Pe­nis trans­plant on sol­dier at Hop­kins con­sid­ered suc­cess

Baltimore Sun - - MARYLAND | NATION & WORLD - By Mered­ith Cohn

More than a year and a half af­ter sur­geons at Johns Hop­kins Hos­pi­tal per­formed a com­plex gen­i­tal trans­plant on a sol­dier who also lost his legs in a bomb blast in Afghanista­n, the man says he has nor­mal func­tions and is “feel­ing whole.”

The man, who chose to re­main anony­mous, re­ceived a do­nated pe­nis, scro­tum and part of an ab­dom­i­nal wall dur­ing a 14-hour surgery in April 2018.

The progress re­port came Thurs­day in a let­ter to the ed­i­tor of the New Eng­land Jour­nal of Medicine from about two dozen doc­tors, mostly from Johns Hop­kins School of Medicine, but also from Cooper Uni­ver­sity Health Care in Cam­den, New Jer­sey, and Duke Uni­ver­sity School of Medicine in Durham, North Carolina.

The let­ter says the man has “near-nor­mal erec­tions and the abil­ity to achieve or­gasm,” and can uri­nate

“while stand­ing, with­out strain­ing, fre­quency, or ur­gency, with the urine dis­charged in a strong stream.”

“The pa­tient has re­turned to school full time and con­tin­ues to live in­de­pen­dently us­ing leg pros­the­ses,” the let­ter says. “He re­ports an im­proved self­im­age and ‘feel­ing whole’ again and states that he is very sat­is­fied with the trans­plant and the im­pli­ca­tions it car­ries for his fu­ture.”

The surgery marked a mile­stone in trans­plant science. There had only been a hand­ful of sim­i­lar trans­plants per­formed at hos­pi­tals in Mas­sachusetts, South Africa and China, but they in­volved only a pe­nis.

Doc­tors and men­tal health pro­fes­sion­als said at the time of the surgery that while not di­rectly life­sav­ing, they con­sid­ered the trans­plants nec­es­sary be­cause of the psy­cho­log­i­cal toll of such an am­pu­ta­tion. Ser­vice mem­bers have said it can be far worse than the toll of los­ing limbs.

The pa­tient had been iden­ti­fied in 2012 for re­con­struc­tion us­ing skin from other parts of the body, but he opted to wait un­til a pe­nis trans­plant would be pos­si­ble.

A trauma reg­istry kept by the De­part­ment of De­fense listed 1,367 male ser­vice mem­bers be­tween 2001 and 2013 with so-called gen­i­touri­nary in­juries that in­clude in­juries to the gen­i­tals.

The trans­plants re­main dif­fi­cult be­cause they re­quire a will­ing donor who is a match med­i­cally as well as in age and skin tone. The fam­ily of the donor to the sol­dier specif­i­cally con­sented, say­ing in a state­ment they wanted to sup­port the man for serv­ing his coun­try.

Hop­kins cov­ered the $300,000 to $400,000 cost of the pro­ce­dure and doc­tors do­nated their time. The hos­pi­tal ap­proved up to 60 more such pro­ce­dures for ser­vice mem­bers, though not for trans­gen­der in­di­vid­u­als or those born with de­fects.

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