The Warren Alpert Medical School of Brown University
Introduction: In May 2016 we performed the first successful penis transplant in the United States in a patient with a history of subtotal penectomy for penile cancer. Here, we report 5-year follow-up outcomes specifically related to erectile function. Until recently he had been using daily Tadalafil 5mg with good effect but had subsequently noted 30-40% decline in erectile quality. Here we report erectile function since the introduction of intraurethral gels (IUG).
Methods: Our patient was evaluated using penile doppler ultrasound with use of both audio/visual stimulation (AVS) and Trimix IUG. His erection response was graded by rigidity on 0-100%scale bymen’s health urologists. Right and left cavernosal velocities were documented as well as SHIM score at each visit. All post-application measurements were taken from 0 to 20 minutes. Given his surgical transplant history, intracavernosal injections were avoided to ensure not injuring the vascular anastomoses. The Trimix IUG are composed of 7.5mg Papaverine, 1mg Phentolamine, and varying amounts of Alprostadil (250mcg to 1000mcg). The patient was exposed to AVS alone as a control followed by AVS and Trimix IUG at subsequent office visits.
Results: At 5-years follow-up after penis transplant, our patient was initially maintained on 5mg daily Tadalafil; however, he noted poor erectile quality. Due to the complexity of his graft and risk of injury, intracavernosal injections were deemed potentially unsafe and he was prescribed intraurethral Trimix gel. Our results demonstrate 60% rigidity using 1000mg Alprostadil Trimix intraurethral gel in the office with our patient noting superior erectile quality at home. His SHIM score was noted to be 20 when using daily Tadalafil combined with on demand Trimix intraurethral gel (500mcg or 750mcg Alprostadil). There were initial venous leak demonstrable; however, at higher doses, there is diminished venous leak and greater rigidity achieved.
Conclusions: Our data is the first to demonstrate and characterize successful achievement of erectile function 5-years after Genito-urinary composite allotransplantation.
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