Doctors in South Africa are celebrating what they describe as the world's first successful penile transplant, after they attached without issue a donor organ to a young man whose penis was amputated three years ago when a botched circumcision during a traditional rite of passage led to a life-threatening infection.
The operation was performed in December last year at Tygerberg Hospital in Cape Town, South Africa, by a team of plastic surgeons and urologists from the hospital and Stellenbosch University.
The doctors, which had been preparing and researching for the operation since 2010, originally anticipated a two-year time frame for the patient's full recovery, but an early show of strong psychological, urinary, and reproductive health led them to reconsider that length and announce the breakthrough last Friday.
"He had such a smile on his face — this amazed look when we took the bandages off," Dr. Frank Graewe, one of the doctors leading the operation, told VICE News. "Three months later, he's having regular intercourse with his partner. We're surprised about the progress that he's made."
The first recorded attempt at a penis transplant took place in China in 2006, but it failed after the new organ showed signs of abnormal swelling and reportedly caused the patient and his wife psychological distress. Doctors removed it two weeks after the operation took place.
Dr. Graewe noted that finding a donor for the procedure was a major challenge. While locating a cadaver with matching blood type and skin color was similar in process to other transplant operations, doctors struggled to convince donor families to grant their abnormal request.
"To ask for a kidney or a heart, that's common," he remarked. "But to ask someone for a penis is entirely new."
The family that finally consented to the necessary donation did so on the condition that doctors reconstruct a new penis on the deceased's body after they removed his organ, which they did with tissue from his abdomen.
"It was so he wouldn't be buried without a penis," said Dr. Graewe.
'He's getting some sensation, the erections are coming back.'
After removing the donor's member, doctors stored it in a "cold medium" before immediately proceeding with the nine-hour transplant operation, which the hospital later described in a statement as a "marathon."
Lining up the patient's blood vessels and nerves precisely with those in the new organ was another significant hurdle. A failure to execute this correctly could lead the body to reject the penis, or result in poor functionality.
"Most penile blood vessels in the patient were damaged due to infective changes [and] the fibrosis that resulted thereafter," said the surgery's leading physician Dr. André van der Merwe in a statement. "We [had] to identify and dissect blood vessels from other regions and transfer them [with] microsurgical techniques."
"The tissue in that region is complex," Dr. Graewe said. He acknowledged that since the operation, levels of sensation in the new organ have been "patchy."
"It's progressing, but we're not sure if sensation will ever reach 100 percent," he said.
Dr. Graewe and his team noted the unique need that a location like South Africa presents for this type of procedure, due to the estimated 100 penis amputations that occur every year in the country, sometimes as a result of unsanitary circumcisions practiced by ethnic communities.
While it is not the only community to practice ritual circumcision in South Africa, the Xhosa ethnic group has received notable attention for its month-long rite to mark the beginning of manhood. Known as ulwaluko, the ceremony involves groups of young males being circumcised with a single spear before spending a month in group isolation.
This has been particularly an issue in the country's Eastern Cape Province, where almost 500 men died as a result of circumcision rituals between 2006 and 2014, some 30 of them over one weekend alone. Some survive without complications, while others develop infections such as gangrene that require amputation of the penis.
Some South African ethnic groups like the Xhosa do not consider a male to be mature until he has had his penis circumcised. In 2008, Fikile Mbalula of South Africa's ruling African National Congress party underwent ulwaloko at the age of 37 after his Xhosa colleagues pressured him into the ritual with an intervention.
Many Xhosa have rejected outside criticism of the ritual, arguing that the poor practices of a few ceremonies has attracted unjustifiable opprobrium to the entire procedure. Thousands of young men undergo the process each year.
"Initiation rituals are not meant to kill; rather they build character based on shared experiences of being in the bush," wrote Dr. Sakhumzi Mfecane, a Xhosa member who lectures on anthropology at University of the Western Cape, in an op-ed published in 2013. "There is nothing inherently deadly about Xhosa initiation rituals, as evidenced by many centuries of successful execution of the ritual."
Dr. Mfecane and other Xhosa community members in South Africa did not respond to requests for comment.
Dr. Nicola Barsdorf, who led the transplantation operation's ethics committee, informed VICE News that the transplant is part one of a registered scientific study. Doctors are working to make the procedure affordable and easily reproducible, so that South African medical institutions can continue to offer penile transplants to those in need.
She noted that confidentiality was an important ethical aspect, because "revealing the identity of our participant could likely expose him to stigma and discrimination within his community."
The patient will need to take immunosuppressive medication indefinitely until the doctors observing him tell him he can stop. Dr. Graewe said that the patient's new penis has a foreskin, but this time, if the patient opts for another circumcision, the medical team will monitor the procedure and its aftermath.
The doctors have performed a few "touch-ups" on the organ since the transplant, and will continue keeping a close eye on it.
"Three months is still a short time," said Dr. Graewe. "But he's getting some sensation, the erections are coming back. Physically, it's a great success."
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