First ‘successful’ penis surgery

The world's first successful penis transplant has been reported by a surgical team in South Africa.

The 21-year-old recipient, whose identity is being protected, lost his penis in a botched circumcision.

Doctors in Cape Town said the operation was a success and the patient was happy and healthy.

The team said there was extensive discussion about whether the operation, which is not life-saving in the same way as a heart transplant, was ethical.

There have been attempts before, including one in China. Accounts suggested the operation went fine, but the penis was later rejected.

Penis replacement

The man was 18 and already sexually active when he had the circumcision.

The procedure is part of the transition from boyhood to adulthood in parts of South Africa.

The boy was left with just 1cm of his original penis.

Doctors say South Africa has some of the greatest need for penis transplants anywhere in the world.

Dozens, although some say hundreds, of boys are maimed or die each year during traditional initiation ceremonies.

Long

Surgeons at Stellenbosch University and Tygerberg Hospital performed a nine-hour operation to attach a donated penis.

One of the surgeons, Andre Van der Merwe, who normally performs kidney transplants, told the BBC News website: "This is definitely much more difficult, the blood vessels are 1.5 mm wide. In the kidney it can be 1 cm."

The team used some of the techniques that had been developed to perform the first face transplants in order to connect the tiny blood vessels and nerves.

The operation took place on 11 December last year. Three months later doctors say the recovery has been rapid.

Full sensation has not returned and doctors suggest this could take two years.

However, the man is able to pass urine, have an erection, orgasm and ejaculate.

Preparation

The procedure required a lot of preparation.

The team needed to be sure the patient was aware of the risks of a life-time of immunosuppressant drugs.

Also some patients cannot cope with a transplant if they fail to recognise it as part of their body.

"Psychologically, we knew it would have a massive effect on the ego," said Dr Van der Merwe.

It took "a hell of a lot of time" to get ethical approval, he added.

One of the concerns is a heart transplant balances the risk of the operation against a certain death, but a penis transplant would not extend life span.

Dr Van der Merwe told the BBC: "You may say it doesn't save their life, but many of these young men when they have penile amputations are ostracised, stigmatised and take their own life.

"If you don't have a penis you are essentially dead, if you give a penis back you can bring them back to life."

Further attempts on other patients are expected to take place in three months time.