Surgeons at Johns Hopkins University have carried out the first ever complete transplant of a penis and scrotum. The procedure is being hailed as a success, with the recipient now on the mend and the team optimistic that he will regain close to regular function of his genitalia.

It took the team of nine plastic surgeons and two urological surgeons 14 hours to carry out the surgery, which took place on March 26. The procedure saw an entire penis, part of the abdominal wall, and the scrotum (without testicles) transplanted from a deceased donor to an anonymous veteran of the US armed services, who was injured in Afghanistan.

"It's a real mind-boggling injury to suffer, it is not an easy one to accept," says the recipient. "When I first woke up, I felt finally more normal… [with] a level of confidence as well. Confidence… like finally I'm okay now."

This procedure is known as a vascularized composite allotransplantation, and involves the transplanation of skin, muscles, tendons, nerves, bones and blood vessels. Using the patient's own tissue taken from other parts of their body, is another way a penis could be reconstructed. However, this would then require a prosthesis for erectile function and also invites a much higher rate of infection.

But vascularized composite allotransplantation is not without its complications, either. As with any type of transplant, there is a possibility the recipient's body will reject the foreign tissues and begin to attack them. Carefully dampening the body's immune response is one way to prevent this, and the team at Johns Hopkins have placed the patient on a regime of immunosuppressive drugs to give the transplanted parts the best chance of survival.

"We are hopeful that this transplant will help restore near-normal urinary and sexual functions for this young man," says Andrew Lee, M.D., professor and director of plastic and reconstructive surgery at the Johns Hopkins University School of Medicine.

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