EURURO Vol. 71 No. 4

594 692

Platinum Priority – Editorial
Referring to the article published on pp. 584–593 of this issue
Getting Ready for Penile Transplantation
Maarten Albersen
a Department of Urology, University Hospitals Leuven, Leuven, Belgium; bLaboratory for Experimental Urology, University of Leuven, Leuven, Belgium
Penile transplantation is currently being considered as an
option for penile reconstruction after near-complete penile
tissue loss as illustrated by the three cases having been
performed over the world. In the October 2006 issue of
European Urology, the first report on penile transplantation
emerged describing the successful transplantation of a 22-yr-
old donor penis onto a 44-yr-old recipient who had suffered a
traumatic penile defect [3_TD$DIFF]The transplantation, which took
place in Guangzhou General Hospital in China, included
anastomosis of the urethra corpus spongiosum and corpus
cavernosum, and connection of the deep dorsal vein, dorsal
artery, dorsal nerve, and superficial dorsal vein. The recipient
could urinate smoothly in a standing position after 10 d,
[4_TD$DIFF]following removal of the Foley catheter. Unfortunately, at
14 d postoperatively, because of severe psychological
problems of the recipient and his wife, the transplanted
penis was removed. In the November issue of the same year,
the authors stated that ‘‘The patient finally decided to give up
the treatment because of the wife’s psychological rejection as
well as the swollen shape of the transplanted penis’’
The second case was described in 2014 and performed in
the Tygerberg hospital in South Africa, where a 21-yr-old
patient with a ritual circumcision gone wrong received a
penile transplant, likely anastomosed on the inferior
epigastric artery (‘‘a blood vessel was rerouted from the
lower abdomen’’) . The surgery was complicated by a
reintervention after 4 d to remove a thrombus from the
anastomosis and another reintervention for hematoma
drainage. The patient, however, reports normal sexual and
urinary function 3.5 mo after transplantation, and recently
it was reported in the lay press that this gentleman [5_TD$DIFF]has been
able to father a child.
The third case was the first US-based penile transplan-
tation (genitourinary vascularized composite allograft
[GUVCA]) performed at Massachusetts General Hospital
which took place in May 2016 on a 64-yr-old recipient who
had had a partial penectomy for penile cancer leaving a [6_TD$DIFF]one
inch penile stump The surgery was complicated by a
hemorrhage needing reintervention at postoperative d 1,
but the patient left the hospital 3.5 wk after surgery with
intact perfusion and no signs of rejection.
The requirement of life-long, multidrug immunosup-
pression bearing the risk of serious side effects still remains
a limiting factor for widespread clinical application of
GUVCA. Whether or not we want to subject recipients of
penile transplantation to potentially harmful side effects
such as hypertension, renal function impairment, neutro-
penia, secondary cancers, diabetes, and others, for the
treatment a nonlife-threatening condition for which
autologous alternatives such as phalloplasty have been
described, is matter of an ethical debate that should be held
but is not the focus of this editorial . Besides, researchers
are investigating novel bone marrow stem cell-based
therapeutic strategies that take into consideration the
unique immunological and biological aspects of vascular-
ized composite allografts and have been able to show
favorable results with regard to minimization of immuno-
suppressive medication and tolerance induction in both
translational and clinical trials in reconstructive transplan-
tation of hands, for example .
Whilst these novel strategies are being further devel-
oped, researchers at Johns Hopkins University are now
raising the question what the effects of both rejection and
immunosuppressant drugs are on the transplanted organ, in
casu the penis, and in particular they have been investigat-
ing the potential effects on erectile function of the
transplant. This translational research is part of a bigger
multidisciplinary effort to set up an evidence based protocol
available at
journal homepage:
DOI of original article: .
* Laboratory for Experimental Urology, University of Leuven, Herestraat 49, Leuven 3000, Belgium. Tel. +32486334999.
E-mail address:
0302-2838/# 2016 European Association of Urology. Published by Elsevier B.V. All rights reserved.