Surgeons at Baltimore’s John Hopkins University have rebuilt the veteran’s entire pelvic region from the parts of a deceased donor.
It is hoped that the operation will give the injured man full urinary and sexual function within weeks.
In an ambitious March operation lasting 14 hours, surgeons connected tiny nerves, blood vessels, skin, muscles and tendons to rebuild both the man’s penis and extensive surrounding tissue.
While a handful of successful penis transplants have been reported in recent years, this was the first to reconstruct the scrotum as well – making it far more complex and expensive than previous procedures.
The recipient, who wishes to remain anonymous, said he “felt finally more normal” on waking up from the operation.
“It’s a real mind-boggling injury to suffer; it is not an easy one to accept,” he said.
The extent of the patient’s injuries – he had lost his penis, scrotum, and much of his abdominal wall – meant taking an exact replica of what was missing was the most sensible option for the surgeons treating him.
“We’ve really replaced like with like,” surgeon Dr Richard Redett said. “We looked at the defect our patient had and procured the exact same graft from our donor.”
Tthe full transplant is radically different to current procedures – often used in transgender surgery or to treat congenital abnormalities – that use a patient’s own skin to construct a penis.
Such operations require patients to use an implant to achieve an erection, bringing a higher risk of infection than the highly experimental full transplant.
But while they avoid such problems, transplants present new ethical problems in penis surgery.
The families of deceased donors need to give explicit permission for a penis – as parts of the face or hands – to be given for transplant, for example.
It was also decided in this operation that a scrotum transplant should not extend to the donor’s testicles, which would bring the possibility of having children. “We just felt there were too many unanswered ethical questions,” surgeon Damon Cooney said.
Surgeons at John Hopkins described lost penises as “an unspoken injury of war”, suffered in silence by patients who face stigma as well as a loss of sexual intimacy and urinary function.
The US Department of Defense trauma registry has recorded 1,367 male service personnel with having suffered genitourinary injuries between 2001 and 2013, although it is not clear whether how many of those resulted in the loss of all or part of the penis.
Patients can also lose a penis through cancer or accidents. One previous penis transplant, in China, was reversed after psychological problems experienced by the recipient and his wife.
After the surgery in March, however, doctors say the first penis and scrotum recipient is doing well.