WASHINGTON (AP) — A veteran who lost his genitals from a blast in Afghanistan has received the world's most extensive penis transplant, and doctors said Monday he is recovering well and expected to leave the hospital this week. 
 
 Saying they wanted to address "an unspoken injury of war," Johns Hopkins University surgeons rebuilt the man's entire pelvic region — transplanting a penis, scrotum and part of the abdominal wall from a deceased donor — in a highly experimental 14-hour operation last month. 
 
 Such transplants "can help those warriors with missing genitalia just as hand and arm transplant transformed the lives of amputees," Dr. W.P. Andrew Lee, Hopkins' chairman of plastic and reconstructive surgery, told reporters Monday. 
 
 The patient, who asked to remain anonymous, is expected to recover urinary and, eventually, sexual function. 
 
 The scrotum transplant did not include the donor's testicles, meaning reproduction won't be possible. "We just felt there were too many unanswered ethical questions" with that extra step, said Hopkins' Dr. Damon Cooney. 
 
 Three other successful penis transplants have been reported, two in South Africa and one in 2016 at Massachusetts General Hospital. Those transplants involved only the penis, not extensive surrounding tissue that made this transplant much more complex. 
 
 The loss of a penis, whether from cancer, accident or war injury, is emotionally traumatic, affecting urination, sexual intimacy and the ability to conceive a child. Many patients suffer in silence because of the stigma their injuries sometimes carry. 
 
 Doctors sometimes reconstruct the form of a penis from a patient's own skin, usually to treat congenital abnormalities or during transgender surgery. That requires using implants to achieve erection. 
 
 For a functional penis transplant, surgeons must connect tiny nerves and blood vessels. Candidates face some serious risks, including rejection of the tissue and side effects from anti-rejection drugs that must be taken for life. 
 
 But penis transplants have generated intense interest among veterans from Iraq and Afghanistan, and a few years ago Hopkins surgeons began planning and rehearsing how to perform such a complex operation in patients with widespread tissue damage. The Department of Defense Trauma Registry has recorded 1,367 male service members who survived with genitourinary injuries between 2001 and 2013. It's not clear how many victims lost all or part of the penis. 
 
 Hopkins is screening additional veterans to see if they are good candidates for this type of reconstructive transplant. Finding donors is an additional hurdle: In the U.S., people or their families who agree to donate organs such as the heart or lung must be asked separately about also donating a penis, hand, face or other body part. 
 
 The Hopkins patient received an extra experimental step, an infusion of bone marrow from his donor that research suggests may help a recipient's immune system better tolerate a transplant. Surgeons said that is enabling the veteran to take one anti-rejection drug instead of several. 
 
 In a statement from Hopkins, the patient was quoted as saying: "When I first woke up, I felt finally more normal." 
 
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 The Associated Press Health & Science Department receives support from the Howard Hughes Medical Institute's Department of Science Education. The AP is solely responsible for all content. ||||| CLOSE Doctors at a Baltimore hospital have performed the world's most extensive penis transplant, this one also involving the scrotum and part of the abdominal wall. (April 23) AP 
 
 Surgeons at the Johns Hopkins University School of Medicine announced Monday that they have performed the first total penis and scrotum transplant on an American military veteran. (Photo: Getty Images) 
 
 A U.S. serviceman severely injured several years ago in an IED blast in Afghanistan has received the world's first total penis and scrotum transplant, surgeons at the Johns Hopkins University School of Medicine announced Monday. 
 
 The man, whose identity was not released, is recovering well and expected to regain both urinary and sexual function, Richard Redett, who led the transplant team, said at a Monday telephone news conference. 
 
 The patient did not receive testicles from his donor to avoid the ethical issues that might ensue if he later had children, said Damon Cooney, another transplant team member. The testicles would have contained sperm from the recently deceased donor. 
 
 The donor was not identified, nor was his cause of death, but in a statement, his family praised the sergeant’s service to his country and noted the donor family includes a number of veterans. 
 
 “We are so thankful to say that our loved one would be proud and honored to know he provided such a special gift to you,” said the statement, read by Alexandra Glazier, president and CEO of New England Donor Services, which arranged for the donation. “We hope you can return to better health very soon and we continue to wish you a speedy recovery.” 
 
 Two years ago, surgeons at Massachusetts General Hospital performed a more limited transplant on a penile cancer patient. That patient, Thomas Manning, continues to do well, though his sexual function hasn’t fully recovered yet, said Curtis Cetrulo, who runs the reconstructive transplantation program at Massachusetts General. The hospital has yet to conduct another penile transplant, as it awaits funding and other logistical issues, he said. 
 
 There have also been several successful penile transplants in South Africa, as well as an unsuccessful one in China. 
 
 The Johns Hopkins surgery, performed in a 14-hour procedure in late March, was the most extensive yet, involving more tissue than has been previously transplanted, the surgeons said. 
 
 In addition to a large skin graft covering part of the sergeant’s abdomen, penis and scrotum, surgeons connected three arteries, four veins and two nerves to provide blood flow and sensation to the donated tissue. His internal organs were not severely damaged by the blast. 
 
 Redett said he expects the patient will regain the ability to urinate by the time he leaves the hospital later this week. It will take about six months for the nerves to regrow enough to restore sexual function and sensation, but Redett said he is optimistic that will take place. 
 
 Johns Hopkins covered the cost of the procedure, and hopes to complete more in the near future, said W. P. Andrew Lee, who directs the hospital’s Department of Plastic and Reconstructive Surgery. 
 
 The hospital does not plan to use the procedure for gender reassignment surgery, he said. 
 
 Once it becomes more routine, penile transplantation is likely to cost about the same as a liver transplant, said L. Scott Levin, chairman of orthopedic surgery and a professor of plastic surgery at Penn Medicine. (One recent estimate puts the total cost of a liver transplant in the United States above $800,000.) It is still an open question who will pay for such procedures, Levin said. 
 
 Another major issue in transplantation is rejection. The recipient’s body may reject the donated tissue at any time, so the Johns Hopkins patient will have to be on continuous therapy to tamp down his immune system, said Gerald Brandacher, who handled the immune aspects of the Johns Hopkins transplant. 
 
 To reduce the risk of rejection, the patient was also infused with bone marrow from the donor. This approach has been used in eight other patients who received transplants, such as arms, that were transformative but not lifesaving. Balancing the donor’s bone marrow with the recipient’s allows the patient to take only one low-dose medication a day instead of the three typically taken by transplant patients, Brandacher said. 
 
 Injuries that affect sexual and urinary function can be devastating to a person’s identity, self-esteem and intimate relationships, said Lee, whose department has been preparing for penile transplantations since 2013. 
 
 “We believe that genital-urinary transplantation can help those warriors with missing genitalia, just as hand and arm transplants transformed the lives of amputees,” he said. 
 
 At Massachusetts General, publicity surrounding the penile transplant encouraged other patients with genitourinary tissue damage to seek care. 
 
 “We’ve had many people who are really despondent come out of the shadows and get worked up,” Cetrulo said. 
 
 Even if they weren’t transplant candidates they have now been helped in other ways, Cetrulo said, noting many people with these conditions consider suicide, and suffer even more emotional pain than people in need of arm or face transplants. 
 
 Hopefully, the Johns Hopkins' patient will inspire others to seek help, Cetrulo said. “That’s one of the most incredible and important contributions of this case, not only to this individual whose life has probably been saved.” 
 
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– A US serviceman has become the world's first man to ever receive a full penis and scrotum transplant. Per USA Today, the veteran was injured by an IED years ago while on combat tour in Afghanistan. Surgeons from the Johns Hopkins University School of Medicine announced the historic news on Monday after performing the unprecedented surgery in Baltimore last month. The patient is expected to recover both urinary and sexual function, according to the surgeons. Surgeons said they rebuilt the man's entire pelvic region over the course of 14 hours. Per the AP, the scrotum transplant did not include the donor's testicles, meaning reproduction won't be possible. "We just felt there were too many unanswered ethical questions" with that extra step, said Hopkins' Dr. Damon Cooney. Three other successful penis transplants have been reported, two in South Africa and one in 2016 at Massachusetts General Hospital. Those transplants involved only the penis, not extensive surrounding tissue that made this transplant much more complex. Hopkins is screening additional veterans to see if they are good candidates for this type of reconstructive transplant. The Hopkins patient received an extra experimental step, an infusion of bone marrow from his donor that research suggests may help a recipient's immune system better tolerate a transplant. Surgeons said that is enabling the veteran to take one anti-rejection drug instead of several. In a statement from Hopkins, the patient was quoted as saying: "When I first woke up, I felt finally more normal."