Abstract
PURPOSE: The first U.S. penis transplant marked a significant milestone in vascularized composite allotransplantation, offering patients the potential to restore urinary/sexual function. However, only five transplants have been performed globally, with only three recipients retaining their grafts. To help establish best practices, we discuss the long-term outcomes of the first U.S. case performed in a 62-year-old male following oncologic subtotal penectomy. METHODS: Eight-year follow-up evaluation included immunologic (regimen/course/biopsies), erection (rigidity/Sexual Health Inventory for Men (SHIM) score/doppler), urinary (cystoscopy/uroflowmetry/ultrasound), and sensory (objective/patient-reported) function. RESULTS: Following induction immunosuppression with rabbit anti-thymocytes globulin, maintenance included tacrolimus/mycophenolate/prednisone. Two brief acute rejections were managed with anti-thymocytes globulin/prednisone and cellular rejection with sirolimus (discontinued). Immunologic status remained stable thereafter, with biopsies at year 6 demonstrating subepithelial/perifollicular fibrosis with mild inflammation but no rejection. Combination of intraurethral Trimix, Tadalafil and audio/visual stimulation resulted in the most significant improvement of erection, sufficient for penetration: 60% rigidity increase, 20 SHIM score (mild dysfunction), mild arterial insufficiency, inhibition of venous leak. There were no urinary anastomotic strictures/irregularities between native and allograft mucosa, and only mild decrease in peak flow, corresponding to the patient’s asymptomatic voiding and post-void ultrasound. The shaft/glans were sensitive to monofilament/vibration/pinprick, albeit with reduced temperature (cold/warm/heat pain) and absent two-point discrimination. The patient reported “some” (3/5) light touch/pressure/temperature/erogenous sensation, denied hypersensitivity/pain, and was overall “very satisfied” with sensation. Excellent aesthetics were achieved. CONCLUSION: These promising long-term immunologic/erectile/urinary/sensory/aesthetic outcomes encourage the broader adoption of penis transplantation, offering new hope for patients with traumatic/oncologic genitourinay loss, including wounded warriors.
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