Surgery: First Penis Transplant in The

RESEARCH HIGHLIGHTS

Nature Reviews Urology | Published online 6 Jun 2017; doi:10.1038/nrurol.2017.88

SURGERY First penis transplant in the USA

Vascularized composite allotransplantation for maintenance consisted of antithymocyte (VCA) is performed in patients with severe globulin, mycophenolate mofetil, tacrolimus injuries to complex organs, such as a hand or and methylprednisolone. At 6 months face. Now, a report of the first US experience At 2 days after surgery, haematoma after VCA, the of a penile VCA has been published. evacuation was required. Tadalafil treatment patient had The first penile VCA in the USA was for erectile conditioning was started from performed by a multidisciplinary team at day 8, the catheter removed at 3 weeks, and normal penile Massachusetts General Hospital, Boston, in a the patient discharged on day 25. On day 28, appearance 64-year-old man who had previously under- an acute grade I rejection reaction was and urinary gone partial penectomy for penile cancer diagnosed, which was treated with methyl- function… and was disease-free at 4 years. Preparation prednisolone. On day 32 a grade III rejection included extensive patient education and reaction was diagnosed, which was treated informed consent, cardiovascular, haemato- with antithymocyte globulin and methylpred- logical and HLA assessment, as well as CT nisolone, followed by decreasing doses of oral angiogram, diagnostic angiography and MRI prednisone, resulting in complete resolution. of the pelvis and penis. The penile allograft At 6 months after VCA, the patient had was procured from a brain-dead donor. normal penile appearance and urinary Reconstructive transplantation included function, as well as partial recovery of penile anastomoses of the urethra, nerves and sensation and erectile function. In addition, vasculature of the corporal bodies, cavernosal he reported increased overall health arteries, deep dorsal vein, as well as a vein satisfaction and an improved self-image. graft and a cadaveric acellular nerve allograft. Clemens Thoma Anastomosis of the external pudendal artery ORIGINAL ARTICLE Cetrulo, C. L. Jr et al. Penis transplantation: was not required for satisfactory perfusion. first US experience. Ann. Surg. http://dx.doi.org/10.1097/ Immunological management at surgery and SLA.0000000000002241 (2017)