LONDON - Surgeons in China who said they performed the first successful penis transplant had to remove the donated organ because of the severe psychological problems experienced by the man and his wife.

The case appears to be the first such transplant reported in a medical journal - European Urology, published by the European Association of Urology.

The Chinese doctors could not be reached for comment, and their report does not explain how the 44-year-old man lost his penis. It says only that "an unfortunate traumatic accident" left him with a small stump, unable to urinate or have sex normally.

Surgeons led by Dr. Hu Weilie at Guangzhou General Hospital performed the complex 15-hour microsurgery to attach the penis in September 2005, a hospital spokesperson said Tuesday. The penis had been donated by the parents of a 22-year-old brain-dead man. The operation was successful but Hu and his team removed the transplant two weeks later.

"There was a strong demand from both the patient and his wife" for a transplant, and the operation "was discussed again and again" and approved by the hospital's ethics committee, Hu wrote in the peer reviewed journal European Urology. The patient had been unable to have intercourse or urinate properly since the accident that occurred 8 months before the surgery was performed.

"Because of a severe psychological problem of the recipient and his wife, the transplanted penis regretfully had to be cut off," Hu said in the report which was published online, without elaborating.

"This is the first reported case of penile transplantation in a human," Hu added.

Ten days after the operation, which had been approved by the hospital's medical ethical committee, the recipient had been able to urinate.

There had been no signs of the 10-centimeter (4-inch) organ being rejected by the recipient's body. But Hu said more cases and longer observation are needed to determine whether sexual sensation and function can be restored.

"The patient finally decided to give up the treatment because of the wife's psychological rejection, as well as the swollen shape of the transplanted penis" Hu added.

Similar to hand, face transplants
In a commentary in the journal, Yoram Vardi, of the Rambam Medical Center in Haifa, Israel, said the successful surgery represents an additional step in contemporary medicine.

But he added that careful patient selection is required as well as thorough informed consent of the patient and his family.

"Satisfactory consideration of these issues must be taken into account so that this approach can be considered a serious therapeutic option in the future," Vardi added.

Despite how shocking and radical the operation sounds, it involves standard microsurgery techniques to reconnect blood vessels and nerves.

From a medical point of view, "the main hurdle is the functional recovery," said Dr. W.P. Andrew Lee, chief of plastic surgery at the University of Pittsburgh Medical Center.

From arm and leg reattachments, it's known that nerve regrowth occurs at a rate of about an inch a month and often is insufficient to allow normal use, he said.

However, the ethical and psychological challenges in such cases can be even more paramount, as this and other recent transplants involving hands and faces illustrate.

"Some of the considerations for a penile transplant are the same as for a hand or face transplant," such as the need to take lifelong immune-suppressing drugs to prevent rejection of the new organ, Lee said.

Psychological issues
The drugs can cause kidney and other damage, acceptable risks when the transplant involves a vital organ such as a liver or heart, but more ethically perilous when the operation is aimed at improving quality of life rather than extending it, Dr. Yoram Vardi, a neurology and urology specialist at the Rambam Medical Center in Haifa, Israel, writes in an accompanying commentary in the urology journal.

Psychological issues are keenly important. The world's first hand transplant recipient stopped taking immune suppression drugs and later requested that the hand be amputated.

Lee recalled speaking with the recipient of the world's first double-hand transplant in France, who told him it took months for him to accept his new hands and stop referring to one as "it."

Fourteen days after the penis transplant, the recipient and his wife requested that the organ be removed "because of the wife's psychological rejection as well as the swollen shape of the transplanted penis," the surgeons report in the journal.

Lab examination showed no sign of rejection, the doctors report.

If adequate attention had been paid to the need for counseling and other psychological concerns surrounding the transplant, "the need for penile amputation could probably have been avoided," Vardi wrote in his commentary.

Print this

Email this