Ten years after the world first penis transplant was successfully done in Cape Town by urologist, Professor André van der Merwe, it remains unmatched across the country and he is keen to do more, even that on transgender females to male, if funding can be provided.
He also performed the first laparoscopic kidney removal in South Africa.
In an interview with the Weekend Argus, van der Merwe, who is the head of urology at the University of Stellenbosch and an associate professor at Tygerberg Hospital, shared his insight and desire to continue his work in performing more penis transplants and to tackle a transplant on a tansgender female using the scrotum and the penis.
The first successful penis transplant was performed on a 21-year-old man by the urology team, headed by Van der Merwe, a surgical team which consisted of Professor Rafique Moosa and Dr Zamira Keyser of Tygerberg Hospital. They were assisted by transplant coordinators, anaesthetists, theatre nurses, a psychologist, an ethicist and other support staff.
The nine hour procedure was used to connect blood vessels and nerves after the patient dubbed “Sipho” had lost his penis during a botched circumcision that he underwent at the age of 18.
Months after the transplant, in March 2015, Sipho reported to have recovered function in his organ which included urination, orgasm and ejaculation and sensation.
In the same year, Sipho astonished the medical team by successfully conceiving a child.
In April 2017, van der Merwe was back with his team and this time they performed the second penis transplant on a 40-year-old male dubbed “Thulani” who had lost his penis at the age of 17 during a botched traditional circumcision.
Van der Merwe for the first time shared the medical and recovery journey of the two patients revealing the first had part of the penis removed and the second, sadly had a removal of it four years ago due to rejection and infection but that both have had active lives sexually.
“In the case of the first one, in 2014, he was still sexually active and he fathered one child, or possibly two and has recently shown me pictures of the child,” said Van der Merwe.
“He stands and urinates and usually with such cases of ritual circumcision there is a complete disaster and there is loss of the penis and they have to sit and urinate.
“He had a few episodes of rejection due to non-compliance with his medication, we had to cut off a significant part of his penis which was done around five years ago.”
Van der Merwe explained the second patient managed to have his new penis for three years and that the donor was a white male and that it was quite controversial at the time.
“We had planned protocol with a medical artist to do the penis to the same colour but he refused, he actually liked his white penis and told the women he had vitiligo.
“He unfortunately started to reject it three years after the surgery and we couldn’t reserve it and we had to remove the penis and at the time he had good sexual function.
“He never married and never fathered a child even though he wanted to.”
“He also suffered kidney failure due to immune suppression and is now out of it.”
The reconstructive surgery team at Johns Hopkins University in the US performed the world’s first total penis and scrotum transplant in the world in 2018.
Van der Merwe has been researching their technique using bone marrow from a donor.
“What we did achieve, we were first and the people in Johns Hopkins were also planning to do it at the time and they did it very successfully and their immune suppression is very advanced,” he added.
“I think should we restart again, we should use the Johns Hopkins model for immuno-suppression.
“What they do in essence is, if there is a donor, they also transplant a bit of the bone marrow.
“With the penis transplant they do a small bone marrow transplant which I am really keen to do.”
Van der Merwe said this has opened the door into researching transplanting a penis into a female that is transgender male.
“We have also done a study, which has not been published publicly, but we have done cadaver studies where we transplant the penis from a male onto a female and it is feasible to do,” he said.
“We also did a total genital transplant, where with the cadaver, we transplant the testicle and the penis and it is possible.
“But this was only done at international conferences and it was well received.”
Laticia Pienaar, Communications Officer, Tygerberg Hospital said penis transplantation does not form part of the package of care offered by their facilities.
“This transplantation was done as part of a research study lead by the University of Stellenbosch.”