A team from Stellenbosch University (SU) and the Tygerberg Academic Hospital recently performed a second penis transplant, making it the first medical centre in the world to successfully perform this procedure twice.

This comes after the world’s first successful penis transplant was done in December 2014 at the same facility.

Prof André van der Merwe, Head of the Division of Urology at SU’s Faculty of Medicine and Health Sciences (FMHS), led the marathon operation of nine and a half hours performed on 21 April.

The recipient was a 40-year-old male who had lost his penis 17 years ago due to complications after a traditional circumcision. His identity is being protected for ethical reasons.

No rejection

“He is certainly one of the happiest patients we have seen in our ward. He is doing remarkably well,” says Prof Van der Merwe.

“There are no signs of rejection and all the reconnected structures seem to be healing well.”

One of the team members Dr Amir Zarrabi says the first operation prepared them for the second one. “It was experimental, but now it is really scientific,” Zarrabi told Health24. 

The patient is expected to regain all urinary and reproductive functions of the organ within six months of the transplant. A colour discrepancy between the recipient and the donor organ will be corrected with medical tattooing between six to eight months after the operation.

“Unfortunately we could not find a donor of the same race. In this case the donor is white and the recipient is black.” 

Western Cape health minister Dr Nomafrench Mbombo called the procedure ground-breaking.

“This is a remarkable procedure. Traditional circumcision has claimed many young lives in South Africa. For this patient, life will never be the same again,” Dr Mbombo said.

The procedure

The entire penis was carefully dissected from the donor to keep blood vessels, nerves and other connecting structures intact. These were marked and connected to the recipient’s correlating tissue during the transplant.

The surgeons connected:

• Three blood vessels (each between 1 and 2mm in diameter) to ensure sufficient blood flow to the transplanted organ;
• Two dorsal nerves (also between 1 and 2mm in diameter) to restore sensation;
• The urethra, which enables the recipient to urinate through the penis; as well as
• The corpus cavernosum (cavernous body of the penis), which will allow the patient to obtain an erection.

“The diverse presentation of the blood vessels and nerves makes the operation very challenging and means each case is unique,” says one of the team members Dr Alexander Zühlke.

“All these structures need to be treated with the utmost delicacy and respect in order to be connected perfectly to ensure good circulation and function in the long term.

The requirement is that the donor must be brain-dead, but the heart must still be beating. “This is most effective way to make sure there is no rejection,” says Zarrabi. 

Future

Dr Zarrabi is confident that their success will lead to more successful operations in the future. 

“The loss of a penis from traditional circumcision is big, and we want to create sustainable programmes to help these people.”

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