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Hu W, Lu J, Zhang L, Wu W, Nie H, Zhu Y, et al. A preliminary report of penile transplantation. Eur Urol 2006;50:851-853.

This fascinating article from China is the first report ever of penile transplantation and therefore deserves mention here. A 44 year old man had a traumatic penile amputation (the exact mechanism of injury is not explained), leaving him with a 1cm stump. The donor penis came from a brain dead patient that had been tissue matched to the recipient. The 1 cm stump meant it was possible to use a tourniquet proximally whilst the various anastomoses were carried out (urethral, tunica albuginea, dorsal vein, artery and nerve). An anti-rejection regime was begun. Post operatively there were problems with penile oedema and segmental skin necrosis but these settled. On day 10 the patient was voiding standing up without a catheter. Unfortunately on day 14 the patient and his wife had severe psychological problems (these are not elaborated upon) and the penis was removed. Interestingly the histology of the graft showed no evidence of rejection.
Whilst the technical ability to transplant a penis exists, and immunosuppression continues to improve, dealing with the psychological issues is less well worked out. Patients who have undergone facial or hand transplants struggle to cope with permanently seeing a dead person’s hand or face, although this improves as sensation develops in the transplant. Perhaps this is also the case with a transplanted penis. It will be interesting to see whether further penile transplants are reported in the literature or whether this will remain an isolated report. When techniques such as radial artery phalloplasty exist that allow urination from the end of the penis and also allow sexual intercourse after insertion of a penile prosthesis, without the need for lifelong immunosuppression and its attendant complications, one wonders whether penile transplantation has any future.