Most Extensive Penis Transplant: Surgery For Veteran Blown Up In Afghanistan

A US veteran who was blown up in Afghanistan losing genitals in the blast has received the world's most extensive penis transplant.

Doctors said they wanted to address "an unspoken injury of war" and said he is recovering well and expected to leave hospital this week.

During a highly experimental 14-hour operation last month, Johns Hopkins University surgeons rebuilt the man's entire pelvic region - transplanting a penis, scrotum and part of the abdominal wall from a deceased donor.

The patient, who asked to remain anonymous, is expected to recover urinary ability before eventually regaining sexual function.

Dr WP Andrew Lee, Hopkins's chairman of plastic and reconstructive surgery said such transplants "can help those warriors with missing genitalia just as hand and arm transplants transformed the lives of amputees”.

The donor's testicles were not included in the scrotum transplant meaning reproduction will not be possible.

Dr Damon Cooney said they "felt there were too many unanswered ethical questions" with that extra step.

In a statement from Hopkins, the patient was quoted as saying: "It's a real mind-boggling injury to suffer; it is not an easy one to accept."

"When I first woke up, I felt finally more normal … [with] a level of confidence as well... like finally I'm okay now."

The loss of a penis is emotionally traumatic, affecting urination and sexual intimacy, and many patients suffer in silence because of the stigma.

There has been a notable increase in interest in penis transplants due to veterans returning from Iraq and Afghanistan.

A few years ago Hopkins surgeons began planning and rehearsing how to perform such a complex operation in patients with widespread tissue damage.

The Department of Defence Trauma Registry has recorded 1,367 male service members who survived with genitourinary injuries between 2001 and 2013.

It is not publicly known how many lost all or part of the penis.

Three other successful penis transplants have been reported, two in South Africa and one in 2016 at Massachusetts General Hospital.

Those transplants involved only the penis, not extensive surrounding tissue that made this transplant much more complex.

Doctors sometimes reconstruct the form of a penis from a patient's own skin, usually to treat congenital abnormalities or during transgender surgery. These types require using implants to achieve an erection.

For a functional penis transplant, surgeons must connect tiny nerves and blood vessels. Candidates face serious risks, including rejection of the tissue and side effects from anti-rejection drugs that must be taken for life.

The Hopkins patient received an extra experimental step, an infusion of bone marrow from his donor that research suggests may help a recipient's immune system better tolerate a transplant.

Surgeons said that enables the veteran to take one anti-rejection drug instead of several.

Hopkins is screening additional veterans to see if they are candidates for this type of reconstructive transplant.

Finding donors is an additional hurdle. In the US, people or their families who agree to donate organs such as a heart or lung must be asked separately about also donating a penis, hand, face or other body parts.