[ロンドン 19日 ロイター] 世界初のペニス移植手術に成功した中国の医師団が、提供されたペニスを切除しなければならなくなった。患者とその妻に起きた深刻な心理的問題のためだという。
フ医師は専門誌「journal European Urology」で詳細には触れず「患者と妻の深刻な心理的問題が原因で、残念ながら移植したペニスを切除した」と報告している。
A preliminary report of penile transplantation.
• Hu W,
Department of Urology, Guangzhou General Hospital of Guangzhou Military Command (Guangzhou Liuhuaqiao Hospital), Guangzhou, PR China.
A 44-year-old male recipient with traumatic penile defect that occurred 8 mo earlier was matched with a 22-year-old, male, brain-dead donor. Transplantation included anastomosis of urethra corpus spongiosum and corpus cavernosum, and sutures of deep dorsal vein, dorsal artery, dorsal nerve, and superficial dorsal vein. Systemic broad-spectrum antibiotics, anticoagulation, antispasm agents, and immunosuppressants were given postoperatively. The recipient could urinate smoothly in a standing position at day 10 after removal of Foley catheter. At day 14 postoperatively because of a severe psychological problem of the recipient and his wife, the transplanted penis was cut off. Pathologic examination showed no rejection.
PMID: 16930814 [PubMed - in process]
Chinese surgeons report penis transplant
(AP) -- Chinese doctors say they successfully transplanted a penis on a man who lost his own in an accident, but had to remove it two weeks later because of psychological problems experienced by the man and his wife.
The case appears to be the first such transplant reported in a medical journal -- European Urology, published by the European Association of Urology.
The Chinese doctors could not be reached for comment, and their report does not explain how the 44-year-old man lost his penis. It says only that "an unfortunate traumatic accident" left him with a small stump, unable to urinate or have sex normally.
Surgeons led by Dr. Hu Weilie at Guangzhou General Hospital performed the transplant in September 2005, a hospital spokesperson said Tuesday. The penis came from a 22-year-old brain-dead man whose parents agreed to donate his organ.
"There was a strong demand from both the patient and his wife" for a transplant, and the operation "was discussed again and again" and approved by the hospital's ethics committee, Hu writes in the journal.
Despite how shocking and radical the operation sounds, it involves standard microsurgery techniques to reconnect blood vessels and nerves.
From a medical point of view, "the main hurdle is the functional recovery," said Dr. W.P. Andrew Lee, chief of plastic surgery at the University of Pittsburgh Medical Center.
From arm and leg reattachments, it's known that nerve regrowth occurs at a rate of about an inch a month and often is insufficient to allow normal use, he said.
However, the ethical and psychological challenges in such cases can be even more paramount, as this and other recent transplants involving hands and faces illustrate.
"Some of the considerations for a penile transplant are the same as for a hand or face transplant," such as the need to take lifelong immune-suppressing drugs to prevent rejection of the new organ, Lee said.
The drugs can cause kidney and other damage, acceptable risks when the transplant involves a vital organ such as a liver or heart, but more ethically perilous when the operation is aimed at improving quality of life rather than extending it, Dr. Yoram Vardi, a neurology and urology specialist at the Rambam Medical Center in Haifa, Israel, writes in an accompanying commentary in the urology journal.
Psychological issues are keenly important. The world's first hand transplant recipient stopped taking immune suppression drugs and later requested that the hand be amputated.
Lee recalled speaking with the recipient of the world's first double-hand transplant in France, who told him it took months for him to accept his new hands and stop referring to one as "it."
Fourteen days after the penis transplant, the recipient and his wife requested that the organ be removed "because of the wife's psychological rejection as well as the swollen shape of the transplanted penis," the surgeons report in the journal.
Lab examination showed no sign of rejection, the doctors report.
If adequate attention had been paid to the need for counseling and other psychological concerns surrounding the transplant, "the need for penile amputation could probably have been avoided," Vardi wrote in his commentary.