Medicine and Health Sciences
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South African team performs another 

successful penis transplant



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

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 at Tygerberg Hospital in Cape Town, South Africa. 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.

"He is certainly one of the happiest patients we have seen in our ward. He is doing remarkably well. There are no signs of rejection and all the reconnected structures seem to be healing well," says Van der Merwe. 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.

"The success of this procedure in the hands of our transplant team is testimony to the high level of skill and expertise that exists in the public health sector in South Africa," says Prof Jimmy Volmink, Dean of the FMHS. "Also of considerable pride is the team's ability to balance compassionate and ethical patient care on the one hand, with a concern for the efficient use of scarce resources on the other."

"This is a remarkable, ground-breaking procedure. I would like to congratulate the Tygerberg Hospital and the SU surgeons for doing such a sterling job. Traditional circumcision has claimed many young lives in South Africa. For this patient, life will never be the same again," said Dr Nomafrench Mbombo, Western Cape health minister.

"Patients describe a penis transplant as 'receiving a new life'. For these men the penis defines manhood and the loss of this organ causes tremendous emotional and psychological distress," says Dr Amir Zarrabi of the FMHS's Division of Urology, who was a member of the transplant team. "I usually see cases of partial or total amputations in July and December – the period when traditional circumcisions are performed."

"We are thrilled on behalf of the patient and the change it will make in his life," says Dr Alexander Zühlke, who heads the FMHS's Division of Plastic and Reconstructive Surgery. "It is also a great achievement to be part of the team that has performed two successful penis transplants."

The team consisted of Van der Merwe, Zühlke, Prof Rafique Moosa, head of the FMHS's Department of Medicine, Zarrabi and Dr Zamira Keyser of Tygerberg Hospital. They were assisted by transplant coordinators, anaesthetists, theatre nurses, a psychologist, an ethicist and other support staff.

In December 2014 Van der Merwe and his team performed the world's first successful penis transplant and more than two years later "the patient is doing extremely well, both physically and mentally", says Van der Merwe. "He is living a normal life. His urinary and sexual functions have returned to normal, and he has virtually forgotten that he had a transplant."

Penile mutilation is more common in South Africa than elsewhere in the world due to complications of circumcisions performed as part of a traditional rite of passage on young men in certain cultures. There is no formal record of the yearly number of penile amputations due to traditional circumcisions, but one study reported up to 55 cases in the Eastern Cape alone. Experts estimate that as many as 250 partial and total amputations take place country-wide every year, with suicides also being reported. 

"At Stellenbosch University and Tygerberg Hospital we are committed to finding cost-effective solutions to help these men," says Van der Merwe. The procedure was part of a proof of concept study to develop a cost-effective penile transplant procedure that could be performed in a typical theatre setting in a South African public sector hospital. By applying lessons learnt from the first transplant, Van der Merwe and his team were able to significantly cut the costs of the second procedure.

The biggest challenge to this SU study is organ donation. "I think the lack of penis transplants across the world since we performed the first one in 2014, is mostly due to a lack of donors. It might be easier to donate organs that you cannot see, like a kidney, than something like a hand or a penis," says Van der Merwe.

"We are extremely grateful to the donor's family who so generously donated not only the penis, but also the kidneys, skin and corneas of their beloved son. Through this donation they are changing the lives of many patients."

The world's first successful penile transplant was performed by Van der Merwe and his team at Tygerberg Hospital in Cape Town on 11 December 2014.

The second was done a year and a half later, on 16 May 2016, at the Massachusetts General Hospital in Boston in the United States of America.