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Here's How Surgeons Performed The World's First Penis And Scrotum Transplant

The patient, a US veteran who was injured by a bomb in Afghanistan, underwent the 14-hour transplant procedure on March 26.

Posted on April 25, 2018, at 2:17 p.m. ET

Devon Stuart for Johns Hopkins Medicine

A team of surgeons at the Johns Hopkins Hospital performed the procedure.

There have been three other penis transplants worldwide, said Dr. Richard Redett, professor of plastic reconstructive surgery at the Johns Hopkins Hospital in Baltimore. But this was the first one to use such an extensive amount of tissue, including the scrotum.

"The big difference with this one is that it involves the abdominal wall or at least part of the abdominal wall, the entire penis, and the scrotum," Redett, the clinical director of the genitourinary transplant program at Johns Hopkins, told BuzzFeed News.

There are other procedures in which surgeons can create a penis using a patient's own tissue and a prosthetic device to achieve erections, but this patient had so much tissue loss that those procedures weren't an option.

The doctors have not revealed the patient's identity, but said that his extensive injuries were caused by an improvised explosive device while he was serving in Afghanistan. These types of injuries can be devastating, Redett said.

"They get characteristic blast patterns where they lose much of the soft tissue of the entire pelvic and lower abdominal region," Redett said.

"A lot of them tell us that that when they wake up in the hospital days or weeks after their injury, the first thing they do is lift the covers up and they see what type of damage they have to their genitalia," he said. "They do that before they look at their legs, so it’s a big deal."

Devon Stuart for Johns Hopkins Medicine

The complex surgery involved connecting three arteries, four veins, and two nerves under a microscope.

The surgery was conducted after five years of research, according to Johns Hopkins. The team included nine plastic surgeons and two urologic surgeons, in addition to anesthesiologists, nurses, and surgical technicians, and took 14 hours to complete.

The testes of the donor were not transferred during the procedure because it's considered unethical. If the testes were transferred, the recipient may have had the ability to reproduce with the donor's sperm.

"Those cells will always produce the sperm with the DNA of the person who had the testes to start," Redett said. "So if you transplant the testes from a donor to recipient you are transplanting the ability to transfer the donor’s DNA and ethically we are just not there yet."

Johns Hopkins Medicine

The patient is doing well and is expected to go home later this week.

The hospital reported that the patient is out of bed and walking, and he's expected to go home later this week or next week. "We are just working out some of his medication but otherwise he is doing superbly," said Redett.

The doctors hope he will have near-normal function of his urinary tract, physical sensation, and sexual function.

"I don’t think there is any question that he’ll be able to urinate standing," Redett said. "I think he will have very good return of sensation and be able to have an erection and be able to have intercourse."

The patient said he now feels more normal. "It's a real mind-boggling injury to suffer; it is not an easy one to accept," he said in a statement released by Johns Hopkins. "When I first woke up, I felt finally more normal … [with] a level of confidence as well. Confidence … like finally I'm OK now."

Johns Hopkins Medicine

While the procedure is currently limited to patients with traumatic injuries, it may one day be an option for those with birth defects or cancer.

The hospital's institutional review board has only approved the procedure for patients with traumatic injuries, not those with birth defects, cancer, or who are transgender.

Transplant patients generally have to take medication for the rest of their lives to prevent their immune system from rejecting the donor tissue. This can increase their risk of infections or other problems, and the transplant can sometimes fail and need to be repeated.

This occurred to one man who recently underwent a second face transplant. Transplants can be so risky that doctors generally only do them if there are no other options, although early treatment can help prevent organ rejection.

"We would hope to catch a graft that’s rejecting way before you would need a second transplant," Redett said.

Johns Hopkins Medicine

The team is grateful to the donor's family for agreeing to the transplant.

When you check on your driver’s license that you will be an organ donor, it does not include a face transplant, a hand transplant, or penis transplant, said Redett. "It’s a special ask."

"We are deeply indebted to our team and the family that agreed to donate the tissue," Redett said.

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