Experts from Stellenbosch University and Tygerberg Academic Hospital have performed a second penile transplant, making it the first medical centre in the world to successfully conduct this groundbreaking procedure twice.
The university’s Faculty of Medicine and Health Sciences (FMHS) Division of Urology head André van der Merwe led the marathon operation of nine-and-a-half hours on April 21 at Tygerberg Hospital. The team consisted of Van der Merwe; FMHS Division of Plastic and Reconstructive Surgery acting head Dr Alexander Zühlke; Department of Medicine head Rafique Moosa; from FMHS’s Division of Urology Dr Amir Zarrabi; and transplant and trauma surgeon Dr Zamira Keyser.
The world’s first successful penile transplant was performed by Van der Merwe and his team at Tygerberg Hospital in December 2014. The patient is doing well physically and mentally, Van der Merwe said.
This time, the recipient was a 40-year-old man who had lost his penis 17 years ago due to complications after a traditional circumcision. The man, originally from the Northern Cape, was circumcised in Khayelitsha.
He received the penis of a 29-year-old white man. A colour discrepancy between the recipient and the donor organ will be corrected with medical tattooing between six to eight months, with doctors positive he will have a perfect result.
While the man is still experiencing swelling, he is recovering well, Van der Merwe said: “He went through a very difficult time (before surgery), he was depressed and suicidal. But this guy has a lot of tenacity and is really positive.”
He was among 12 patients on a waiting list but many had fallen off the list as they lost hope of receiving a transplant.
“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.”
The man is expected to regain all urinary and reproductive functions within six months, but will have to take immuno-suppressive medication for the rest of his life to prevent his body rejecting the organ.
The entire penis was carefully dissected from the donor to keep blood vessels, nerves and other connecting structures intact. These were marked and connected to the recipient’s correlating tissue during the transplant.
“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,” Van Der Merwe said.
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 countrywide every year, with suicides also being reported.
“Patients describe a penile 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,” Zarrabi said. “I usually see cases of partial or total amputations in July and December - the period when traditional circumcisions are performed.”
Moosa said the safety of circumcisions should be improved. “It is sad that this should have happened in the first instance, what we should do going forward is improve the safety of circumcisions. We need to talk to various departments of health in various provinces.”
He also appealed to the public to become organ donors.
Faculty dean Jimmy Volmink said: “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.
“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.”
The Western Cape Provincial Health Department funded the procedure.
While the team does not have funding for more operations of this nature, they said they hope to shorten the duration of the operation as well as lessen costs in the future.