World-first successful penile transplant preformed in South Africa

The marathon nine-hour penile transplant operation, led by Prof. André van der Merwe, head of SU’s Division of Urology, was performed on 11 December 2014 at Tygerberg Hospital in Bellville, Cape Town. This is the second time that this type of procedure has been attempted, but the first time in history that a successful long-term result was achieved.

The patient, whose identity is being protected for ethical reasons, has made a full recovery and has regained all function in the newly transplanted organ.

“Our goal was that he would be fully functional within two years and we are very surprised by his rapid recovery,” says Van der Merwe. The end result of the transplant was the restoration of all the patient’s urinary and reproductive functions.

Amputation after traditional circumcision complications

Three years ago, the now 21-year-old recipient’s penis had to be amputated, in order to save his life, having developed severe complications after a traditional circumcision.

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Although there are no formal records on the number of penile amputations per year due to traditional circumcision, one study reported up to 55 cases in the Eastern Cape alone, and experts estimate as many as 250 amputations per year across the country.

“There is a greater need for this type of procedure in South Africa than elsewhere in the world, as many young men lose their penises every year due to complications from traditional circumcision,” explains Van der Merwe.

“This is a very serious situation. For a young man of 18 or 19 years the loss of his penis must be deeply traumatic. He doesn’t necessarily have the psychological ability to process this. There are even reports of suicide among these young men,” says Van der Merwe.

Pilot study turned world’s first

The procedure was part of a pilot study to develop a penile transplant procedure that could be performed in a typical South African hospital theatre setting.

The planning and preparation started in 2010. After extensive research Van der Merwe and his surgical team decided to employ certain aspects of the model and techniques developed for the first facial transplant.

“We used the same type of microscopic surgery to connect small blood vessels and nerves, and the psychological evaluation of the patient was also similar. The procedure has to be sustainable and has to work in our environment at Tygerberg,” says Van der Merwe.

“South Africa remains at the forefront of medical progress,” says Prof. Jimmy Volmink, Dean of SU’s Faculty of Medicine and Health Sciences (FMHS). “This procedure is another excellent example of how medical research, technical know-how and patient-centred care can be combined in the quest to relieve human suffering. It shows what can be achieved through effective partnerships between academic institutions and government health services.”

Van der Merwe was assisted by Prof. Frank Graewe, head of the Division of Plastic Reconstructive Surgery at SU FMHS, Prof. Rafique Moosa, head of the FMHS Department of Medicine, transplant coordinators, anaesthetists, theatre nurses, a psychologist, an ethicist and other support staff.

“It’s a massive breakthrough. We’ve proved that it can be done – we can give someone an organ that is just as good as the one that he had,” says Graewe. “It was a privilege to be part of this first successful penis transplant in the world.”

The real heroes

“The heroes in all of this for me are the donor, and his family. They saved the lives of many people because they donated the heart, lungs, kidneys, liver, skin, corneas, and then the penis,” says Van der Merwe. Finding a donor organ was one of the major challenges of the study.

This procedure could eventually also be extended to men who have lost their penises from penile cancer or as a last-resort treatment for severe erectile dysfunction due to medication side effects. As part of the study, nine more patients will receive penile transplants.

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