In March last year, the world's first full penis and scrotum transplant was completed in the United States.
Recently, the medical team reported on the recovery of the patient in the New England Journal of Medicine (NEJM): After a year and a half of replacing the "new" genitals, his penis returned to normal perception and he could stand Pee, erectile function is basically normal, and can have orgasm.
In the patient's own words: "I feel that I am complete!"
The testicles are in the scrotum and have not been transplanted this time.丨
"It seems like this is the case in life."
The accident occurred in 2010.
In the raging battlefield of Afghanistan, a simple explosive device caused the young man to be seriously injured. His legs were amputated and he lost part of the scrotum, testicles and lower abdominal wall, leaving only 1.5 cm of penis tissue.
For him, the pain of losing the genitals is far more than the amputation.
Genital injuries are not uncommon in the military. According to statistics, between 2001 and 2013, more than 1,300 American infantry serving in Iraq and Afghanistan suffered different degrees of damage to the genitals. However, for the patient, this is a "lonely wound."
The accident caused him to lose his legs and genitals.丨
The young man had been interviewed by The New York Times, but in an anonymous form. In his interview, he revealed that he once had the idea of suicide: "It’s like you have been in this life, you have to be alone and lonely... I can’t think of myself as a man for a long time.”
Later, he could walk independently with prosthetic limbs, and he didn't mind wearing summer shorts to expose the prosthetic limbs to the sun, but the old wounds hidden under the clothes were always an "unspeakable" secret, only immediate family members and the closest. Several friends know that, because the residual urethra is too short, he can't stand to pee.
“ Porting a real genital ”
Three years after the accident, he took the courage to seek the help of a doctor.
At first, he didn't know that there was a "transplant" approach. The surgery that was done at that time was generally "penisplasty", which used the forearm, thigh and other tissues to create a penis. The penis thus created can urinate but does not form a spontaneous erection.
After some exchanges, Richard Redett, an orthopaedic surgeon at Johns Hopkins Hospital, felt that the young man could have a penis transplant – not to create a penis, but to transplant a real genitalia .
Of course, this operation is not simple. Prior to this, there were three successful penile transplants in the world, but this time, in addition to the penis, there were scrotum and part of the abdominal wall. Surgery not only completes the connection of the urethra, but also anastomoses and sutures. These operations are very delicate, and some have an inner diameter of only 1 to 2 mm.
Only when the blood vessels, nerves, etc. are properly engaged, the patient's body can supply blood to the transplanted organs, and the organs can function normally.丨
In order to ensure the smooth operation, the medical team conducted several drills in advance. At the same time, they also communicated with patients many times to ensure that he was aware of the risks of surgery and was supported by his family. The young man has never wavered, and he is very eager for this operation.
Next, the young man has to wait. Similar to other organ transplants, the transplanted penis donor will also come from a donor who has just died. But in this organ, the problem is much more complicated: first, many people do not know that the genitals can also donate; second, doctors must not only see whether the donor's blood type matches, whether the organs are healthy, but also other factors. Such as age, skin color, size...
In March 2018, he finally waited for a call from the hospital: Now, there may be a suitable donor.
"This is the best decision I have ever made."
The operation lasted for 14 hours. Because the time was too long, the doctors were allowed to drink coffee and go to the bathroom. The transplanted tissue weighs more than 2 kg, including the penis, scrotum, and part of the lower abdominal wall.
The doctor did not transplant the testicles in consideration of ethical issues. The testicle is the part that produces sperm. Once the testicle is transplanted, the sperm contained in this patient contains the genetic material from the donor. In other words, if the patient has a future generation, it is difficult to tell who the child is from a genetic point of view.
Because there is no testicle, he cannot be a father in the physiological sense. But for him, this is enough, he finally has the "self" genitals again.
Young people after transplant surgery
In fact, penile transplants may cause a relatively large psychological burden. In 2006, a penile transplant was performed in Guangzhou, but the patient's wife could not accept the sexual organ from the "outsiders". At the same time, due to organ rejection, the transplanted penis was removed after 15 days of surgery.
Before the operation, the young man had hesitated whether he could treat this new organ as his own, but after the operation, he did not have this confusion. Psychologically, he completely accepted this new organ.
But is his body acceptable?
Rejection is an important issue after organ transplant surgery. For protection purposes, our body recognizes parts that are not part of itself, such as bacteria, viruses, transplanted organs and tissues, and then launches the immune system to attack it.
Our body recognizes parts that are not part of ourselves and then launches the immune system to attack it.丨
But for transplant surgery, this is a burden. In order to reduce rejection, patients should take immunosuppressive agents for a long time after surgery, but these drugs have side effects, which may damage the kidneys and damage the immune system.
In fact, penile transplant surgery has been controversial due to rejection. Transplantation of kidneys, heart and other organs can save lives, and transplanting the penis is not necessary for survival. It seems that at most it only improves the quality of life. Is it worth the risk of rejection?
For this problem, the medical team offers another possibility. Two weeks after the operation, they injected the patient's bone marrow from the donor, which reduced the patient's rejection of the transplanted organ. Now, this patient only needs to take one tablet a day. The doctor hopes that he can get rid of immunosuppression in the next 5 to 10 years.
The medical team performing the transplant operation丨
Now, more than a year has passed since the surgery. From the medical team's report, the patient has recovered well. The patient himself said that his pleasure index has improved significantly.
Today, he returned to school, became extroverted, and was less afraid to meet new people. The life that had been broken before was slowly coming back together.
"I don't regret it, this is the best decision I have ever made!"