Tuesday, December 08, 2015

U.S.: Penis Transplants Being Planned
to Help Wounded Troops

Within a year, maybe in just a few months, a young soldier with a horrific injury from a bomb blast in Afghanistan will have an operation that has never been performed in the United States: a penis transplant.
The organ will come from a deceased donor, and the surgeons, from Johns Hopkins University School of Medicine in Baltimore, say they expect it to start working in a matter of months, developing urinary function, sensation and, eventually, the ability to have sex.
From 2001 to 2013, 1,367 men in military service suffered wounds to the genitals in Iraq or Afghanistan, according to the Department of Defense Trauma Registry. Nearly all were under 35 and were hurt by homemade bombs, commonly called improvised explosive devices, or I.E.D.s. Some lost all or part of their penises or testicles — what doctors call genitourinary injuries.
Missing limbs have become a well-known symbol of these wars, but genital damage is a hidden wound — and, to many, a far worse one — cloaked in shame, stigma and embarrassment.
“These genitourinary injuries are not things we hear about or read about very often,” said Dr. W. P. Andrew Lee, the chairman of plastic and reconstructive surgery at Johns Hopkins. “I think one would agree it is as devastating as anything that our wounded warriors suffer, for a young man to come home in his early 20s with the pelvic area completely destroyed.”
Only two other penis transplants have been reported in medical journals: a failed one in China in 2006 and a successful one in South Africa last year. The surgery is considered experimental, and Johns Hopkins has given the doctors permission to perform 60 transplants. The university will monitor the results and decide whether to make the operation a standard treatment. The risks, like those of any major transplant operation, include bleeding, infection and the possibility that the medicine needed to prevent transplant rejection will increase the odds of cancer.
Dr. Lee cautioned that patients should be realistic and not “think they can regain it all.” But doctors can give the recipients a range of what to expect. 
“Some hope to father children,” Dr. Lee said. “I think that is a realistic goal.”
Just the penis will be transplanted, not the testes, where sperm are produced. So if a transplant recipient does become a father, the child will be his own genetically, not the offspring of the donor. Men who have lost testicles completely may still be able to have penis transplants, but they will not be able to have biological children.
In the 2006 case in China, the recipient asked that the transplant be removed a few weeks after the operation because of “apparent psychological rejection,” the Johns Hopkins doctors said, adding that in photographs the transplant had patches of dead and peeling skin, possibly from inadequate blood flow.
But the South African recipient, a young man whose penis had been amputated because of a botched circumcision, recently became a father, said Dr. Gerald Brandacher, the scientific director of the reconstructive transplantation program at Johns Hopkins.
Doctors who treat young men wounded in combat say that no matter how bad their other injuries are, the first thing the men ask about when they wake up from surgery is whether their genitals are intact.
“Our young male patients would rather lose both legs and an arm than have a urogenital injury,” said Scott E. Skiles, the polytrauma social work supervisor at the Veterans Affairs Palo Alto Health Care System.
Sgt. First Class Aaron Causey, who lost both legs, one testicle and part of the other from an I.E.D. while in Afghanistan with the Army in 2011, said the testicular damage was the most troubling of his injuries. The wound to his groin involved only the testicles.
“I don’t care who you are — military, civilian, anything — you have an injury like this, it’s more than just a physical injury,” Sergeant Causey said.
Some doctors have criticized the idea of penis transplants, saying they are not needed to save the patient’s life. But Dr. Richard J. Redett, director of pediatric plastic and reconstructive surgery at Johns Hopkins, said, “If you meet these people, you see how important it is.”
“To be missing the penis and parts of the scrotum is devastating,” Dr. Redett said. “That part of the body is so strongly associated with your sense of self and identity as a male. These guys have given everything they have.”
U.S. military field hospital
US military field hospital
Jeffrey Kahn, a bioethicist at Johns Hopkins, said that at a conference convened last year by the Bob Woodruff Foundation, which aids injured veterans, wives said that genitourinary injuries had eroded their husbands’ sense of manhood and identity. Most telling, Dr. Kahn said, was that the men themselves attended the conference but did not speak about their wounds.
Although surgeons can create a penis from tissue taken from other parts of a patient’s own body — an operation being done more and more on transgender men — erections are not possible without an implant, and the implants too often shift position, cause infection or come out, Dr. Redett said. For that reason, he said, the Johns Hopkins team thinks transplants are the best solution when the penis cannot be repaired or reconstructed. If the transplant fails, he said, it will be removed, leaving the recipient no worse off than before the surgery.
But can men — and their partners — get used to the idea that their most intimate part came from another man’s body?
The best analogy is hand transplants, Dr. Brandacher said, because hands are personal and distinctive — a transplant that the recipient can see, unlike a kidney or liver.
“I can tell you from all the patients — and I’ve been involved since 1998 — every single one, after surgery, look at the graft, try to move it and they immediately call it ‘my hand,’ ” Dr. Brandacher said. “They immediately incorporate it as part of their body. I would assume, extrapolating, that this is going to be the same for this kind of transplant.”
Dr. Kahn said it was essential that the families of organ donors be asked specifically for permission to use the penis, just as special permission was required for face and hand transplants. It is not assumed that people willing to donate kidneys or livers will also consent to having their loved one’s genitals removed. The surgeons want a relatively young donor to increase the odds that the transplanted organ will function sexually.
For now, the operation is being offered only to men injured in combat, Dr. Lee said. It is not available to transgender people, though that may change in the future.
“Once this becomes public and there’s some sense that this is successful and a good therapy, there will be all sorts of questions about whether you will do it for gender reassignment,” Dr. Kahn said. “What do you say to the donor? A 23-year-old wounded in the line of duty has a very different sound than somebody who is seeking gender reassignment.”
For a transplant to be possible, certain nerves and blood vessels have to be intact in the recipient, as does the urethra, the tube that carries urine out of the body. The screening process, as for any organ transplant, also involves making sure that the candidate is psychologically ready, understands the risks and benefits, can stick to the regimen of anti-rejection medicine and has a family support network.
Click here to read the full article
Source: The New York Times, Denise Grady, December 6, 2015

I published the following piece on soldiers genital injuries in November 2013. Definitely a must read.

We Sent Them to Brutal Wars:
Now, the Untold Story
Of What Happens When Soldiers Come Home

“Nothing in my experience prepared me for the catastrophic nature of these injuries.”

A powerful scene in the US Hospital at Bagram base, excerpted from "They Were Soldiers: How the Wounded Return from America's Wars—The Untold Story"

The following is an excerpt from Ann Jones' new book, They Were Soldiers: How the Wounded Return from America's Wars—The Untold Story (Haymarket Books / Dispatch Books, 2013). Jones' new book takes us on a powerful journey from the devastating moment an American soldier is first wounded in rural Afghanistan to his return home for recovery. This excerpt picks up at Ann Jones' visit to Craig Hospital, a Level III Trauma Center at Bagram Airforce Base in Afghanistan. Craig Hospital is often the first serious medical stop on the "medevac pathway" that sends critically wounded soldiers to Landstuhl Regional Medical Center in Germany and the US for further extensive treatment.

"At Bagram the three orthopedic surgeons work 14-hour days at a minimum with one night on call, the next night on backup, and the third night, if they’re lucky, asleep. When I talked with them in 2011 they were riding a long wave of wounds, and it was still spring. The winter when fighting falls off was just passing, and in summer they knew everything would be worse.
"The catastrophic blasts brought other surgical specialties to Bagram. The explosions seemed to everyone only to get more powerful and the wounds more extensive. Blasts now regularly rose into the perineal area, where the two legs meet, to smash genitals and into the pelvic cavity to pulverize soft tissue and sever intricate bodily systems. In response to a surge of such catastrophic injuries, the army dispatched a urological surgeon from Walter Reed to Bagram in 2010. Six months later, in March 2011, a navy commander stepped into that position. It was his first deployment to a war zone, but after his residency at a level one trauma center and seven years of work as a Naval surgeon at hospitals in the States and Japan, he thought he knew what he was in for. After two months at Bagram, he told me, “Nothing in my experience prepared me for the catastrophic nature of these injuries.”
"His first surgical patient, three days after he arrived at Bagram, was a young soldier who had stepped on an IED, triggering an upward blast that destroyed his legs and left his pelvic cavity “hollowed out.” His urinary system was in shreds. His testicles were destroyed. His penis was attached to his body by only “a little thread of skin.” That first surgery, the doctor said, was “emotional” for everyone on the surgical team. “The others hadn’t seen anything like these injuries for a while,” he said, “and I had never seen anything like it. To have to amputate that boy’s penis and watch it go into the surgical waste container—it was emotional.”
"In two months at Bagram, the urological surgeon had done 20 similar surgeries, though that was the worst. Injuries confined mainly to the testicles are “easier,” he says, but for the soldiers they are brutally serious. Most soldiers who survive blasts that require high-level amputations of their legs also suffer severe injury to the scrotum and ruptured testicles. Surgeons can debride and clean the scrotum, and in many cases salvage at least part of one testicle and put it back. Keeping even part of his genitals is a psychological break for the soldier, but since the testicles produce testosterone, he still faces the inevitable ill effects of a deficient supply—a long and imperfectly understood list headed by osteoporosis, metabolic syndrome, cardiovascular problems including coronary artery disease and atherosclerosis, erectile dysfunction with its attendant psychological difficulties, low sperm count impairing fertility, obesity, depression, and a lifetime seesaw of hormonal treatment. (...)
"By early 2012, 3,000 soldiers had been killed by IEDs in Iraq and Afghanistan, and 31,394 wounded. Among the wounded were more than 1,800 soldiers with severe damage to their genitals. (...)
“It’s not a huge number of people,” the urological surgeon says, speaking of the surgeries he has performed himself, “but the severity of the injuries, and the possibility of complications down the road—that weighs heavily. The kind of injuries—you don’t have any idea of the devastation until you see it up close. This has been eye opening. It’s given me a new understanding of the costs of armed conflict. Even being in the military, I didn’t know.” An ER nurse, an Army major on her second deployment at Bagram, tells me that catastrophic cases pass through the ER four days out of seven, and quadruple amputees “often.” She says, “I’ve taken care of twenty or thirty of them myself.” She has lost count. I ask how she would describe the typical case she sees in the ER. She replies, “Amputees up to the waist. No arms. No legs. No genitals. Age 21 or 22. We cry."
Click here to read the full article 
Source: AlterNet, November 6, 2013


joseph said...

radical contre les coups de pompe!

another country said...

Un sujet passé sous silence mais qui rappelle le vrai sens du mot "guerre" à tous ceux qui sont pressés "to put boots on the ground". Le second article est particulièrement émouvant. Le premier est synonyme d'espoir.