A team of surgeons says it has repaired the genitals of a serviceman severely injured by an explosion in Afghanistan. It's the first time a penis has been transplanted to treat a war wound.
Doctors at Johns Hopkins Hospital in Baltimore say 11 surgeons were involved in the 14-hour surgery in March.
The patient, who requested anonymity, is expected to be released from the hospital later this week, "and we are optimistic that he will regain near-normal urinary and sexual functions following full recovery," Dr. W.P. Andrew Lee said at a news conference announcing the surgery on Monday.
The man's fertility won't be restored, however. His testicles did not survive his ordeal and a testicle transplant would raise deep ethical issues, because the genetic material in the sperm would be from the donor, not the recipient.
Surgeons in South Africa and Boston have previously reported successful penis transplants. "Our transplant is different because it's a much larger piece of tissue," said Dr. Richard Redett, one of the Hopkins plastic surgeons. The surgery involved reconnecting three arteries, four veins and two nerves. Doctors expect that feeling will return to the transplanted organ in about six months, and at that point they will know more about the degree to which the man's sexual function has been restored.
Hopkins announced in 2015 that it was planning to undertake this operation for war wounded. But the Hopkins team says it took a long time to find a good match for this man, who had a rare blood type.
The medical team says the donor was an anonymous man in New England, whose family agreed to this unusual request because they believed he would have wanted to restore function to a man wounded in service of his country.
One of the challenges from this type of injury is that transplants typically require patients to take strong anti-rejection drugs for the rest of their lives. Those drugs pose a risk, which must be balanced against the benefit of surgery that is designed to improve quality of life but is not essential to health.
To address that, doctors at Hopkins have developed a method to minimize the drugs required for these patients. That involves infusing some blood cells from the donor, to prime the recipient's immune system to recognize the foreign tissue as "self." Doctors at Hopkins say they can then treat the patient with a single anti-rejection drug rather than the usual cocktail of three.
Unlike previous penis transplants, this surgery included the scrotum and some tissue from the lower abdomen, in order to reconstruct a large wound. The patient was injured by an improvised explosive device. He also lost his legs below the knee as a result of the IED attack.
Doctors focused on genital transplants because they are deeply personal and especially disturbing wounds.
Iraq-war veteran Oscar Olguin found that was the case when he spent time at the Walter Reed Army Medical Center in 2004 after he was injured by a suicide car-bomb.
"We all jokingly made the statement that's the first area I checked to make sure it was OK," he said. "Even if we'd just seen a major injury that's the organ we were all worried about."
The tone regarding genital injuries may have been jocular, "but we were all pretty serious," Olguin adds. It is really no joke to lose an important element of one's manhood.
Olguin, who now works for the Disabled American Veterans in Roanoke, Va., says he feels fortunate that he didn't sustain that injury, even though he lost part of his right leg. "It's much easier to get a prosthetic for the leg as opposed to that area."
The surgery is still highly experimental. The surgeons and Johns Hopkins volunteered their services, which would otherwise have cost hundreds of thousands of dollars and wouldn't have been covered by veterans benefits or insurance, they say.
Olguin says he hopes that the surgery will eventually become routine enough that the government will pay for it as part of its commitment to injured vets.
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