Penile Transplantation in Gender Affirmation Surgery: A Theoretical Feasibility Study

Abstract

Background It can be argued that individuals in the transgender and gender nonbinary (TGNB) community suffer from a similar impact on quality of life in the face of gender dysphoria, with psychosocial and physical consequences. Indications for penile allotransplantation for patients wishing to undergo gender affirmation surgery have yet to be elucidated, but technical lessons for feasibility can be gleaned from penis transplants that have already been performed on cisgender males to date.

Methods This study investigates the theoretical feasibility for penile-to-clitoral transplantation, prior penile transplants, and current multidisciplinary gender affirmation health care modalities.

Results Penile allotransplantation offers a potential solution for individuals in the TGNB community for a more aesthetic penis, improved erectile function without the need of a prosthesis, optimal somatic sensation, and improved urethral outcomes.

Conclusion Questions remain about ethics, patient eligibility, and immunosuppressive sequelae. Before these issues are addressed, feasibility of this procedure must be established.

Keywords

penile transplant - microvascular surgery - gender affirmation surgery

Publikationsverlauf

Eingereicht: 20. November 2022

Angenommen: 02. Mai 2023

Accepted Manuscript online:
04. Mai 2023

Artikel online veröffentlicht:
15. Juni 2023

• References

• 1 Meerwijk EL, Sevelius JM. Transgender population size in the United States: a meta-regression of population-based probability samples. Am J Public Health 2017; 107 (02) e1-e8
• 2 Beckwith N, Reisner SL, Zaslow S, Mayer KH, Keuroghlian AS. Factors associated with gender-affirming surgery and age of hormone therapy initiation among transgender adults. Transgend Health 2017; 2 (01) 156-164
• 3 Akhavan AA, Sandhu S, Ndem I, Ogunleye AA. A review of gender affirmation surgery: what we know, and what we need to know. Surgery 2021; 170 (01) 336-340
• 4 Scott KB, Thuman J, Jain A, Gregoski M, Herrera F. Gender-affirming surgeries: a national surgical quality improvement project database analyzing demographics, trends, and outcomes. Ann Plast Surg 2022; 88 (5, Suppl 5): S501-S507
• 5 Hu W, Lu J, Zhang L. et al. A preliminary report of penile transplantation. Eur Urol 2006; 50 (04) 851-853
• 6 Hu W, Lu J, Zhang L. et al. A preliminary report of penile transplantation: part 2. Eur Urol 2006; 50 (05) 1115-1116 , discussion 1116
• 7 van der Merwe A, Graewe F, Zühlke A. et al. Penile allotransplantation for penis amputation following ritual circumcision: a case report with 24 months of follow-up. Lancet 2017; 390 (10099): 1038-1047
• 8 Cetrulo Jr CL, Li K, Salinas HM. et al. Penis transplantation: first US experience. Ann Surg 2018; 267 (05) 983-988
• 9 Redett III RJ, Etra JW, Brandacher G. et al. Total penis, scrotum, and lower abdominal wall transplantation. N Engl J Med 2019; 381 (19) 1876-1878
• 10 Doornaert M, Hoebeke P, Ceulemans P, T'Sjoen G, Heylens G, Monstrey S. Penile reconstruction with the radial forearm flap: an update. Handchir Mikrochir Plast Chir 2011; 43 (04) 208-214
• 11 Djinovic RP. Metoidioplasty. Clin Plast Surg 2018; 45 (03) 381-386
• 12 Meyer III WJ, Webb A, Stuart CA, Finkelstein JW, Lawrence B, Walker PA. Physical and hormonal evaluation of transsexual patients: a longitudinal study. Arch Sex Behav 1986; 15 (02) 121-138
• 13 Vukadinovic V, Stojanovic B, Majstorovic M, Milosevic A. The role of clitoral anatomy in female to male sex reassignment surgery. Sci World J 2014; 2014: 437378
• 14 Tuffaha SH, Cooney DS, Sopko NA. et al. Penile transplantation: an emerging option for genitourinary reconstruction. Transpl Int 2017; 30 (05) 441-450
• 15 Abelson B, Sun D, Que L. et al. Sex differences in lower urinary tract biology and physiology. Biol Sex Differ 2018; 9 (01) 45
• 16 Prateek G, Himanshu P, Mahendra S. et al. Functional and aesthetic outcome after ventral spatulation of urethra in partial penectomy. Urologia 2022; 89 (02) 274-279
• 17 Tuffaha SH, Sacks JM, Shores JT. et al. Using the dorsal, cavernosal, and external pudendal arteries for penile transplantation: technical considerations and perfusion territories. Plast Reconstr Surg 2014; 134 (01) 111e-119e
• 18 Landström JT, Schuyler RW, Macris GP. Microsurgical penile replantation facilitated by postoperative HBO treatment. Microsurgery 2004; 24 (01) 49-55
• 19 Botter C, Sawan D, SidAhmed-Mezi M. et al. Clitoral reconstructive surgery after female genital mutilation/cutting: anatomy, technical innovations and updates of the initial technique. J Sex Med 2021; 18 (05) 996-1008
• 20 Tuffaha SH, Budihardjo JD, Sarhane KA, Azoury SC, Redett RJ. Expect skin necrosis following penile replantation. Plast Reconstr Surg 2014; 134 (06) 1000e-1004e
• 21 Tiftikcioglu YO, Erenoglu CM, Lineaweaver WC, Bilge O, Celik S, Ozek C. Anatomic basis for penis transplantation: cadaveric microdissection of penile structures. Ann Plast Surg 2016; 76 (06) 729-734
• 22 Hannan JL, Cheung GL, Blaser MC. et al. Characterization of the vasculature supplying the genital tissues in female rats. J Sex Med 2012; 9 (01) 136-147
• 23 Fischer S, Lian CG, Kueckelhaus M. et al. Acute rejection in vascularized composite allotransplantation. Curr Opin Organ Transplant 2014; 19 (06) 531-544
• 24 Schneeberger S, Gorantla VS, Brandacher G. et al. Upper-extremity transplantation using a cell-based protocol to minimize immunosuppression. Ann Surg 2013; 257 (02) 345-351
• 25 Nahata L, Quinn GP, Caltabellotta NM, Tishelman AC. Mental health concerns and insurance denials among transgender adolescents. LGBT Health 2017; 4 (03) 188-193