Arthur L. Burnett II, MD, MBA, FACS, presented “Penile Allotransplantation: An Advance in Genitourinary Reconstruction” during the Jackson Hole Seminars on January 31, 2019 in Jackson Hole, Wyoming.
How to cite: Burnett II, Arthur L. “Penile Allotransplantation: An Advance in Genitourinary Reconstruction” January 31, 2019. Accessed [date today]. https://grandroundsinurology.com/penile-allotransplantation-an-advance-in-genitourinary-reconstruction/
Penile Allotransplantation: An Advance in Genitourinary Reconstruction – Summary
Arthur L. Burnett II, MD, MBA, presents penile allotransplantation as an emerging alternative to autogenous reconstruction. He discusses the benefits for military trauma patients in particular, and the importance of considering potential complications as well as improved quality of life.
According to a recent retrospective review of the number, nature, and severity of genitourinary injuries of male United States service members deployed to Iraq and Afghanistan, genitourinary trauma has become an increasingly common, devastating occurrence. The consequences of severe penile loss include loss of intimacy in personal relationships, psychological detriment, and a diminished quality of life.
An emerging option for penile restoration that could benefit these patients is penile allotransplantation. Though the allotransplantation procedure is not yet widely performed and has its drawbacks, for military and other victims of severe penile loss, it offers a promising alternative to reconstruction.
The traditional option of autogenous reconstruction can incur complications. These include chronic wound issues, urethral strictures, and the need for repeated operations to reach successful outcomes. Furthermore, any necessary tissue grafts from arms or legs for reconstruction may affect the strength of the source extremities, or may be unattainable if the patient is missing those limbs.
The 2018 penile allotransplantation performed by the Johns Hopkins Medical Institutions has thus far proved to be a success. Infection prophylaxis, graft healing, and function and sensation gained by the patient within 9 months of the procedure supports this determination.
There have been complications with past allotransplantation procedures, including necrosis and psychological problems between patients and their respective partners. Other factors should also be considered, such as side effects from lifelong immunosuppression (including erectile dysfunction) and ethical concerns surrounding the donation and reception of genital organs.
Considerations for penile transplant implementation are extensive, and should include a multidisciplinary team of surgeons, psychiatrists, bioethicists, and other specialists, in addition to technical planning and practice.
Future improvements needed in order to improve penile allotransplantation include the evaluation of novel immunosuppression regimens, careful patient selection, and a focus on lessening procedure costs.
About the Ralph E. Hopkins Urology Seminar
The Ralph E. Hopkins Urology Seminar, or Jackson Hole Seminars (JHS), is a multi-day conference that focuses on patient safety and cutting-edge updates in the assessment, diagnosis, and treatment of urologic conditions. The topics discussed include urologic cancers, stone disease, urologic reconstruction, female urology, infertility, emerging surgical techniques, and general urology. In addition to didactic expert lectures, this conference features unique interactive critique panel. Dr. Burnett presented this lecture during the 39th Annual JHS. Please visit this page in order to register for future JHS meetings.