By Gene Emery

(Reuters Health) – Doctors who transplanted a complete penis and scrota onto the body of a soldier wounded by an improvised explosive device in Afghanistan reported Wednesday that the man has regained near-normal erections and the ability to achieve orgasm more than one year after the surgery was completed.

The landmark 14-hour operation was done at Johns Hopkins Hospital in Baltimore, Maryland, on March 26, 2018, by nine plastic surgeons and two urological surgeons.

The transplant included part of the abdominal wall, but not the testicles. Previously, only four successful penis-only transplants have been reported.

“His recovery has exceeded expectations,” Dr. Richard Redett III, a professor of plastic and reconstructive surgery at Johns Hopkins, told Reuters Health in an email.

He and his colleagues report in a letter to the New England Journal of Medicine that the soldier, who lost both legs above the knee as a result of the IED, “has normal sensation to the shaft and tip of the transplanted penis and can localize touch sensation.”

“The patient urinates while standing, without straining, frequency, or urgency, with the urine discharged in a strong stream,” the Redett team writes in its report. “The patient has returned to school full-time and continues to live independently using leg prostheses. He reports an improved self-image and ‘feeling whole’ again and states that he is very satisfied with the transplant and the implications it carries for his future.”

The team had been preparing for such surgery on the man since 2013, Redett said. “Our patient was initially referred for an evaluation using conventional reconstructive techniques. Because he had concomitant extremity injuries (flap donor sites) and his defect was so large and included the lower abdominal wall, penis and scrotum, and some medial thigh tissue, conventional reconstructive options were very limited. At the same time, we had started exploring penile transplantation.”

The man was on a wait-list for 15 months.

In addition to matching blood and tissue types, the procedure, known as vascularized composite allograft (VCA) surgery, “also requires matching other features such as skin tone, size and age of the graft,” Redett noted. “When people sign up as an organ donor they are not authorizing a VCA donation. The family makes the decision about VCA donation after death, which adds another step to the approval process.”

The process included infusions of bone marrow from the donor to the soldier beginning two weeks after the surgery to tamp down the immune system’s response to the donated tissue.

The marrow transplant was designed to allow the patient to only need a single small dose of the drug tacrolimus each day to suppress immune rejection of the transplant.

SOURCE: The New England Journal of Medicine, online November 6, 2019.