Penis "En Bloc": From Reproducible Harvesting to Transplantation in a Cadaver study.

BACKGROUND AND

OBJECTIVE

Our aim was to assess the reproducibility of en bloc penile harvesting with a focus on the vascular structures to determine whether the procedure could be performed while preserving critical vascular supply.

METHODS

A single-center, prospective cadaver study was conducted from November 2023 to October 2024 using 15 male cadavers, a number determined a priori. The main outcome criterion was successful harvesting and transplantation. This was defined as a harvest that included the entire corpora cavernosa, the urethra up to the subprostatic region, the pudendal nerves, the external pudendal arteries to their origin, the external pudendal veins to their termination, and the internal pudendal arteries to their origin, the deep dorsal vein. Transplantation was considered successful if arterial, venous, urethral, and nerve anastomoses were possible.

KEY FINDINGS AND LIMITATIONS: Thirteen harvests were deemed successful and were associated with 13 transplantations. The external pudendal vessels were anastomosed to the superficial femoral artery, the great saphenous vein, or one of its accessory branches. The internal pudendal artery was anastomosed to either the external iliac artery or the deep inferior epigastric artery. The urethra, pudendal nerves, and deep dorsal vein were anastomosed with their respective counterparts in the recipient. The main study limitation is the cadaver setting.

CONCLUSIONS AND CLINICAL IMPLICATIONS: Our study confirms that harvesting of the entire penile structure-including the external pudendal vessels, deep dorsal vein, pudendal nerves, internal pudendal arteries, and urethra-is both feasible and reproducible in a cadaver model. Furthermore, use of such a graft appears to be anatomically achievable.

PATIENT SUMMARY: In a cadaver study, we demonstrated that our technique for harvesting the entire penis is feasible and reproducible. This could expand the range of conditions for which a penis transplant is possible.