MD University Children's Hospital, Faculty of Medicine, University of Belgrade
Introduction: Penile transplantation presents an ideal treatment for penile agenesis, traumatic penile amputation, penile cancer or gender dysphoria in transmen. Until now, all four reported cases underwent cadaveric penile transplantation. We evaluated possibilities for using all penile entities after their removal in transfemale gender affirming surgery for live donor penile transplantation. Main goal of this cadaveric study was to develop techniques for anatomical harvesting of the penile entities (corpora cavernosa with distal urethra and glans) that could be used for safe and successful donor penile transplantation. Methods: Between January and September 2022, penile dissection was performed in 18 male cadavers, aged from 19 to 51 years (mean 38.5 years). Dissection was based on penile disassembly principles: corpora cavernosa with urethra, glans with neurovascular bundle and penile skin. Penile skin with small piece of the glans and proximal urethra were separated as a tissue for creating the female genitalia. This way completely preserved cavernosal bodies, distal urethra and largest part of the glans were precisely measured with associated blood vessels and nerves. Results: Mean penile length was 10.5cm (from 6 to 13cm) in flaccid and 15cm (from 12 to 18cm) in stretched state, and mean circumference 8cm (from 7 to 9cm). Neurovascular bundle had regular anatomy in 16 cases, while in remaining 2 anatomical variations were detected: single penile artery in one and a common trunk of both penile arteries in another case. Mean diameters of deep dorsal vein, right and left left artery were measured 2.9mm, 2.5mm and 2.2mm, respectively. Penile nerves were found in all cases with anatomical distribution. A circumflex branches and perforators of the blood vessels were detected in all cases. Mean length and girth of cavernosal bodies were 20cm (from 18 to 24cm), and 7.4cm (from 6.5 to 11cm), respectively. Both crural arteries are identified in all cases. Mean length of the distal urethra was 11.4cm (from 9.5 to 14cm) without registered anomalies. The mean volume of the remaining glans after creation of the neoclitoris was 87% (from 85 to 90%). All dissections were finished successfully, and all entities were joined again in all cadavers. Conclusions: Preliminary results of cadaveric penile dissection confirm feasibility of using all remaining entities such as corpora cavernosa, minimally reduced glans, distal urethra and preserved neurovascular elements during transfemale gender affirming surgery for possible penile transplantation. Surgical technique is suggested and will be established with further research. SOURCE OF Funding: Science Fund of the Republic of Serbia, Project IDEAS.
