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Penile Reconstruction Versus Transplantation: Which One Is Ideal?

  • Fatih Zor
  • Mustafa Sengezer
  • Michael R. Davis
Vascularized Composite Allografts (V Gorantla and R Barth, Section Editors)
  • 26 Downloads
Part of the following topical collections:
  1. Topical Collection on Vascularized Composite Allografts

Abstract

Purpose of Review

Reconstruction of composite tissues or organs is challenging, with limited functional and esthetic outcomes. Nearly 100 years passed from the first penile reconstruction is performed; however, the outcomes were far from ideal. With the beginning of the reconstructive transplantation era, new choices became possible.

Recent Findings

Until now, four penis transplantations were performed worldwide, with encouraging short-term results. Although with a short follow-up, these penile transplantations reported success. However, the problems related to systemic lifelong immunosuppression remain as the major problem related to these life-enhancing transplantations.

Summary

In this review, we revisit and evaluate the conventional methods of penis reconstruction, overview the up-to-date results of penis transplantation, and discuss advantages and disadvantages of these two techniques.

Keywords

Vascularized composite allotransplantation Penile transplantation Penile reconstruction 

Notes

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.
    Remington AC, Morrison SD, Massie JP, Crowe CS, Shakir A, Wilson SC, et al. Outcomes after phalloplasty: do transgender patients and multiple urethral procedures carry a higher rate of complication? Plast Reconstr Surg. 2018;141(2):220e–9e.  https://doi.org/10.1097/PRS.0000000000004061.CrossRefPubMedGoogle Scholar
  2. 2.
    Selvaggi G, Dhejne C, Landen M, Elander A. The 2011 WPATH standards of care and penile reconstruction in female-to-male transsexual individuals. Adv Urol. 2012;2012:581712–3.  https://doi.org/10.1155/2012/581712.CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Janak JC, Orman JA, Soderdahl DW, Hudak SJ. Epidemiology of genitourinary injuries among male U.S. service members deployed to Iraq and Afghanistan: early findings from the trauma outcomes and urogenital health (TOUGH) project. J Urol. 2017;197(2):414–9.  https://doi.org/10.1016/j.juro.2016.08.005.CrossRefPubMedGoogle Scholar
  4. 4.
    Callens N, De Cuypere G, T'Sjoen G, Monstrey S, Lumen N, Van Laecke E, et al. Sexual quality of life after total phalloplasty in men with penile deficiency: an exploratory study. World J Urol. 2015;33(1):137–43.  https://doi.org/10.1007/s00345-014-1283-8.CrossRefPubMedGoogle Scholar
  5. 5.
    Nnamani NS, Janak JC, Hudak SJ, Rivera JC, Lewis EA, Soderdahl DW, et al. Genitourinary injuries and extremity amputation in operations enduring freedom and Iraqi freedom: early findings from the trauma outcomes and urogenital health (TOUGH) project. J Trauma Acute Care Surg. 2016;81(5 Suppl 2 Proceedings of the 2015 Military Health System Research Symposium):S95–S9.  https://doi.org/10.1097/TA.0000000000001122.CrossRefPubMedGoogle Scholar
  6. 6.
    Hage JJ, Bout CA, Bloem JJ, Megens JA. Phalloplasty in female-to-male transsexuals: what do our patients ask for? Ann Plast Surg. 1993;30(4):323–6.CrossRefGoogle Scholar
  7. 7.
    Salgado CJ, Monstrey S, Hoebeke P, Lumen N, Dwyer M, Mardini S. Reconstruction of the penis after surgery. Urol Clin N Am. 2010;37(3):379–401.  https://doi.org/10.1016/j.ucl.2010.04.015.CrossRefGoogle Scholar
  8. 8.
    • Morrison SD, Shakir A, Vyas KS, Kirby J, Crane CN, Lee GK. Phalloplasty: a review of techniques and outcomes. Plast Reconstr Surg. 2016;138(3):594–615.  https://doi.org/10.1097/PRS.0000000000002518 This study is an updated rewiew of the surgical techniques used in penile reconstruction.CrossRefPubMedGoogle Scholar
  9. 9.
    Cetrulo CL Jr, Li K, Salinas HM, Treiser MD, Schol I, Barrisford GW, et al. Penis transplantation: first US experience. Ann Surg. 2017:1.  https://doi.org/10.1097/SLA.0000000000002241.
  10. 10.
    Hage JJ, De Graaf FH. Addressing the ideal requirements by free flap phalloplasty: some reflections on refinements of technique. Microsurgery. 1993;14(9):592–8.CrossRefGoogle Scholar
  11. 11.
    Rashid M, Tamimy MS. Phalloplasty: the dream and the reality. Indian J Plast Surg. 2013;46(2):283–93.  https://doi.org/10.4103/0970-0358.118606.CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Felici N, Felici A. A new phalloplasty technique: the free anterolateral thigh flap phalloplasty. J Plast Reconstr Aesthet Surg. 2006;59(2):153–7.CrossRefGoogle Scholar
  13. 13.
    Young VL, Khouri RK, Lee GW, Nemecek JA. Advances in total phalloplasty and urethroplasty with microvascular free flaps. Clin Plast Surg. 1992;19(4):927–38.PubMedGoogle Scholar
  14. 14.
    Hoebeke PB, Decaestecker K, Beysens M, Opdenakker Y, Lumen N, Monstrey SM. Erectile implants in female-to-male transsexuals: our experience in 129 patients. Eur Urol. 2010;57(2):334–40.  https://doi.org/10.1016/j.eururo.2009.03.013.CrossRefPubMedGoogle Scholar
  15. 15.
    Monstrey S, Hoebeke P, Selvaggi G, Ceulemans P, Van Landuyt K, Blondeel P, et al. Penile reconstruction: is the radial forearm flap really the standard technique? Plast Reconstr Surg. 2009;124(2):510–8.  https://doi.org/10.1097/PRS.0b013e3181aeeb06.CrossRefPubMedGoogle Scholar
  16. 16.
    Sadove RC, Sengezer M, McRoberts JW, Wells MD. One-stage total penile reconstruction with a free sensate osteocutaneous fibula flap. Plast Reconstr Surg. 1993;92(7):1314–23 discussion 24-5.PubMedGoogle Scholar
  17. 17.
    Sengezer M, Zor F. Penile reconstruction with free sensate osteocutaneous fibula flap in female-to-male gender reassignment surgery. Turkiye Klinikleri J Plast Surg-Special Topics. 2016;5(3):71–7.Google Scholar
  18. 18.
    Sengezer M, Ozturk S, Deveci M, Odabasi Z. Long-term follow-up of total penile reconstruction with sensate osteocutaneous free fibula flap in 18 biological male patients. Plast Reconstr Surg. 2004;114(2):439–50 discussion 51-2.CrossRefGoogle Scholar
  19. 19.
    Sengezer M, Ozturk S, Deveci M. The first use of free fibula flap as an autogenous penile implant. Plast Reconstr Surg. 2004;114(1):142–6.CrossRefGoogle Scholar
  20. 20.
    Papadopulos NA, Schaff J, Biemer E. The use of free prelaminated and sensate osteofasciocutaneous fibular flap in phalloplasty. Injury. 2008;39(Suppl 3):S62–7.  https://doi.org/10.1016/j.injury.2008.05.019.CrossRefPubMedGoogle Scholar
  21. 21.
    Yang M, Zhao M, Li S, Li Y. Penile reconstruction by the free scapular flap and malleable penis prosthesis. Ann Plast Surg. 2007;59(1):95–101.  https://doi.org/10.1097/01.sap.0000253745.07940.da.CrossRefPubMedGoogle Scholar
  22. 22.
    D'Arpa S, Colebunders B, Stillaert F, Monstrey S. Pre-expanded anterolateral thigh perforator flap for phalloplasty. Clin Plast Surg. 2017;44(1):129–41.  https://doi.org/10.1016/j.cps.2016.08.004.CrossRefPubMedGoogle Scholar
  23. 23.
    Hu W, Lu J, Zhang L, Wu W, Nie H, Zhu Y, et al. A preliminary report of penile transplantation. Eur Urol. 2006;50(4):851–3.  https://doi.org/10.1016/j.eururo.2006.07.026.CrossRefPubMedGoogle Scholar
  24. 24.
    Bateman C. World’s first successful penis transplant at Tygerberg Hospital. S Afr Med J. 2015;105(4):251–2.CrossRefGoogle Scholar
  25. 25.
    •• van der Merwe A, Graewe F, Zuhlke A, Barsdorf NW, Zarrabi AD, Viljoen JT, et al. Penile allotransplantation for penis amputation following ritual circumcision: a case report with 24 months of follow-up. Lancet. 2017;390(10099):1038–47.  https://doi.org/10.1016/S0140-6736(17)31807-X This study reports the 24-month follow-up result of the a penile transplant patient, which is the longest follow-up currently. CrossRefPubMedGoogle Scholar
  26. 26.
    First-Ever Penis and Scrotum Transplant Makes History at Johns Hopkins. 2018; Available from: https://www.hopkinsmedicine.org/news/articles/first-ever-penis-and-scrotum-transplant-makes-history-at-johns-hopkins.
  27. 27.
    Tuffaha SH, Sacks JM, Shores JT, Brandacher G, Lee WP, Cooney DS, et al. Using the dorsal, cavernosal, and external pudendal arteries for penile transplantation: technical considerations and perfusion territories. Plast Reconstr Surg. 2014;134(1):111e–9e.  https://doi.org/10.1097/PRS.0000000000000277.CrossRefPubMedGoogle Scholar
  28. 28.
    Morrison SD, Shakir A, Vyas KS, Remington AC, Mogni B, Wilson SC, et al. Penile replantation: a retrospective analysis of outcomes and complications. J Reconstr Microsurg. 2017;33(4):227–32.  https://doi.org/10.1055/s-0036-1597567.CrossRefPubMedGoogle Scholar
  29. 29.
    Caplan AL, Kimberly LL, Parent B, Sosin M, Rodriguez ED. The ethics of penile transplantation: preliminary recommendations. Transplantation. 2017;101(6):1200–5.  https://doi.org/10.1097/TP.0000000000001352.CrossRefPubMedGoogle Scholar
  30. 30.
    Tian Y, Ji ZG, Tang YW, Zhang L, Lu WC, Lin J, et al. Prevalence and influential factors of erectile dysfunction in male renal transplant recipients: a multiple center survey. Chin Med J. 2008;121(9):795–9.PubMedGoogle Scholar
  31. 31.
    Amaral S, Levin LS. Pediatric and congenital hand transplantation. Curr Opin Organ Transplant. 2017;22(5):477–83.  https://doi.org/10.1097/MOT.0000000000000453.CrossRefPubMedGoogle Scholar
  32. 32.
    Gordon CR, Zor F, Siemionow M. Skin area quantification in preparation for concomitant upper extremity and face transplantation: a cadaver study and literature review. Transplantation. 2011;91(9):1050–6.  https://doi.org/10.1097/TP.0b013e318212c815.CrossRefPubMedGoogle Scholar
  33. 33.
    Gorantla VS, Demetris AJ. Acute and chronic rejection in upper extremity transplantation: what have we learned? Hand Clin. 2011;27(4):481–93, ix.  https://doi.org/10.1016/j.hcl.2011.08.006.CrossRefPubMedGoogle Scholar
  34. 34.
    Caplan A, Purves D. A quiet revolution in organ transplant ethics. J Med Ethics. 2017;43(11):797–800.  https://doi.org/10.1136/medethics-2015-103348.CrossRefPubMedGoogle Scholar
  35. 35.
    Zhang LC, Zhao YB, Hu WL. Ethical issues in penile transplantation. Asian J Androl. 2010;12(6):795–800.  https://doi.org/10.1038/aja.2010.88.CrossRefPubMedPubMedCentralGoogle Scholar
  36. 36.
    Tuffaha SH, Cooney DS, Sopko NA, Bivalacqua TJ, Lough DM, Cooney CM, et al. Penile transplantation: an emerging option for genitourinary reconstruction. Transpl Int. 2017;30(5):441–50.  https://doi.org/10.1111/tri.12928.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2018

Authors and Affiliations

  • Fatih Zor
    • 1
  • Mustafa Sengezer
    • 2
  • Michael R. Davis
    • 3
  1. 1.Plastic, Reconstructive and Aesthetic SurgeonWake Forest Institute for Regenerative MedicineWinston-SalemUSA
  2. 2.Plastic, Reconstructive and Aesthetic Surgeon, Private PracticeAnkaraTurkey
  3. 3.United States Army Institute for Surgical ResearchSan Antonio Military Medical CenterSan AntonioUSA

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