In the United States, a man has had a successful penis transplant. In France, this feat has still not been achieved for ethical reasons.
This is the third time that this feat has been achieved across the world. In the United States, a man has just undergone a penis transplant. “A success”, according to the American press which echoed it this weekend. The 64-year-old man, suffering from penile cancer, had had his limb amputated. At the end of an operation of more than fifteen hours and after a week of recovery, he is in a state allowing “reasonable” hopes.
“If all goes as planned, Thomas Manning will be able to urinate normally in a few weeks and have sexual activity in a few months”, said the surgeon at the head of the medical team involved, quoted by the New York Times. Good news for the other candidates for the operation, while around sixty mutilated soldiers could benefit from it.
In France, the intervention never took place. In fact, although the operating technique is not the simplest, it is above all for ethical questions that France has still not involved its teams in such projects, as explained by Prof. François Desgrandchamps, Chief of the urology department at Saint-Louis hospital (Paris).
Is this operation particularly technical?
Prof. François Desgrandchamps : Transplantation is technically tricky but not insurmountable. Our teams have long been ready to carry out such an intervention. This is microsurgery; it is necessary to anastomose the cavernous arteries and the cavernous nerves, so that they communicate again to find an erectile function in addition to the urinary function. This whole protocol has been worked out with our plastic surgeons; it is ready to be applied.
The other difficulty is immunological. The penis is a highly immunogenic composite tissue [capable d’induire une réaction immunitaire, ndlr], there is skin, subcutaneous. The risk of rejection is high. But here too, we have overcome the technical issue. Immunosuppression is the same as for a composite transplant such as the hand or the face.
So why have you never carried out this operation in France?
Prof. François Desgrandchamps : Because the only aspect on which we have not yet decided is of an ethical nature. To transplant this appendix, the penis, it is necessary to take a heavy immunosuppression until the end of his life. In the current state of available therapies, this immunosuppression is a vector of infectious and even tumor complications.
What has blocked us so far with the Biomedicine Agency is the ethical aspect. When can we ethically think that transplanting a rod has more advantages than disadvantages? At first glance, we say to ourselves that the answer is obvious, but given the heaviness of the treatments and the associated risks, it is not so simple.
François Desgrandchamps, head of the urology department in Saint-Louis: “ We offer a combined kidney and penis transplantation, for patients with renal insufficiency with a congenital malformation “
But why is it more ethical to transplant a hand than a rod?
Prof. François Desgrandchamps : When you don’t have a hand, you can’t catch anything. When you don’t have a penis, you can still urinate; the urethra begins much further back from the penis, a perineal urethrostomy is sufficient to restore urinary function. Likewise, you can still experience cerebral pleasure even without an erection. Patients with penile stumps always have orgasms. On the other hand, they lose their reproductive function since it takes at least four centimeters of penis to allow the sperm to find its way to the oocyte.
In fact, penis transplantation is more of a pleasure and aesthetic aspect than a vital question. A hand, a face, it’s vital. Not a rod. This is why the ethical dimension linked to the benefit and the risk of this intervention arises more. However, it is hoped that the immunosuppression will progress to become less severe and then this obstacle will be removed.
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