Steven HudakSteven Hudak More articles by this author , Judson JanakJudson Janak More articles by this author , Jean OrmanJean Orman More articles by this author , and Michael DavisMichael Davis More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.2925AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES In our initial review of the Trauma Outcomes and Urogenital Health (TOUGH) cohort, we identified 423 male US service members (SMs) who sustained penile injuries (PI) while deployed in support of Operations Iraqi Freedom and Enduring Freedom (OIF/OEF). Conventional penile reconstruction is challenged by the unique structure and function of the penile tissues. Thus, penile transplantation is being investigated as a potential means for penile replacement after severe PI. We have made the clinical observation that many SMs who sustained severe PI during OIF/OEF presented with complex polytrauma which may have excluded them from enrollment in existing penile transplantation protocols. The objective of this study was to evaluate the injury patterns among members of the TOUGH cohort who sustained PI with a focus on comorbid conditions which may impact candidacy for penile transplantation. METHODS The previously identified members of the TOUGH cohort who sustained PI were further characterized based on injury severity as well as the presence of comorbid conditions which may impact eligibility for penile transplantation. Severe PI was defined as an Abbreviated Injury Scale severity of 3 or greater (cutaneous avulsion, laceration through glans/cavernosum/urethra, or partial/total penectomy). Five comorbid conditions were identified which may negatively impact penile transplant candidacy: traumatic brain injury (TBI), massive blood transfusion, colorectal injury, pelvic fracture, and extremity amputation(s). SMs with severe PI were stratified by the number of comorbid conditions diagnosed. RESULTS Among the 423 men with PI identified in the TOUGH cohort, 86 (20.3%) sustained severe PI. SMs with severe PI were largely young (median age: 23) and injured during battle (n=81; 94%) by explosive mechanisms (n=77; 90%) resulting in severe polytrauma (median ISS=29). Comorbid conditions which could impact penile transplantation candidacy were common, including massive transfusion (n=56; 65%), lower extremity amputation(s) (n=55; 64%), TBI (n=34; 40%), colorectal injury (n=29; 34%), and pelvic fracture (n=27; 31%). Overall, 83% of SMs (n=71) had at least one of these conditions and 47% (n=41) had ≥ 3. CONCLUSIONS Severe PI was relatively rare during OIF/OEF. Life-threatening polytrauma was common and nearly all SMs with severe PI had comorbid immunologic, physical, and/or neurologic diagnoses which could disqualify them from penile transplantation given the current restrictions identified in existing transplant protocols. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e1254 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Steven Hudak More articles by this author Judson Janak More articles by this author Jean Orman More articles by this author Michael Davis More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Ushering in the era of penile transplantation.

Penile transplantation is a novel approach to management of penile loss in the developing field of composite tissue allotransplantation (CTA). Prior management for significant penile loss has been free flap phalloplasty with issues related to function, cosmesis, and functional loss from the location of flap harvest. Transplantation has been an evolving field with advancement in CTA over the past several decades leading to the option of penile transplant. Management of penile injury with replantation provided some preliminary groundwork on the technical aspects for penile transplantation. Additionally, penile transplantation raises many ethical, emotional, and psychological considerations with need for patience amidst ongoing advancement within the field.

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

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 ...

Penile transplantation: an emerging option for genitourinary reconstruction.

Penile transplantation is an emerging option for patients with severe genital defects not amenable to traditional reconstructive options. In this article, we discuss the burgeoning problem of severe male genitourinary trauma in the military, the limitations of traditional reconstructive options in addressing these problems, and the potential for penile transplantation to provide improved outcomes. We also review the preclinical research and limited worldwide experience with penile transplantation to date, including lessons learned, and discuss the many important technical, logistical, and ethical considerations pertaining to penile transplantation that must be addressed to maximize the likelihood of successful implementation.

The current situation in penile transplantation; a morphological evaluation

Basarili penis nakli ameliyatlari yakin zamanda gerceklestirilmistir. Penis ile ilgili hasarlar dogumsal olabildigi gibi sunnet islemi sirasinda, psikotik hastaliklar sonucu ya da savasta patlayan bomba veya atesli silah yaralanmasi sonucu gibi cok cesitli travmatik nedenlerle olabilmektedir. Bu durumlar kismi veya tam penis kaybina yol acabilmekte ve penis onarimi ihtiyacini dogurmaktadir. Onarim yapilamayan durumlarda penis nakli fikri alternatif bir secenek olarak ortaya cikmistir. Penis nakli ile ilgili cok sinirli sayida ameliyat yapilmistir ve henuz bilgi ve deneyimler yetersizdir. Bu derlemede penis naklindeki guncel durum ele alinmis, bu nakiller icin onem arz eden anatomik ve histolojik yapilar guncel literatur ile degerlendirilmistir.

Penile transplantation: A long way to routine clinical practice.

Organ transplantation is an ideal treatment for certain late-stage diseases. With the report of a penile transplantation in Tygerberg Hospital, South Africa, this topic has, once again, aroused exploration in the field. At present, two penile transplantation operations have been performed and gained some positive results. Patients can gain void standing, erectile function and better cosmetic appearance. However, debates and potential risks still exist. Here, we briefly review the progress of studies in this filed and discusses the potential risks and debates in penile transplantation.

016 Ex-Vivo Model of Human Penile Transplantation and Rejection: Effects of Rejection and Immunosuppresion on Erectile Physiology

016 Ex-Vivo Model of Human Penile Transplantation and Rejection: Effects of Rejection and Immunosuppresion on Erectile Physiology

337 Penile Transplantation: A Long Way to Clinical Therapy

337 Penile Transplantation: A Long Way to Clinical Therapy

The Ethics of Penile Transplantation: Preliminary Recommendations.

For men with significant genitourinary injury, penile transplantation is being considered as an option when reconstruction is not feasible or proves unacceptable to the injured patient. A review of the literature was conducted to assess the current state of penile reconstruction and transplantation options, as well as to evaluate scholarly research addressing the ethical dimensions of penile transplantation. The state of penile transplantation is elementary. If reconstruction is not a possibility, proceeding ethically with research on penile vascularized composite allotransplantation will require the articulation of guidelines. To date, very little has been published in the scholarly literature assessing the ethics of penile transplantation. Guidelines should be developed to address penile transplantation and must cover the donation of tissue, consent, subject selection, qualifications of the surgical team, and management of both failure and patient dissatisfaction. Unless guidelines are established and disseminated, penile transplants should not be undertaken. The preliminary recommendations suggested in this article may help to inform development of guidelines.