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PostPosted: Tue Mar 17, 2015 12:24 pm 
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World's first penis REDUCTION surgery: Teenager requested op after his manhood grew so large it stopped him having sex
By Alex Robertson
12 February 2015

A 17-year-old boy has undergone the world's first penis reduction surgery, surgeons claim.

The American teen requested the surgery after his penis grew too large, restricting his ability to have sex or play competitive sports. The boy's surgeons were shocked when he came to them complaining that his penis was too big. When flaccid, it measured almost seven inches in length and had a circumference of 10 inches - around the size of a grapefruit. Surgeons described it as being shaped like an American football.

The surgeon who treated the teenager, Rafael Carrion, a urologist at the University of South Florida, told MailOnline: 'There comes a time in every urologist's career that a patient makes a request so rare and impossible to comprehend that all training breaks down and leaves the physician speechless. 'That question was "can you make my penis smaller"?'

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A 17-year-old boy in Florida is thought to be the first person to undergo penis reduction surgery. The teenager requested the operation after his penis (pictured on an X-ray) grew too large

The teenager had suffered from several bouts of priapism - an unwanted erection, due to having a condition in which abnormally-shaped blood cells block vessels in the penis, causing it to swell. These episodes had left his penis bloated and misshapen. He said he was unable to have sex or play competitive sport, had difficulty wearing his pants due to his 'large and heavy phallus', and was embarrassed by how visible it appeared underneath regular clothing. Though his penis was so large, it did not grow when he had erections - it merely became firmer.

'His penis had inflated like a balloon,' said Dr Carrion. 'It sounds like a man's dream - a tremendously inflated phallus - but unfortunately although it was a generous length, it's girth was just massive, especially around the middle. 'It looked like an American football.' Dr Carrion and his team looked at the medical literature but couldn't find any precedent for what to do. 'Lord knows there's a global race on how to make it longer and thicker in plastic surgery circles, but very little on how to make it smaller,' he said.

In the end, they decided to embark on a surgical technique normally used to treat Peyronie's disease, a condition where scar tissue develops along the penis, causing it to bend. The surgeons sliced along an old circumcision scar, unwrapped the skin of the penis, and cut out two segments of tissue from either side. 'It was a bit like having two side tummy-tucks - that's how we explained it to him,' said Dr Carrion. The doctors were able to bypass the urethra - the tube which carries urine through the penis - and all of the nerves that provide sensation.

The teenager spent just two days in hospital before returning home, apparently 'ecstatic' with his new penis. The doctors did not take final measurements of the penis, although Dr Carrion told MailOnline the result was 'generous'. 'It's slightly longer and slightly thicker than the average male, but now it looks symmetrical, and the patient was very satisfied,' he said. The teen now has no problem having normal erections and has full sensation. 'It looks cosmetically appealing, and he said it was a life-changing event, he's all smiles,' said Carrion.

Since the paper describing the surgery was published in The Journal of Sexual Medicine, Dr Carrion has only had one person approach him to request the same surgery. He said: 'This [second] man seems to have a naturally large penis, because there's nothing unusual in his medical history, so it doesn't seem like there's any real abnormality in this case'. Whereas the first teenager had an obvious medical condition that needed treating, performing surgery on someone who is completely healthy but having difficulties with the size of his penis is another matter, said Dr Carrion. 'These are controversial waters we're stepping in,' he added. 'Who is to judge what is a legitimate complaint and what isn't? 'You don't normally have men complaining about this kind of thing. These are very unique cases.'

Source: Daily Mail UK.

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PostPosted: Thu Mar 26, 2015 6:50 am 
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Agony of man, 42, who broke his PENIS during sex (and says he heard it snap)
By Madlen Davies
12 March 2015

A man was left in agony after fracturing his penis during sex.

The 42-year-old had to undergo emergency surgery after snapping a fibrous membrane inside the organ. His erect phallus had inadvertently collided with his partner’s perineum, the area in front of the anus. The man heard a snap, felt his penis become immediately flaccid, and noticed a rush of blood from the tip. He was rushed to the A&E department of a Boston hospital as he was suffering severe pain, according to a case report in the New England Journal of Medicine.

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A 42-year-old man rushed to hospital after fracturing his penis during sex. After accidentally hitting his erect penis on his partner's perineum, he heard a loud snap, saw a spurt of blood and felt searing pain (file picture)

Doctors found he had torn his tunica albuginea, the watertight and fibrous outer sheath of one of the penis' inner chambers, the corpus cavernosa. The corpus cavernosa runs along the length of the penis and is filled with spongy tissue, into which blood flows to create an erection. The tunica albuginea helps to trap the blood in the corpus cavernosa, maintaining an erection.

    WHAT IS THE TUNICA ALBUGINEA?
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    Picture shows a cross section of a penis. The tunica albuginea is the white membrane of the large red chamber, called the corpus cavernosa, in the centre

  • The tunica albuginea is the watertight outer sheath of one of the penis' inner chambers, the corpus cavernosa.
  • The corpus cavernosa runs along the length of the penis and is filled with spongy tissue, into which blood flows to create an erection.
  • The tunica albuginea helps to trap the blood in the corpus cavernosa, maintaining an erection.
  • It is a whitish and fibrous membrane.

The snap had led to a tear in the corpus cavernosa’s sheath, which meant blood leaked out, creating swelling. It was forced out of his body through the urethra, the tube by which a man passes urine, which is why he saw blood coming out of the end of his penis.

When he arrived at hospital, he was taken straight to the operating room for emergency repair. Doctors said the consequences of such a fracture include erectile dysfunction, as scar tissue known as fibrous plaques can form in the penis, meaning. They warned it is also possible to suffer a curve or bend in the penis, and damage to the nerves in the genitals. Fortunately, the man, who was seen three and six months after surgery, regained his ability to obtain an erection - without any noticeable curvature or plaque forming in his penis.

The news comes after MailOnline reported on the story of Edward Stalling, who endured a painful erection for several weeks. He has suffered a rare side effect to a sleeping tablet given to him in hospital. Mr Stalling was hospitalised for 10 days as doctors treated his prolonged erection. He developed fibrosis – where the arteries and muscles in the penis becoming hardened with fibrous tissue – as a result of the continued erection. He claims this has left him impotent and with difficulty urinating - and is suing the hospital for not making the side effects of the sleeping tablets clear to him.

Source: Daily Mail UK.

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PostPosted: Sat Dec 12, 2015 4:43 pm 
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Penis Transplants Being Planned to Help Wounded Troops
6 December 2015
By DENISE GRADY

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From left, Dr. W.P. Andrew Lee, Dr. Richard J. Redett and Dr. Gerald Brandacher at Johns Hopkins Hospital in Baltimore this month. They hope to perform what will be the first penis transplant in the United States within a year. Credit Lexey Swall for The New York Times

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.

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“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.”

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.

A few initial candidates are being evaluated. “We have one that we’re moving forward with, and we’re very far in the process,” Dr. Redett said, adding that he expected the patient to be put on the transplant waiting list soon. “That means you are really only waiting for a donor.”

A spokeswoman for Johns Hopkins said the candidates and their families had declined to be interviewed. The university will pay for the first transplant, Dr. Lee said, adding that he had asked the Defense Department for money to cover more operations. The surgeons are donating their time, he said. Comparing the surgery to hand transplants performed at Johns Hopkins, he estimated the cost at $200,000 to $400,000 per operation. He said the Department of Veterans Affairs would pay for the drug that the men will need to prevent transplant rejection.

The project has been years in the making, the doctors said, with extensive research and practice surgery on cadavers. Some of the work involved injecting brightly colored food dyes into the cadavers to map out the circulatory system in the penis. Dr. Lee said the research had found previously unknown aspects of its blood supply, which will be critical to the transplant’s success.

The operation should take about 12 hours, Dr. Lee said. The surgeons will connect two to six nerves, and six or seven veins and arteries, stitching them together under a microscope.

For the first few weeks after the surgery, a catheter will be left in place to drain urine. Sexual function will take longer to develop — probably a few months, Dr. Lee said. He said nerves would grow from the recipient into the transplant at a rate of about one inch per month, so the timing will depend in part on the extent of the recipient’s injuries and how far the nerves need to go. After the transplant, the men will begin taking anti-rejection medication and will need it for the rest of their lives. Such drugs work by suppressing the immune system and can increase the odds of infections and cancer.

To minimize the risks, the Johns Hopkins team has found a way to use just one drug, rather than the three usually needed for other transplants. At the time of the penis transplant, they will treat the recipient with a medication that reduces immune system cells. About two weeks later, he will receive an infusion of stem cells from the donor. The infusion dials back the tendency of the recipient’s immune system to attack the transplant, and just one anti-rejection drug, tacrolimus, is then enough to keep it in check. Doctors have used this technique successfully in patients who have had hand transplants.

Ultimately, the goal is to restore function, not just form or appearance, Dr. Brandacher emphasized. That is what the recipients want most. “They say, ‘I want to feel whole again,’ ” Dr. Brandacher said. “It’s very hard to imagine what it means if you don’t feel whole. There are very subtle things that we take for granted that this transplant is able to give back.”

Alain Delaquérière contributed research.
Source: New York Times.

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