Penile Allotransplantation for Complex Genitourinary Reconstruction

Reconstruction of complex functional structures is increasingly being performed with vascularized composite allo-transplantation (VCA). Penile transplantation is a novel VCA treatment option for severe penile tissue loss and disfigurement. Three allogeneic human penile transplantations have been reported. We review these cases as well as penile transplant indications, pre-clinical models, and immunosuppression therapy.

We performed a comprehensive literature review for the years 1970 to 2016 via MEDLINE, PubMed, and Google with the key words "penis transplantation", "penile rejection", "penile replantation", "penile tissue loss", and "penis vascularized composite allo-transplantation". Relevant articles, including original research, reviews, and non-scientific press reports were selected based on contents. A review of this literature was generated.

Three human allogeneic penile transplantations have been performed to date, one of which was removed 14 days following transplantation. The second recipient reports natural spontaneous erections and impregnating his partner. All three patients were able to spontaneously void through the graft's urethra. The complexity of the transplant is determined by how proximal the penile shaft anastomosis is performed, and additional pelvic tissue may be transplanted en bloc if needed.

Penile transplantation is a technically demanding procedure with significant ethical and psychosocial implications that can provide tissue and functional replacement including urinary diversion and natural erections. It is unclear how rejection and immunosuppression may affect graft function. Better models and more pre-clinical research are needed to better understand and optimize penile transplantation.

The Journal of urology. 2017 Mar 10 [Epub ahead of print]

Nikolai A Sopko, Sami H Tuffaha, Denver Lough, Gerald Brandacher, W P Andrew Lee, Trinity J Bivalacqua, Richard J Redett, Arthur L Burnett

The James Buchannan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD, USA., Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA., The James Buchannan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD, USA. Electronic address: .

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