En Bloc Surgical Dissection for Penile Transplantation for Trans-Men: A Cadaveric Study

Abstract

Introduction The surgical techniques currently available for penile reconstruction for trans-men with gender dysphoria present with multiple drawbacks and often fail to meet patients' expectations. Literature reports three cases where penile transplantation has been performed for cis-men, with the last two cases being considered successful. Aim To determine whether an en bloc surgical dissection can be performed in a male cadaver, in order to include structures necessary for penile transplantation (from a deceased donor male) to a recipient with female genitalia in gender affirmation surgery. Method The study was conducted in the form of explorative dissections of the genital and pelvic regions of three male cadavers preserved in phenol-ethanol solution. Results The first two dissections failed to explant adequately all the relevant structures. The third dissection, which was performed along the pubic arch and through the perineum, succeeded in explanting the relevant structures: it, in fact, allowed for identification and adequate transection of urethra, vessels, dorsal nerves, crura of corpora cavernosa, and bulb of corpus spongiosum, in en bloc explantation of male genitalia. Conclusions It is possible to explant the penis and associated vessels, nerves, and urethra en bloc from a cadaver. This study suggests a surgical technique for en bloc explantation aiming for transplantation of the penis from a cadaveric donor male to a recipient with female genitalia.

Techniques and considerations of prosthetic surgery after phalloplasty in the transgender male

“…Though preliminary results have been promising, longer-term studies are needed to determine the comparative utility of this device. Finally, with cadaveric penile transplantation emerging as an option for patients with genital loss, this may conceivably serve as a future option for transgender men (46,47). With greater recognition of the needs of transgender patients, we are hopeful that further developments of trans-specific devices are on the horizon.…”

Functional reconstruction of injured corpus cavernosa using 3D-printed hydrogel scaffolds seeded with HIF-1α-expressing stem cells

“…The repair of injured corpora cavernosa has always been difficult due to a variety of anatomical, aesthetic, and functional challenges 2 . Allopenis transplantation, a reported approach, is controversial because of ethical issues 3,4 . Acellular matrix replacement also has defects because of limited sources, potential immunogenicity, and low porosity and fails to restore penile function 5 .…”

“…Surprisingly, angiogenesis induced by the expression of the HIF-1α and VEGF (via HIF-1α mutated MDSCs) in the hydrogel scaffolds effectively repaired the injured corpora cavernosa, and restored penile erection and ejaculation function in vivo within 4 months ( Fig. 1), in sharp contrast to unsuccessful repair by the aforementioned traditional repairing methods [3][4][5] . Specifically, the angiogenic factors generated by HIF-1α over-expressed MDSCs were enriched on the surface of 3D-printed hydrogel scaffolds by the adsorption of heparin and then stimulated blood vessel formation in vivo.…”

Ethical considerations regarding penis transplantation surgery in transgender men—an empirical ethics study

“…Selvaggi et al have shown that it is possible to explant the penis and associated vessels, nerves, and urethra en bloc from a cadaver. 20 These authors concluded that this technique would enable penile transplantation from a cadaveric donor male to a recipient with natal female pelvic anatomy, a finding that has been previously confirmed by Tiftikcioglu et al 21 …”