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Lopez CD, Yusuf CT, Girard AO, Lake IV, Cooney DS, Redett RJ. Penile Transplantation in Gender Affirmation Surgery: A Theoretical Feasibility Study. J Reconstr Microsurg 2024; 40:96-101. [PMID: 37142254 DOI: 10.1055/a-2085-9943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
BACKGROUND It can be argued that individuals in the transgender and gender nonbinary (TGNB) community suffer from a similar impact on quality of life in the face of gender dysphoria, with psychosocial and physical consequences. Indications for penile allotransplantation for patients wishing to undergo gender affirmation surgery have yet to be elucidated, but technical lessons for feasibility can be gleaned from penis transplants that have already been performed on cisgender males to date. METHODS This study investigates the theoretical feasibility for penile-to-clitoral transplantation, prior penile transplants, and current multidisciplinary gender affirmation health care modalities. RESULTS Penile allotransplantation offers a potential solution for individuals in the TGNB community for a more aesthetic penis, improved erectile function without the need of a prosthesis, optimal somatic sensation, and improved urethral outcomes. CONCLUSION Questions remain about ethics, patient eligibility, and immunosuppressive sequelae. Before these issues are addressed, feasibility of this procedure must be established.
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Affiliation(s)
- Christopher D Lopez
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Cynthia T Yusuf
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Division of Plastic and Reconstructive Surgery, University of Maryland School of Medicine, Baltimore, Maryland
| | - Alisa O Girard
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Isabel V Lake
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Damon S Cooney
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Richard J Redett
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Ruiz F, Cetrulo CL, Timsit MO, Lantieri L, Lellouch AG. Modified Surgical Model for Genitourinary Vascularized Composite Allotransplantations: An Anatomical Study. Plast Reconstr Surg 2023; 152:468e-471e. [PMID: 36735818 DOI: 10.1097/prs.0000000000010263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
SUMMARY Total penile reconstruction represents a surgical challenge. Autologous reconstructions offer limited aesthetic results and variable urinary function recovery. To date, five genitourinary vascularized composite allotransplantations have been performed worldwide. However, in all cases, vascular complications have been reported. The objective of this study was to develop a modified surgical model for penile allotransplantation to limit the number of microsurgical anastomoses and ensure vascular reliability. The authors studied penile allotransplantation by performing dissections on 12 subjects. The study was carried out to ensure the vascularization of the entire penis shaft while limiting the number of anastomoses. The penis vasculature includes numerous angiosomes between its different subunits. The penile skin envelope is supplied by both external and internal pudendal vessels. The cavernous and spongy bodies are supplied by terminal branches of the internal pudendal vessels. The anterior pubic osteotomy approach allows access to the root of the cavernous bodies and to the Alcock ducts. This modified surgical model for penile allotransplantation could help future teams involved in genitourinary vascularized composite allotransplantations to improve urinary and sexual function. CLINICAL RELEVANCE STATEMENT The authors introduce an improved surgical technique for penile transplantation that enhances vascularization and graft viability. This innovative procedure optimizes blood flow through meticulous microsurgical anastomosis, resulting in improved functional outcomes. Its potential to revolutionize penile transplantation warrants further exploration and validation within the surgical community.
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Affiliation(s)
- François Ruiz
- From the Departments of Plastic, Reconstructive and Aesthetic Surgery
| | - Curtis L Cetrulo
- the Vascularized Composite Allotransplantation Laboratory, Center for Transplantation Sciences, Massachusetts General Hospital, Harvard Medical School
| | - Marc-Olivier Timsit
- Urology, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris
| | - Laurent Lantieri
- From the Departments of Plastic, Reconstructive and Aesthetic Surgery
| | - Alexandre G Lellouch
- From the Departments of Plastic, Reconstructive and Aesthetic Surgery
- the Vascularized Composite Allotransplantation Laboratory, Center for Transplantation Sciences, Massachusetts General Hospital, Harvard Medical School
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3
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Veeramani A, Hwang CD, Gardenier JC, Fruge SE, Khouri KS, Ehret AL, Vieira BL, Buta MR, Cetrulo CL. Posttraumatic Penile Replantation with Minimal Skin Necrosis. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2023; 11:e5205. [PMID: 37636329 PMCID: PMC10448931 DOI: 10.1097/gox.0000000000005205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 06/29/2023] [Indexed: 08/29/2023]
Abstract
Penile amputation is a surgical emergency where practical and timely perioperative management is crucial for ensuring a successful outcome. Tenuous viability of penile and scrotal skin has been well described in the literature, with a putative mechanism attributed to the transection of distal branches of the external pudendal artery. Although the perforasomes critical to penile replantation have been debated, this case report details a patient who successfully recovered sensation and function with minimal necrosis after penile replantation. Surgically, this was facilitated by intentional drain placement, aggressive debridement beyond the zone of injury, and planned redundancies with dorsal artery/vein anastomoses via interposition grafts of the dorsal penile vessels alone.
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Affiliation(s)
- Anamika Veeramani
- From the Division of Plastic and Reconstructive Surgery, Department of Surgery, Massachusetts General Hospital, Harvard University, Boston, Ma
| | - Charles D. Hwang
- From the Division of Plastic and Reconstructive Surgery, Department of Surgery, Massachusetts General Hospital, Harvard University, Boston, Ma
| | - Jason C. Gardenier
- From the Division of Plastic and Reconstructive Surgery, Department of Surgery, Massachusetts General Hospital, Harvard University, Boston, Ma
| | - Seth E. Fruge
- From the Division of Plastic and Reconstructive Surgery, Department of Surgery, Massachusetts General Hospital, Harvard University, Boston, Ma
| | - Kimberly S. Khouri
- From the Division of Plastic and Reconstructive Surgery, Department of Surgery, Massachusetts General Hospital, Harvard University, Boston, Ma
| | - Ashley L. Ehret
- From the Division of Plastic and Reconstructive Surgery, Department of Surgery, Massachusetts General Hospital, Harvard University, Boston, Ma
| | - Brittany L. Vieira
- From the Division of Plastic and Reconstructive Surgery, Department of Surgery, Massachusetts General Hospital, Harvard University, Boston, Ma
| | - Martin R. Buta
- From the Division of Plastic and Reconstructive Surgery, Department of Surgery, Massachusetts General Hospital, Harvard University, Boston, Ma
| | - Curtis L. Cetrulo
- From the Division of Plastic and Reconstructive Surgery, Department of Surgery, Massachusetts General Hospital, Harvard University, Boston, Ma
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4
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Cristofari S, Ramelli E, Phan YC, Cetrulo CL, Ng ZY, Lellouch AG. Genitourinary vascularized composite allotransplantation for gender affirmation in trans men: An anatomical feasibility study. J Plast Reconstr Aesthet Surg 2023; 83:117-125. [PMID: 37276729 DOI: 10.1016/j.bjps.2023.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 02/01/2023] [Accepted: 04/07/2023] [Indexed: 06/07/2023]
Abstract
PURPOSE Gender affirmation in trans men requires multiple staged procedures. The final masculinizing step involves phalloplasty or metoidioplasty and further incorporation of penile and testicular prostheses. However, these are functionally suboptimal and associated with high complication rates. Therefore, we sought to investigate the anatomical feasibility of one-stage genitourinary vascularized composite allotransplantation (GUVCA) for such gender-affirming surgeries. METHODS Twenty fresh cadaveric dissections were performed to delineate the neurovascular anatomy of the proposed GUVCA. Specifically, in donors (n = 14), besides the penis and scrotum, the GUVCA included an inferior bladder patch with the urinary sphincter, prostate, seminal vesicles, as well as a strip of the pubic bone. In trans men recipients, osteotomies of the pubic bone to match that of the donor GUVCA were required. Five cadaveric GUVCA transplants were then performed to simulate one-stage gender affirmation surgery. RESULTS The GUVCA required (1) vascular anastomoses between the recipient's deep inferior epigastric, external pudendal, and superficial circumflex iliac (or superficial inferior epigastric) vessels to the donor's internal pudendal, external pudendal and genitofemoral vessels respectively; (2) neurosynthesis between the recipient pudendal and dorsal clitoral nerves to the donor pudendal and genitofemoral nerves; and (3) urinary bladder anastomosis at the bladder neck, upstream of the urinary sphincter. Average donor measurements (length (cm), diameter (mm)) were: external pudendal artery (2.5, 2.0) and vein (2.0, 3.5), internal pudendal artery (15.0, 4.0), pudendal (15.0, 3.0) and genitofemoral nerves (8.0, 2.0). CONCLUSIONS We have described the anatomical basis for a one-stage GUVCA in trans masculine genitourinary reconstruction.
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Affiliation(s)
| | - Eloi Ramelli
- LVTS, INSERM U1148, X. Bichat hospital, INSERM, Paris, France
| | - Yih Chyn Phan
- Department of Urology, Queen Alexandra Hospital, Portsmouth, UK
| | - Curtis L Cetrulo
- Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Vascularized Composite Allotransplantation Laboratory, Center for Transplantation Sciences, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Department of Plastic Surgery, Shriners Hospitals for Children, Boston, MA, USA
| | - Zhi Yang Ng
- Department of Plastic and Reconstructive Surgery, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Alexandre G Lellouch
- Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Vascularized Composite Allotransplantation Laboratory, Center for Transplantation Sciences, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Department of Plastic Surgery, Shriners Hospitals for Children, Boston, MA, USA; Service de Chirurgie Plastique, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris (APHP), Université Paris Descartes, Paris, France.
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5
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Lopez CD, Girard AO, Lake IV, Oh BC, Brandacher G, Cooney DS, Burnett AL, Redett RJ. Lessons learned from the first 15 years of penile transplantation and updates to the Baltimore Criteria. Nat Rev Urol 2023; 20:294-307. [PMID: 36627487 PMCID: PMC9838304 DOI: 10.1038/s41585-022-00699-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/02/2022] [Indexed: 01/11/2023]
Abstract
Since 2006, five penis transplants have been performed worldwide. Mixed outcomes have been reported, and two of the five penile transplants have required explantation. However, the long-term outcomes have been encouraging when compliance is implemented, whether standard induction and triple therapy maintenance, or single therapy maintenance. Follow-up monitoring of transplant recipients has enabled a synthesis of technical considerations for surgical success and has shown stable leukocyte counts and renal function after a donor bone-marrow-based immunomodulatory regimen followed by tacrolimus monotherapy as long as 3 years post-transplant, as well as continuous nerve regeneration of penile allografts 3 years post-transplant. Areas of uncertainty include the ethics of donor-recipient colour mismatch, surveillance for sexually transmitted infections and how to optimize patient compliance. Questions also remain with respect to the long-term immunological sequelae of penile tissue, functional outcomes, psychosocial implications and patient selection. Patient counselling should be modified to mention the possibility of long-term improvement in nerve regeneration and sufficient renal function with single-therapy maintenance, and to build a longitudinal dialogue and partnership between the patient and the multidisciplinary care team regarding the risks of sexually transmitted infection instead of surveillance.
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Affiliation(s)
- Christopher D. Lopez
- grid.21107.350000 0001 2171 9311Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MA USA
| | - Alisa O. Girard
- grid.21107.350000 0001 2171 9311Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MA USA
| | - Isabel V. Lake
- grid.21107.350000 0001 2171 9311Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MA USA
| | - Byoung Chol Oh
- grid.21107.350000 0001 2171 9311Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MA USA
| | - Gerald Brandacher
- grid.21107.350000 0001 2171 9311Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MA USA
| | - Damon S. Cooney
- grid.21107.350000 0001 2171 9311Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MA USA
| | - Arthur L. Burnett
- grid.21107.350000 0001 2171 9311Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MA USA
| | - Richard J. Redett
- grid.21107.350000 0001 2171 9311Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MA USA
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Kachare MD, Elfanagely O, Safeek RH, Barrow B, Simpson AM, O’Toole A, Hsiao EC, Kachare SD, Engineer N, Quintero J, Wilhelmi BJ. Complete Penile Amputation: An Anatomical Reference and Surgical Pearls to Ensure a Successful Replantation. EPLASTY 2022; 22:ic12. [PMID: 36160661 PMCID: PMC9490876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
How common are penile amputations, and how are they treated?What key anatomic structures are involved?What are some technical pearls for a successful replantation?What are common complications, and how can they be prevented/treated?
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Affiliation(s)
- Milind D Kachare
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Louisville, Louisville, KY
| | - Omar Elfanagely
- Department of Surgery, Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Rachel H Safeek
- School of Medicine, University of Louisville, Louisville, KY
| | - Brooke Barrow
- School of Medicine, University of Louisville, Louisville, KY
| | - Alyssa M Simpson
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Louisville, Louisville, KY
| | - Adam O’Toole
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Louisville, Louisville, KY
| | - Eugene C Hsiao
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Louisville, Louisville, KY
| | - Swapnil D Kachare
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Nitin Engineer
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Louisville, Louisville, KY
| | - Juan Quintero
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Louisville, Louisville, KY
| | - Bradon J Wilhelmi
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Louisville, Louisville, KY
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7
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Machado B, Scherzer N, Harmsworth A. Penile autoamputation with successful reimplant a case report and new preoperatory mnemonic classification system: P.E.N.I.S. Urol Case Rep 2021; 40:101881. [PMID: 34646748 PMCID: PMC8501494 DOI: 10.1016/j.eucr.2021.101881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 10/02/2021] [Accepted: 10/05/2021] [Indexed: 12/02/2022] Open
Abstract
Genital self-mutilation is a rare condition. Psychiatric disease and accidents are the most common causes. We a case of genital amputation connected to religious delusions known as Klingsor Syndrome. Due to the scarcity of cases, each author describes the amputation injuries ununiformly, making the comparison of the cases difficult. We propose an anatomical pre-operatory score: The P.E.N.I.S.* score, it is an innovative pre-operative 5-grade score that aims to standardize the injury classification. Penile self-amputations are rare; medical literature lacks standardized classification that permits comparison between cases described. The P.E.N.I.S. score can be a helpful tool to fill this current gap.
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8
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Goldman C, Shaw N, du Plessis D, Myers JB, van der Merwe A, Venkatesan K. Gunshot wounds to the penis and scrotum: a narrative review of management in civilian and military settings. Transl Androl Urol 2021; 10:2596-2608. [PMID: 34295746 PMCID: PMC8261456 DOI: 10.21037/tau-20-1175] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 09/08/2020] [Indexed: 11/29/2022] Open
Abstract
Gunshot wounds (GSW) to the penis and scrotum are present in two thirds of all genitourinary (GU) trauma, with a growing proportion of blast injuries in the military setting. Depending on the energy of the projectile, the injury patterns present differently for military and civilian GSWs. In this review, we sought to provide a detailed overview of GSWs to the external genitalia, from mechanisms to management. We examine how ballistic injury impacts tissues, as well as the types of injuries that occur, and how to assess these injuries to the external genitalia. If there is concern for injury to the deep structures of the penis or scrotum, operative exploration and repair is warranted. Relevant history and physical examination, role of imaging, and choice of conservative or surgical treatment options in the civilian and military setting are discussed, as well as guidelines for management set forth by the American Urological Association (AUA) and European Association of Urology (EAU).
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Affiliation(s)
- Charlotte Goldman
- Georgetown University School of Medicine, Department of Urology, Washington, DC, USA
| | - Nathan Shaw
- Georgetown University School of Medicine, Department of Urology, Washington, DC, USA
| | - Danelo du Plessis
- Division of Urology, Department of Surgical Sciences, Stellenbosch University and Tygerberg Academic Hospital, Cape Town, South Africa
| | - Jeremy B Myers
- Division of Urology, Department of Surgery, University of Utah, Salt Lake City, UT, USA
| | - Andre van der Merwe
- Division of Urology, Department of Surgical Sciences, Stellenbosch University and Tygerberg Academic Hospital, Cape Town, South Africa
| | - Krishnan Venkatesan
- Georgetown University School of Medicine, Department of Urology, Washington, DC, USA.,MedStar Washington Hospital Center, Department of Urology, Washington, DC, USA
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9
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Selvaggi G, Manner K, Sakinis A, Olausson M. A pilot retrospective CT angio study of the internal pudendal arteries in male bodies, for the purpose of penis transplantation to trans men. J Plast Surg Hand Surg 2021; 56:63-68. [PMID: 34010105 DOI: 10.1080/2000656x.2021.1927058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Literature reports four successful cases where penile transplantation has been performed for cis men. To date, no penis transplantation has ever been attempted for trans men. Modern surgical techniques for penis reconstruction for (trans) men with gender incongruence present multiple drawbacks, and sometimes fail to meet patients' expectations. Penis transplantation could represent an alternative solution. With the aim of planning penis transplantation to trans men, a previous study from our same group suggested a surgical technique for explantation of penis and associated vessels, nerves and urethra en-bloc from a cadaver: further radiographic imaging of vascular anatomy was recommended. To measure length and diameter of the internal pudendal arteries at three set points in biological males, in order to confirm its viability for transplantation. A retrospective examination of existing CT images visualizing the internal pudendal arteries in 12 bodies, assigned male at birth, was performed. Diameters were measured in three points: 1. the take off of the artery; 2. distal to its rectal branch; and, 3. at the bifurcation of the two terminal branches of the artery, i.e. the bulbourethral artery and the dorsal artery of the penis. Mean diameters of the selected points were 2.4 mm, 1.9 mm, and 1.5 mm on both sides. Mean lengths of internal pudendal arteries were 111.2 mm on the left, and 120.1 mm on the right side. Diameters of the internal pudendal artery is sufficient for arterial anastomosis at all measured points. Lengths are sufficient to reach recipient vessels.
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Affiliation(s)
- Gennaro Selvaggi
- Department of Plastic Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, Sahlgrenska University Hospital, University of Gothenburg, Gothenburg, Sweden
| | - Kristiina Manner
- Department of Plastic Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, Sahlgrenska University Hospital, University of Gothenburg, Gothenburg, Sweden
| | - Augustinas Sakinis
- Department of Radiology, Institute of Clinical Sciences, Sahlgrenska Academy, Sahlgrenska University Hospital, University of Gothenburg, Gothenburg, Sweden
| | - Michael Olausson
- Department of Transplantation Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, Sahlgrenska University Hospital, University of Gothenburg, Gothenburg, Sweden
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10
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Wilcox Vanden Berg RN, Gaffney CD, Paduch DA. Presentation and resolution of gender dysphoria as a positive symptom in a young schizophrenic man who presented with self-emasculation: Frontiers of bioethics, psychiatry, and microsurgical genital reconstruction. Clin Case Rep 2020; 8:1735-1740. [PMID: 32983487 PMCID: PMC7495809 DOI: 10.1002/ccr3.2935] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 02/24/2020] [Accepted: 04/24/2020] [Indexed: 02/02/2023] Open
Abstract
Gender dysphoria can present as a positive symptom of schizophrenia. Completion of gender affirmation surgeries should not occur as a result of male genital self-mutilation via a deferral of emergent surgical reconstruction. Instead, gender affirmation should be considered after a full workup and assessment for resolution of any acute psychosis.
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Affiliation(s)
| | - Christopher D. Gaffney
- Department of UrologyNew York Presbyterian HospitalWeill Cornell Medical CollegeNew YorkNYUSA
| | - Darius A. Paduch
- Arthur Smith Institute for UrologyNorthwell HealthGreat NeckNYUSA
- Consulting Research Services, IncNorth BergenNJUSA
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11
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Elmaraghi S, Chen TJ, Heckman JE, Shiau JM, Williams DH, Abel EJ, Afifi AM. Functional penile replantation after traumatic avulsion amputation below the pubis: A case report. Microsurgery 2019; 40:70-73. [PMID: 30714225 DOI: 10.1002/micr.30425] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Revised: 10/14/2018] [Accepted: 12/27/2018] [Indexed: 11/09/2022]
Abstract
Penile amputation is a rare injury with significant posttraumatic ramifications. We present a case of successful immediate replantation after traumatic penile avulsion in a 52-year-old male patient. The patient reported his penis was caught in machinery during a boating accident, and avulsed at the level of the pubis. Immediate replantation of this proximal avulsion injury with no suitable proximal arterial stumps required transfer of the superficial inferior epigastric artery for arterial inflow. One artery and two veins were repaired. The urethral injury was found to be immediately distal to the urethral sphincter in the membranous portion, and repaired primarily. Urinary diversion was performed with a suprapubic catheter until the repair had healed. The postoperative course was complicated by less than 10% skin necrosis requiring skin grafting. At three years follow up, the patient has a penis with normal urinary function and is able to obtain erections with pharmacologic aids. Avulsion should not preclude penile replantation, which may have acceptable functional and esthetic results.
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Affiliation(s)
- Shady Elmaraghi
- Division of Plastic Surgery, Department of Surgery, University of Wisconsin-Madison, Madison, Wisconsin
| | - Tzujane Jenny Chen
- Division of Plastic Surgery, Department of Surgery, University of Wisconsin-Madison, Madison, Wisconsin
| | - Jennifer E Heckman
- Department of Urology, University of Wisconsin-Madison, Madison, Wisconsin
| | - Jonathan M Shiau
- Department of Urology, University of Wisconsin-Madison, Madison, Wisconsin
| | - Daniel H Williams
- Department of Urology, University of Wisconsin-Madison, Madison, Wisconsin
| | - E Jason Abel
- Department of Urology, University of Wisconsin-Madison, Madison, Wisconsin
| | - Ahmed M Afifi
- Division of Plastic Surgery, Department of Surgery, University of Wisconsin-Madison, Madison, Wisconsin.,Cairo University, Cairo, Egypt
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12
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Inferior External Pudendal Artery Anastomosis: Additional Approach to Prevent Skin Necrosis in Replanted Penis. Plast Reconstr Surg 2018; 142:535e-540e. [PMID: 30252820 DOI: 10.1097/prs.0000000000004818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Microsurgical anastomosis of the dorsal artery of the penis either with or without anastomosis of the cavernosal artery is the preferred technique for penile replantation. However, postoperative penile skin necrosis is commonly reported with this technique. This study aimed to characterize the anatomy of the vascular supply of the penis pertinent to penile replantation surgery and to report a successful case of penile replantation without postoperative necrosis using anastomosis of the inferior external pudendal artery. METHODS The authors dissected 15 penises of fresh cadavers under acrylic dye injection by means of the inferior external pudendal and dorsal arteries of the penis to identify vascular anastomoses between arteries supplying the penis and to measure other parameters of the arteries. RESULTS Mean diameters at the base of the penis of the inferior external pudendal, dorsal, and cavernosal arteries were 0.94, 1.43, and 0.80 mm, respectively. Penile skin is mainly supplied by the inferior external pudendal artery under three patterns with anastomoses across the midline. Preputial skin receives additional blood supply from perforators of the dorsal artery without visible anastomosis between the perforators and the inferior external pudendal artery. Deep structures receive blood supply from the dorsal, cavernosal, and urethral arteries, with visible anastomoses between the arteries. In a patient with amputated penis, the inferior external pudendal artery diameter was 0.7 mm, which was sufficient for microsurgical anastomosis. No postoperative necrosis developed, and patency of the inferior external pudendal artery was confirmed with duplex ultrasound. CONCLUSION The diameter of the inferior external pudendal artery at the base and midshaft of the penis is sufficiently large for microsurgical anastomosis, and additional vascular anastomosis of at least one inferior external pudendal artery may help to prevent postoperative penile skin necrosis. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, V.
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13
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Selvaggi G, Wesslen E, Elander A, Wroblewski P, Thorarinsson A, Olausson M. En Bloc Surgical Dissection for Penile Transplantation for Trans-Men: A Cadaveric Study. BIOMED RESEARCH INTERNATIONAL 2018; 2018:6754030. [PMID: 29854779 PMCID: PMC5964499 DOI: 10.1155/2018/6754030] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Accepted: 04/01/2018] [Indexed: 02/02/2023]
Abstract
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.
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Affiliation(s)
- Gennaro Selvaggi
- Department of Plastic Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University Hospital, Göteborg, Sweden
| | - Erica Wesslen
- Department of Plastic Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University Hospital, Göteborg, Sweden
| | - Anna Elander
- Department of Plastic Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University Hospital, Göteborg, Sweden
| | - Peter Wroblewski
- Department of Plastic Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University Hospital, Göteborg, Sweden
| | - Andri Thorarinsson
- Department of Plastic Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University Hospital, Göteborg, Sweden
| | - Michael Olausson
- Department of Transplantation Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University Hospital, Göteborg, Sweden
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Successful Second Microsurgical Replantation for Amputated Penis. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2017; 5:e1512. [PMID: 29062672 PMCID: PMC5640378 DOI: 10.1097/gox.0000000000001512] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Accepted: 08/08/2017] [Indexed: 02/07/2023]
Abstract
Penile amputation is a rare emergency, but the best method for its repair is required due to the organ's functional and societal role. Since the first successful microsurgical replantation of the amputated penis, microsurgical techniques have matured and become the standard treatment for the penile replantation. However, the successful second microsurgical replantation for amputated penis has been rarely reported. We present the case of a 40-year-old man with schizophrenia who had a past history of penile self-mutilation and successful replantation at another hospital 2 years ago. After stopping oral medication for schizophrenia, he again cut his penis with a kitchen knife. We successfully replanted the amputated penis by anastomosing both circumflex arteries, the superficial dorsal vein, and the deep dorsal vein using microsurgical techniques. Postoperatively, the foreskin of the replanted penis gradually developed partial necrosis, requiring surgical debridement. The aesthetic and functional results were satisfactory and retrograde urethrography showed no evidence of leakage and stricture of the urethra. Although skin necrosis after penile replantation has been reported as an unavoidable process owing to the nature of injury, the rate would be higher after secondary replantation because of scar formation due to the previous operation. Therefore, our case of successful secondary replantation suggests that skin necrosis would be a predictable postoperative complication and the debridement timing of the devitalized foreskin should be closely monitored, and also secondary amputation is not a contraindication of replantation.
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15
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van der Merwe A, Graewe F, Zühlke A, Barsdorf NW, Zarrabi AD, Viljoen JT, Ackermann H, Spies PV, Opondo D, Al-Qaoud T, Bezuidenhout K, Nel JD, Bailey B, Moosa MR. Penile allotransplantation for penis amputation following ritual circumcision: a case report with 24 months of follow-up. Lancet 2017; 390:1038-1047. [PMID: 28823494 DOI: 10.1016/s0140-6736(17)31807-x] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Revised: 05/30/2017] [Accepted: 06/13/2017] [Indexed: 01/19/2023]
Abstract
INTRODUCTION 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. METHODS 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. FINDINGS 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. INTERPRETATION Penile transplantation restored normal physiological functions in this transplant recipient without major complications in the first 24 months. FUNDING Department of Health, Western Cape Government.
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Affiliation(s)
- André van der Merwe
- Division of Urology, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Academic Hospital, Cape Town, South Africa.
| | - Frank Graewe
- Division of Plastic and Reconstructive Surgery, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Academic Hospital, Cape Town, South Africa
| | - Alexander Zühlke
- Division of Plastic and Reconstructive Surgery, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Academic Hospital, Cape Town, South Africa
| | - Nicola W Barsdorf
- Health Research Ethics, Division of Research Development and Support, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Academic Hospital, Cape Town, South Africa
| | - Amir D Zarrabi
- Division of Urology, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Academic Hospital, Cape Town, South Africa
| | - Jeremy T Viljoen
- Division of Urology, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Academic Hospital, Cape Town, South Africa
| | - Hilgard Ackermann
- Division of Urology, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Academic Hospital, Cape Town, South Africa
| | - Pieter V Spies
- Division of Urology, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Academic Hospital, Cape Town, South Africa
| | - Dedan Opondo
- Division of Urology, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Academic Hospital, Cape Town, South Africa
| | - Talal Al-Qaoud
- Division of Transplant Surgery, Department of Surgery, University of Wisconsin, Milwaukee, WI, USA
| | - Karla Bezuidenhout
- Division of Nephrology, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Academic Hospital, Cape Town, South Africa
| | - Johan D Nel
- Division of Nephrology, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Academic Hospital, Cape Town, South Africa
| | - Bertha Bailey
- Renal Unit, Tygerberg Academic Hospital, Cape Town, South Africa
| | - M Rafique Moosa
- Division of Nephrology, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Academic Hospital, Cape Town, South Africa
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16
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Abstract
BACKGROUND Acquired or congenital absence of the penis can lead to severe physical limitations and psychological outcomes. Phallic reconstruction can restore various functional aspects of the penis and reduce psychosocial sequelae. Moreover, some female-to-male transsexuals desire creation of a phallus as part of their gender transition. Because of the complexity of phalloplasty, there is not an ideal technique for every patient. This review sets out to identify and critically appraise the current literature on phalloplasty techniques and outcomes. METHODS A comprehensive literature search of the MEDLINE, PubMed, and Google Scholar databases was conducted for studies published through July of 2015 with multiple search terms related to phalloplasty. Data on techniques, outcomes, complications, and patient satisfaction were collected. RESULTS A total of 248 articles were selected and reviewed from the 790 identified. Articles covered a variety of techniques on phalloplasty. Three thousand two hundred thirty-eight patients underwent phalloplasty, with a total of 1753 complications reported, although many articles did not explicitly comment on complications. One hundred four patients underwent penile replantation and two underwent penile transplantation. Satisfaction was high, although most studies did not use validated or quantified approaches to address satisfaction. CONCLUSIONS Phalloplasty techniques are evolving to include a number of different flaps, and most techniques have high reported satisfaction rates. Penile replantation and transplantation are also options for amputation or loss of phallus. Further studies are required to better compare different techniques to more robustly establish best practices. However, based on these studies, it appears that phalloplasty is highly efficacious and beneficial to patients.
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17
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Sopko NA, Tuffaha SH, Lough D, Brandacher G, Lee WPA, Bivalacqua TJ, Redett RJ, Burnett AL. Penile Allotransplantation for Complex Genitourinary Reconstruction. J Urol 2017; 198:274-280. [PMID: 28286074 DOI: 10.1016/j.juro.2016.10.134] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/03/2016] [Indexed: 01/31/2023]
Abstract
PURPOSE Reconstruction of complex functional structures is increasingly being performed with vascularized composite allotransplantation. Penile transplantation is a novel vascularized composite allotransplantation treatment option for severe penile tissue loss and disfigurement. Three allogeneic human penile transplantations have been reported. We review these cases as well as penile transplant indications, preclinical models and immunosuppression therapy. MATERIALS AND METHODS We performed a comprehensive literature review for the years 1970 to 2016 via MEDLINE®, PubMed® and Google with the key words "penis transplantation," "penile rejection," "penile replantation," "penile tissue loss" and "penis vascularized composite allotransplantation." Relevant articles, including original research, reviews and nonscientific press reports, were selected based on contents, and a review of this literature was generated. RESULTS Three human allogeneic penile transplantations have been performed to date, of which 1 was removed 14 days after transplantation. The second recipient reports natural spontaneous erections and impregnating his partner. All 3 patients were able to void spontaneously through the graft's urethra. The complexity of the transplant is determined by how proximally the penile shaft anastomosis is performed and additional pelvic tissue may be transplanted en bloc if needed. CONCLUSIONS Penile transplantation is a technically demanding procedure with significant ethical and psychosocial implications that can provide tissue and functional replacement, including urinary diversion and natural erections. It is unclear how rejection and immunosuppression may affect graft function. Better models and more preclinical research are needed to better understand and optimize penile transplantation.
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Affiliation(s)
- Nikolai A Sopko
- The James Buchannan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Sami H Tuffaha
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Denver Lough
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Gerald Brandacher
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - W P Andrew Lee
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Trinity J Bivalacqua
- The James Buchannan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Richard J Redett
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Arthur L Burnett
- The James Buchannan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, Maryland.
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18
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Tuffaha SH, Cooney DS, Sopko NA, Bivalacqua TJ, Lough DM, Cooney CM, Brandacher G, Lee WPA, Burnett AL, Redett RJ. Penile transplantation: an emerging option for genitourinary reconstruction. Transpl Int 2017; 30:441-450. [PMID: 28130926 DOI: 10.1111/tri.12928] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2016] [Revised: 12/05/2016] [Accepted: 01/24/2017] [Indexed: 01/10/2023]
Abstract
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.
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Affiliation(s)
- Sami H Tuffaha
- Department of Plastic and Reconstructive Surgery, The Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Damon S Cooney
- Department of Plastic and Reconstructive Surgery, The Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Nikolai A Sopko
- Department of Urology, The Johns Hopkins School of Medicine, Baltimore, MD, USA
| | | | - Denver M Lough
- Department of Plastic and Reconstructive Surgery, The Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Carisa M Cooney
- Department of Plastic and Reconstructive Surgery, The Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Gerald Brandacher
- Department of Plastic and Reconstructive Surgery, The Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Wei-Ping Andrew Lee
- Department of Plastic and Reconstructive Surgery, The Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Arthur L Burnett
- Department of Urology, The Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Richard J Redett
- Department of Plastic and Reconstructive Surgery, The Johns Hopkins School of Medicine, Baltimore, MD, USA
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Merwe AVD, Zarrabi A, Zühlke A, Barsdorf N, Moosa R. Lessons learned from the world's first successful penis allotransplantation. JOURNAL OF MATERIALS SCIENCE. MATERIALS IN MEDICINE 2017; 28:27. [PMID: 28074434 DOI: 10.1007/s10856-016-5836-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Accepted: 12/16/2016] [Indexed: 06/06/2023]
Abstract
We performed a successful penis allotransplantation on 11 December 2014. Sharing the lessons learned might help more patients in need to be treated this way. We divided the project into manageable segments that was each overseen by an expert. The ethical review and conduct paved the way for a publically acceptable and successful project. Screening for a psychological stable recipient is important. The most difficult part of the project was finding a donor penis. This was successfully negotiated with the family of a brain dead donor by creating a neo-phallus for the donor, thereby maintaining the dignity of the donor. Working with transplant coordinators that are sympathetic to aphallic men is crucial. Surgeons versed in microvascular techniques is a critical part of the team. Transplant immunologists have to adapt to treat composite tissue transplantation patients.
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Affiliation(s)
- Andre van der Merwe
- Division of Urology, Department of Medicine and Health Sciences, Stellenbosch University and Tygerberg Academic Hospital, Cape Town, South Africa.
| | - Amir Zarrabi
- Division of Urology, Department of Medicine and Health Sciences, Stellenbosch University and Tygerberg Academic Hospital, Cape Town, South Africa
| | - Alexander Zühlke
- Division of Plastic and Reconstructive surgery, Department of Medicine and Health Sciences, Stellenbosch University and Tygerberg Academic Hospital, Cape Town, South Africa
| | - Nicola Barsdorf
- Health Research Ethics, Division of Research Development and Support, Department of Medicine and Health Sciences, Stellenbosch University and Tygerberg Academic Hospital, Cape Town, South Africa
| | - Rafique Moosa
- Division Nephrology and Renal Transplantation, Department of Internal Medicine, Department of Medicine and Health Sciences, Stellenbosch University and Tygerberg Academic Hospital, Cape Town, South Africa
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21
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Penis Allotransplantation in Beagle Dog. BIOMED RESEARCH INTERNATIONAL 2016; 2016:1489204. [PMID: 26977412 PMCID: PMC4761661 DOI: 10.1155/2016/1489204] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Revised: 11/30/2015] [Accepted: 12/10/2015] [Indexed: 11/17/2022]
Abstract
This is an original research of penis allotransplantation. The paper presents an experiment allogenic penis transplantation model in Beagles, with a focus on recovery of blood supply and changes in tissue architecture. Twenty adult Beagles were allocated to 10 pairs for penile transplantation. After operation, the skin and glans were observed. If adverse symptoms occurred, the transplanted penis was resected and pathologically examined. Frequency of urination, urinary stream, and patency level were recorded 7 days after transplantation. Cystourethrography was performed on Day 10. The transplanted penises were resected on Day 14 for pathological examination. The research showed that transplanted penises survived after allotransplantation, and the dogs regained urination ability. Penis autotransplantation in Beagles is feasible. This preliminary study shows a potential for application of this new procedure for penis transplantation in humans.
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