The recent announcement of the first U.S. penile transplant is exciting news, and brings hope for many men, including injured combat veterans. But the procedure also comes with risks that must be weighed against the benefits for patients, experts say.
On Monday (May 16), doctors announced that a 64-year-old man in Massachusetts had become the first person in the United States to receive a penile transplant. The patient, Thomas Manning, needed his penis removed in 2012 because of aggressive penile cancer. The 15-hour transplant operation, performed earlier this month, involved connecting the blood vessels and nerves of a penis from a deceased donor onto the blood vessels and nerves of the patient, his doctors said.
Men who have injuries to the genitals may experience severe psychological difficulties, as these injuries can affect their sense of identity.
After such injuries, a penile transplant may have some advantages over more typical procedures to reconstruct male genitals, experts say. [8 Wild Facts About the Penis]
For example, doctors can instead reconstruct a penis using muscle tissue from another part of a patient's body, such as the forearm or thigh, but some men who have this procedure won't regain sexual function, said Dr. Lee Zhao, assistant professor of urology at NYU Langone Medical Center, who was not involved in Manning's treatment. For these men, doctors can perform another surgery to place a penile implant that will help with erections, Zhao said.
But with a penile transplant, the patient may be able to achieve erections without needing an implant, Zhao said. Manning's doctors are optimistic that he will regain sexual function without another procedure.
And cosmetically, the appearance of the penis after a penile transplant may be more natural compared with what is achieved with some other reconstructive operations, Zhao said.
However, patients who undergo a penile transplant need to take drugs that suppress their immune system for the rest of their lives, to prevent their body from rejecting the transplanted organ, and these drugs come with their own set of risks, Zhao said.
Being on these drugs makes people more prone to infections, Zhao said. In addition, because the immune system plays a role in fighting cancer, Zhao said he would worry that using immunosuppressant drugs in patients who've had cancer could increase the risk of cancer coming back.
And even with immunosuppressing drugs, there's still a 6 to 18 percent chance that the patient's body could reject the organ, Manning's doctors said.
A penile transplant "is an exciting developing in genital reconstructive surgery... [but] we really have to be cognizant of the risks involved," with immunosuppressing drugs, Zhao said.
There are also other things that can go wrong with a penile transplant that are similar to the risks involved when doctors reattach an amputated penis, Zhao said.
There could be a narrowing of the urethra due to scar tissue, which would lead to problems with urination, Zhao said. And if the skin of the penis doesn't have a proper blood supply, some of the skin tissue can die and come off, he said.
Manning's doctors said he will remain in the hospital for 10 more days, and then will have frequent follow-ups with the medical team to see how he is progressing.