Rising to the occasion

By | Science & Technology
The surgical team performing the surgery at Tygerberg Hospital. Credit@StellenboschUniversity

Tygerberg Hospital in Cape Town saw a surgeon team carry out the world’s first successful penile transplantation back in December last year. Now, three months later, the team reports that the patient is recovering well without any major side effects. The 21-year-old patient had his penis removed following a ritual circumcision when he was 18. The ritual met a hitch and the young man became gangrenous and eventually his penis needed to be amputated.

The Xhosa people of South Africa traditionally practise a manhood ritual – a secret rite of passage to mark the transition from boyhood to manhood – known as ‘Ulwaluko’. Following the ritual circumcision, the initiate, or ‘abakwetha’, lives in isolation for a few weeks. Whilst they heal, they cover their bodies in white clay and witness a number of taboos. However researchers decided to step in, following the release of a website by a Dutch doctor that featured a number of photographs depicting many mishaps from the rituals. Team leader and Head of the Division of Urology at Stellenbosch University, Professor André van der Merwe stated, “There is a greater need in South Africa for this type of procedure than elsewhere in the world,” because apparently many young men each year have their penises amputated due to hitches faced during traditional circumcision.

The secret rite of passage of the Xhosa people - they smear white clay over their bodies as they heal from the ritual circumcision. Credit@JamesNachtwey

The secret rite of passage of the Xhosa people – they smear white clay over their bodies as they heal from the ritual circumcision. Credit@JamesNachtwey

The university had been investigating the feasibility of such transplants because of the increasing number of incidents resulting from these rituals and how it can affect the young patients when it happens.

The nine-hour procedure involved techniques developed for facial transplants – in particular, microscopic surgery – to link tiny blood vessels and nerve endings. Penile blood vessels are relatively small in comparison to the rest of the body; the blood vessels the surgeons worked with are around a fifth the size of those found in the kidney. Locating a donated penis was a challenge for the researchers, however they eventually succeeded by replacing the donor’s penis with a replacement made from skin.

A lot of preparation was required beforehand in order to successfully perform the surgery, especially for the patient. Van der Merwe explained that, “Psychologically, we knew it would have a massive effect on the ego.” Therefore, the preparation involved both dealing with biological rejection, by prescribing a lifetime regime of immunosuppressant drugs, and coaching the patient to help him accept the transplant as part of his own body.

The team spent a length of time convincing the government for ethical approval (considering the potential gambles involved) specifically because the surgery is a non-life-saving procedure. However, Van der Merwe maintained that the surgery is life-saving after all because when these young men with penile amputations are ostracised, they may sometimes take their own life. He went on to say, “If you give a penis back you can bring them back to life.”

The recipient is now three months out of the operation and reportedly responding well without any major side effects. The transplanted organ is fully functional for sex and urination and he may even have children if he chooses. A full return of sensation is expected to take up to two years. This surgery seems like a major breakthrough, meaning nine more patients are looking to receive penile transplants as well in three months time. The surgery is also being peddled as a treatment for cases of erectile dysfunction and penile cancer.

How might penis transplants influence the development of more complex surgeries, such as head transplants?

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