Image copyright Johns Hopkins Medicine Image caption Dr Andrew Lee (second from left) and his team at Johns Hopkins University

A team of US doctors has successfully carried out the world's first total transplant of a penis and scrotum.

Surgeons at Johns Hopkins University in Baltimore, Maryland, performed the operation on a soldier who had been wounded by a bomb in Afghanistan.

They used a penis, scrotum and partial abdominal wall transplanted from a deceased donor.

They say the soldier should be able to regain sexual function, which is impossible with penis reconstructions.

The team of 11 surgeons performed the transplant over 14 hours on 26 March.

It is the first surgery on a combat veteran injured on duty and the first to transplant a complete section of tissue including the scrotum and surrounding abdominal area.

Doctors said the donor testicles were not transplanted, due to ethical considerations.

"While extremity amputations are visible and resultant disability obvious," said Dr WP Andrew Lee, head of Plastic and Reconstructive Surgery at Johns Hopkins University, during a telebriefing on Monday, "some war injuries are hidden and their impact not widely appreciated by others."

Dr Lee called genitalia wounds an "unspoken injury of war".

"In a 2014 symposium co-sponsored by Johns Hopkins titled 'Intimacy After Injury', we heard from the spouses, families, and caregivers of these wounded warriors about the devastating impact of genitourinary injuries on their identity, self-esteem and intimate relationships," he said.

The soldier, who wishes to remain anonymous, said in a statement released by the university: "When I first woke up, I felt finally more normal like finally I'm okay now."

His injury was the result of stepping on a hidden bomb in Afghanistan.

In medical terms, the surgery is called a vascularised composite allotransplantation - which is all to say that the process involves transplanting skin, bone, muscles, tendons and blood vessels.

The Johns Hopkins Genital Transplant Program, which funded the surgery, has initially focused on post-traumatic cases, particularly injured soldiers, as their wounds generally make conventional options impossible.

Experts from the surgical team expect the soldier will be fully recovered in six to 12 months.

Dr Rick Redett, clinical director of the genitourinary transplant programme, said that the soldier is recovering well and is expected to be discharged from hospital this week.

"It is our hope that such a life enhancing transplant will allow him to regain urinary and sexual function and lead a more normal life," Dr Redett said. "It is also our goal to offer the procedure in the future to other suitable patients."

The transplant team also said that the university has approved 60 genital transplant surgeries as a part of the programme.

The first penis transplant in the US was in 2016 at Massachusetts General Hospital in Boston.

In 2014, South African surgeons performed the world's first successful penis transplant.</s>A team of surgeons in the US has performed the world’s first full penis and scrotum transplant.

Doctors at Johns Hopkins University in Baltimore, Maryland, carried out the operation on a veteran who was injured in Afghanistan.

They transplanted an entire penis, scrotum and partial abdominal wall from a deceased donor. The donor’s testicles were not used in the operation.

Nine plastic surgeons and two urological surgeons were involved in the 14-hour operation on March 26.

They say the soldier should be able to regain sexual function within the coming months.

Dr WP Andrew Lee, professor and director of plastic and reconstructive surgery at the Johns Hopkins University School of Medicine, said: “We are hopeful that this transplant will help restore near-normal urinary and sexual functions for this young man.”

The soldier, who wishes to remain anonymous, said in a statement: “It’s a real mind-boggling injury to suffer, it is not an easy one to accept.

“When I first woke up, I felt finally more normal … (with) a level of confidence as well. Confidence … like finally I’m OK now.”

Dr Lee said that while it is possible to reconstruct a penis using tissue from other parts of the body, the procedure would require a prosthesis implant to achieve an erection.

In medical terms, a surgery where a body part or tissue is transferred from one individual to another is called a vascularised composite allotransplantation.

The world’s first successful penis transplant was performed in 2014 by doctors in South Africa.</s>Physicians at Johns Hopkins University School of Medicine in Baltimore have performed the first total penis and scrotum transplant in the world, the hospital announced on Monday.

The surgery, which took place over 14 hours on March 26, was performed by a team of nine plastic surgeons and two urological surgeons. The penis and scrotum (without testicles) and partial abdominal wall came from a deceased donor. The recipient is a military veteran who was injured by an improvised explosive device (IED) blast in Afghanistan and wishes to remain anonymous. The hospital said he has recovered from the surgery and will be discharged from the hospital this week.

“It’s a real mind-boggling injury to suffer, it is not an easy one to accept,” the transplant recipient said in a statement released by Johns Hopkins. “When I first woke up, I felt finally more normal… [with] a level of confidence as well. Confidence… like finally I’m okay now.”

The procedure is the second penis transplant to be publicly reported in the United States, but the first full transplant of this kind. In 2016, surgeons at Massachusetts General Hospital performed the first penis transplant in the U.S. on a man who had his penis amputated due to penile cancer.

Read more: The New Transplant Revolution

The Johns Hopkins team has been planning for penis transplant procedures for years, with the goal of eventually helping wounded veterans. A 2016 report found that from 2001 to 2013, 1,367 men in the United States military suffered injuries to their genitals or urinary tract in Iraq or Afghanistan. The report also found that most of the injuries were caused by bomb blasts, and over a third were considered severe. Among the injured men, 94% were age 35 or younger. “Many men sustained disfiguring genital injuries during their peak years of sexual development and reproductive potential,” researchers wrote in the 2016 report.

A penis transplant is a complicated procedure that includes connecting all the arteries, veins, nerves, the skin and the urethra to the recipient. Each penis removal and injury can be different depending on which parts are removed, but surgeons hope that for at least some men, sexual function can be restored. “We are hopeful that this transplant will help restore near-normal urinary and sexual functions for this young man,” Dr. W.P. Andrew Lee, professor and director of plastic and reconstructive surgery at the Johns Hopkins University School of Medicine, said in a statement. Other men are now undergoing screening for the procedure, Lee said in a news conference.

The Johns Hopkins team decided not to transplant the donor’s testicles because such a transplant could allow genetic material to be passed on from the donor. The hospital said there are too many unanswered ethical questions surrounding that kind of transplant.

Penis transplants are estimated to cost $50,000 to $75,000. As of now, hospitals are largely footing the bills. Since the procedures are still considered experimental, they are not covered by insurance. Johns Hopkins covered the cost of the veteran’s transplant, and the doctors there are in the process of applying for a research grant that would offer coverage for further procedures.</s>A US soldier suffered an almost unthinkable injury while serving in Afghanistan when an explosive device damaged his genitals. In a world first, doctors with Johns Hopkins performed a total penis and scrotum transplant on the veteran, who has chosen to remain anonymous.

Surgeons in South Africa performed the first successful penis transplant in 2014. A man who lost his penis to cancer became the first US penis transplant recipient in 2016. The Johns Hopkins operation is groundbreaking for also involving the transplant of the scrotum.

The Johns Hopkins team consisted of nine plastic surgeons and two urological surgeons (some members of the same surgical team were responsible for a rare double-arm transplant in 2012 for a soldier wounded in Iraq.). The genital operation, performed in Baltimore, lasted 14 hours and took place on March 26. The organ came from a deceased donor.

The complex surgery is called a "vascularized composite allotransplantation" and requires transplanting skin, muscles and tendons, nerves, bone and blood vessels.

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

Johns Hopkins shared a statement from the anonymous soldier: "When I first woke up, I felt finally more normal … [with] a level of confidence as well. Confidence … like finally I'm OK now."

The veteran is on a regimen of drugs designed to minimize the risk of tissue rejection and is expected to leave the hospital this week.</s>Doctors at Johns Hopkins University performed the world’s first total penis-and-scrotum transplant last month, on a U.S. military veteran who lost his legs and genitals in an IED blast in Afghanistan.

During the 14-hour surgery, nine plastic surgeons and two urological surgeons transplanted the penis, scrotum, and part of the abdominal wall from a deceased donor onto the vet, connecting blood vessels and nerves from the patient to the donor’s tissue “to provide complete blood transfusion and sensation.” This is different from previous genital transplants, which have only included the penis. Because of potential ethical issues, doctors first removed the donor’s testes before the transplant.

The patient, who has asked to remain anonymous, is set to be released from the hospital later this week, and is expected to regain “near-normal” urinary and sexual functions. In a statement released by Johns Hopkins, he wrote:

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

According to the Baltimore Sun, 1,367 male service members were placed on the Department of Defense Trauma Registry with genitourinary injuries between 2001 and 2013.

Johns Hopkins covered the cost of the transplant, which was between $300,000 and $400,000, and is assessing whether other patients are eligible for the procedure. Currently, the university is only considering injured service members for the transplant, not transgender individuals, or those born with defects.</s>The world’s first successful total penis and scrotum transplant was completed at Johns Hopkins Hospital on March 26, according to a news release issued Monday.

The procedure lasted 14 hours and involved nine plastic surgeons, two urological surgeons and a team of anesthesiologists, nurses and surgical technicians, according to the release. The transplant recipient, who wished to remain anonymous, is a young US serviceman who sustained injuries to his lower pelvis, lower abdominal wall and lower extremities in an improvised explosive device blast while serving in Afghanistan.

“While war injuries cause great suffering, disfigurement, and disability, they have also provided the impetus for medical discoveries,” said Dr. W.P. Andrew Lee, chairman of the Department of Plastic and Reconstructive Surgery at Johns Hopkins University and one of the surgeons in the case, in a news briefing.

“While extremity amputations are visible and resultant disability obvious, some war injuries are hidden and their impact not widely appreciated by others,” Lee added. “Genitourinary injury, where the male service members’ external genitalia are lost or severely damaged, is one such ‘unspoken injury of war.’ ”

In order to perform the transplant, the team had to obtain the necessary tissues — consisting of a penis, scrotum, and part of the lower abdominal wall — from a deceased donor, according to Dr. Rick Redett, clinical director of the Johns Hopkins genitourinary transplant program and another surgeon on the case.

“To perform the transplant, we procured the necessary tissue from the donor to restore normal anatomy in the recipient,” Redett said in a statement.

During the procedure, three arteries, four veins, and two nerves were connected under microscopic guidance in order to provide adequate blood flow and sensation to the transplanted tissue, Redett said.

According to Lee, the transplant serves as the culmination of over five years of research and collaboration between multiple medical disciplines at Johns Hopkins.

“In 2013, we assembled a team of plastic surgeons, urologists, transplant specialists, psychologists and bioethicists and began the preparation for genitourinary transplantation,” he said.

“We performed multiple surgical rehearsals of transplant in cadavers. We took notes of what we learned, refined our techniques and devised a plan for both graft procurement and transplantation.”

In 2014, the first successful penis transplant was performed in South Africa by a team of physicians at Stellenbosch University in Cape Town and Tygerberg Hospital. But the current case is the first to include transplantation of the scrotum and parts of the lower abdominal wall, according to Lee.

The transplant is an example of a type of procedure called vascularized composite allotransplantation, or VCA. VCA refers to the transplantation of multiple types of tissue such as skin, muscle and bone, according to the American Society of Transplantation. The term often refers to the transplantation of body parts such as arms, hands, faces and — now — genitals.

“These life-changing VCA transplants can only occur when a donor family looks past their grief and gives to someone in need,” said Alexandra Glazier, president of New England Donor Services, in a statement.

New England Donor Services is a federally designated organization that helps to coordinate organ and tissue transplants in the Northeast region, according to Glazier.

“Since 2009, New England Donor Services has requested and received permission 13 times from families for VCA donation resulting in the transplant of 19 VCA grafts,” she added. “In this case, we worked closely with our colleagues at the Living Legacy Foundation, the organ procurement organization serving most of Maryland, to facilitate and coordinate the recovery of this unique donation for transplant by the Hopkins team.”

According to Lee, the Comprehensive Transplant Center at Johns Hopkins has been a pioneer in many of the recent advancements in VCA procedures.

“Just over five years ago, the first quadruple amputee survivor in Iraq, US Army Sgt. Brendan Marrocco, received a double arm transplant at Johns Hopkins,” Lee said. “And just over five months ago, our team transplanted two new arms into Army National Guard Sgt. Eric Lund, who lost both arms just below his shoulders from a roadside bomb in Afghanistan.”

Nearly one month after the procedure, the penis transplant recipient appears to be recovering well and is expected to be discharged later this week, according to Redett.

“Our patient is recovering from the transplant well. He is up walking, and the graft shows no signs of infection or rejection,” Redett said. “It is our hope that such a life-enhancing transplant will allow him to regain urinary and sexual function and lead a more normal life.”

After the announcement of the surgery, the donor’s family, which also was not mentioned by name, also released a statement thanking the recipient for his service: “We are all very proud that our loved one was able to help a young man that served this country. 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. As a family, we are very supportive of all the men and women who serve our country and grateful for the job you did for this nation.”</s>An image released by the hospital where the surgery was performed

An image released by the hospital where the surgery was performed

DOCTORS IN THE US have performed the world’s first total penis and scrotum transplant on a military serviceman who was wounded in Afghanistan.

The 14-hour operation took place at Johns Hopkins University in Baltimore, Maryland, on 26 March. It was performed by a team of nine plastic surgeons and two urologic surgeons.

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

The patient was severely injured by a blast from an improvised explosive device in Afghanistan several years ago, Lee said.

The entire penis, scrotum (without testicles) and partial abdominal wall came from a deceased donor.

“It’s a real mind-boggling injury to suffer, it is not an easy one to accept,” a statement from the recipient, who has asked to remain anonymous, said.

“When I first woke up, I felt finally more normal … [with] a level of confidence as well … like finally I’m okay now,” he added.

The man is now up and walking around, and is expected to be released from hospital this week. He lost his testicles in the explosion and did not get them restored as part of his transplant.

“The testicles were not transplanted because we had made a decision early in the programme to not transplant germline tissue … tissue that generates sperm, because this would raise a number of ethical questions,” plastic surgeon Damon Cooney said.

“In particular, the ability of the recipient of the transplant to have children would result in genetic material being transmitted from the donor of the transplanted tissue to the recipient’s offspring,” Cooney added.

Doctors are hopeful the man will be able to urinate with his penis in the coming weeks.

The patient retained his prostate gland in the blast but, as he lost his testicles, he will not be able to ejaculate. The extent of his sexual function will not be known for about six months, doctors said.

While it is possible to reconstruct a penis using tissue from other parts of the body, Lee said, a prosthesis implant would be necessary to achieve an erection, and that comes with a much higher rate of infection. Additionally, due to other injuries, servicemen often don’t have enough viable tissue from other parts of their bodies to work with.

This type of transplant, where a body part or tissue is transferred from one individual to another, is called vascularised composite allotransplantation. The surgery involves transplanting skin, muscles and tendons, nerves, bone and blood vessels.

As with any transplant surgery, tissue rejection is a concern. The patient is put on a regimen of immunosuppressive drugs to prevent rejection. Lee’s team has developed an immune modulation protocol aimed at minimising the number of these drugs needed to prevent rejection.

The first penis transplant in the world took place in China in 2006, but it was later removed due to “a severe psychological problem of the recipient and his wife”, doctors said.

Only four penis transplants have ever been done successfully, including the one announced yesterday, doctors said.

Two have been done in South Africa, the nation that achieved the first such successful surgery in 2015. The United States performed its first successful penis transplant in 2016.</s>A US veteran who was severely wounded in Afghanistan has received the world’s first total penis and scrotum transplant, doctors in Maryland announced Monday.

The former soldier, who wants to remain anonymous, is now recovering and should be released from the hospital later this week, according to physicians from Johns Hopkins University School of Medicine in Baltimore.

A team of 11 specialists – nine plastic surgeons and two urological surgeons – performed the 14-hour procedure on March 26, transplanting the entire penis, scrotum and part of the abdominal wall from a deceased donor.

The veteran, who was wounded by an improvised explosive device, said he finally “felt more normal” after last month’s groundbreaking surgery.

“It’s a real mind-boggling injury to suffer, it is not an easy one to accept,” he said in a statement released by the hospital. “When I first woke up, I felt finally more normal … [with] a level of confidence as well. Confidence … like finally I’m OK now.”

W.P. Andrew Lee, professor and director of plastic and reconstructive surgery at Johns Hopkins, said it’s possible to reconstruct a penis using tissues from other parts of the body, but a prosthesis implant would then be needed to achieve an erection. Veterans like the man who received last month’s surgery also often don’t have enough viable tissues in other parts of their bodies, he said.

“We are hopeful that this transplant will help restore near-normal urinary and sexual functions for this young man,” Lee said.

As with any transplant surgery, tissue rejection is a concern for doctors, so the patient has been put on a series of immunosuppressive drugs to prevent that possible development, according to Johns Hopkins officials.

The deceased donor was also not identified, but the man’s family said in a statement obtained by USA Today that his relatives included 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,” according to the statement by New England Donor Services, which set up the donation. “We hope you can return to better health very soon and we continue to wish you a speedy recovery.”

Richard Redett, an associate professor of plastic and reconstructive surgery at Johns Hopkins who led the transplant, told reporters during a news conference that the former sergeant did not receive the donor’s testicles to avoid potential ethical issues if he later had children.

The first penis transplant in the United States occurred in May 2016 at Massachusetts General Hospital, where patient Thomas Manning had a more limited procedure than last month’s operation after being diagnosed with penile cancer in 2012.

“I just can feel like movement and life in it already,” Manning said at the time. “I feel that we belong together.”

Manning’s condition continues to improve, although the hospital has not completed another penile transplant since his 15-hour operation, USA Today reports. Prior to Manning’s operation, two earlier successful penile transplants were completed in South Africa, with the first in 2015.</s>Doctors at Johns Hopkins University said Monday they have performed the world’s first total penis and scrotum transplant on a US military serviceman who was wounded in Afghanistan.

The 14-hour operation took place on March 26, and was performed by a team of nine plastic surgeons and two urologic surgeons.

“We are optimistic that he will regain near-normal urinary and sexual functions following a full recovery,” W.P. Andrew Lee, professor and director of plastic and reconstructive surgery at the Johns Hopkins University School of Medicine, told reporters on a conference call.

The patient was severely injured by a blast from an improvised explosive device in Afghanistan several years ago, Lee said.

The entire penis, scrotum without testicles and partial abdominal wall came from a deceased donor.

“It’s a real mind-boggling injury to suffer; it is not an easy one to accept,” said a statement from the recipient, who asked to remain anonymous.

He is now up and walking around, and is expected to be released from hospital this week.

The man lost his testicles in the explosion and did not get them restored as part of his transplant.

“The testicles were not transplanted because we had made a decision early in the program to not transplant germline tissue, that is to say not transplant tissue that generates sperm because this would raise a number of ethical questions,” said JHU plastic surgeon Damon Cooney.

“In particular, the ability of the recipient of the transplant to have children would result in genetic material being transmitted from the donor of the transplanted tissue to the recipient’s offspring,” Cooney added.

Doctors said they are hopeful he will be able to urinate with his penis in the coming weeks, and that he will eventually regain enough sensation to achieve an erection.

The patient retained his prostate gland in the blast, but since he lost his testicles, he will not be able to ejaculate.

The extent of his sexual function will not be known for about six months, doctors said.

The first penis transplant in the world took place in China in 2006, but it was later removed due to “a severe psychological problem of the recipient and his wife,” doctors said.

Two have been done in South Africa, the nation that achieved the first such successful surgery in 2015. The United States performed its first successful penis transplant in 2016.</s>BALTIMORE (WJZ)– The Johns Hopkins reconstructive surgery team has successfully performed the first total penis and scrotum transplant in the world.

The transplant recipient is a veteran who sustained injuries in Afghanistan.

“He had sustained just a devastating blast injury from an IED in Afghanistan, and he came to me originally for what we call conventional reconstruction,” Dr. Rick Redett said. “When we saw him and met him and examined him, and we knew we didn’t have much to offer him, we started thinking about transplantation.”

He is expected to be discharged from the hospital this week after recovering from the 14-hour surgery back on March 26.

“We are hopeful that this transplant will help restore near-normal urinary and sexual functions for this young man,” W.P. Andrew Lee, M.D., professor and director of plastic and reconstructive surgery at the Johns Hopkins University School of Medicine, said in a release.

The penis and scrotum came from a deceased donor, and nine plastic surgeons and two urological surgeons were involved in the transplant surgery.

In a statement through the hospital, the patient said “When I first woke up, I felt finally more normal with a level of confidence as well. Confidence, like, finally I’m okay now.”

The patient has chose to remain anonymous.

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Doctors at the Johns Hopkins University in Baltimore, Maryland, perform the world's first successful transplant of a penis and scrotum from a deceased donor to a U.S. soldier injured in Afghanistan. The testicles are not transplanted.