Surgeons transplant a testicle from one brother to his twin
Now open: Certificate Course in Management of Covid-19 by Govt. Of Gujarat and PlexusMDKnow more...Now open: Certificate Course in Management of Covid-19 by Govt. Of Gujarat and PlexusMDKnow more...
A 36-year-old man born without testicles received one transplanted from his identical twin brother in a six-hour operation performed on Tuesday in Belgrade, Serbia, by an international team of surgeons.

The surgery was intended to give the recipient more stable levels of the male hormone testosterone than injections could provide, to make his genitals more natural and more comfortable, and to enable him to father children, said Dr. Dicken Ko, a transplant surgeon and urology professor at Tufts University School of Medicine in Boston, who flew to Belgrade to help with the procedure.

The operation was only the third known transplant of this type. The first two were performed 40 years ago in St. Louis, also for identical twins, each pair with a brother lacking testicles.

The absence of testicles is an exceedingly rare condition, but doctors say that the surgery may have broader applications for transgender people, accident victims, wounded soldiers and cancer patients. But the procedure raises questions about the ethics of transplants that are not lifesaving, and about the possibility of recipients’ someday fathering children with sperm from donors who may not even be related to them.

The surgery was performed at the University Children’s Clinic in Tirsova, a section of Belgrade. The Serbian brothers are doing well, doctors said. By Friday, the recipient already had normal testosterone levels.

“He’s good, he looks good, his brother looks good,” Dr. Ko said in a telephone interview on Friday. The donor, who already has children, should remain as fertile as he was before, despite giving up a testicle.

Because the patients are identical twins with the same genetic makeup, there is no concern that the recipient’s body will reject the transplant, so he does not have to take the immune-suppressing drugs that most transplant patients need.

Surgeons operated on the brothers simultaneously, in adjoining rooms. The procedure was challenging because it required sewing together two arteries and two veins that were less than 2 millimeters wide.

Dr. Bojovic said. Without a blood supply, a testicle is viable for only four to six hours. It can take 30 to 60 minutes to make each of the four blood-vessel connections. But the team managed to complete them all in less than two hours, he said.

Dr. Ko and Dr. Bojovic were both part of the surgical team that performed the first penis transplant in the United States, in 2016, on a man whose penis had been removed because of cancer.

Dr. Miroslav Djordjevic, who led the team in Belgrade, specializes in urologic reconstruction and sex reassignment surgery at Mount Sinai Hospital in New York and at the University of Belgrade. He said the brothers approached him after learning that he had performed a successful uterus transplant between twins sisters, which enabled the recipient to give birth.

But a transplant from any donor other than an identical twin would require immune-suppressing drugs to prevent rejection. The drugs have side effects that lead some experts to argue that the bar for such transplants must be very high.

The first report of a testicle transplant, by Dr. Sherman J. Silber, a fertility specialist in St. Louis, was published in a medical journal in 1978. In that case, the twin brothers were 30 when they consulted Dr. Silber.

The brother without testicles had not reached puberty until he was given testosterone at age 18, which caused a growth spurt that left him four inches taller than his brother. He needed regular testosterone injections to maintain his masculine characteristics, but the hormone levels fluctuated and sometimes caused mood swings.

He spent five years searching for a doctor who could perform a testicle transplant before he found Dr. Silber, after reading a New York Times article about his work published in 1975.

Dr. Silber said that he had performed more than 2,000 kidney transplants in rats, which required microsurgical techniques to sew together minute blood vessels the same size as those in human testicles.

“So doing a testicle transplant was not a big deal,” he recalled in an interview on Thursday. “It was like just another kidney transplant in a rat.” He said the operation took two hours.

Read more at: https://www.nytimes.com/2019/12/06/health/testicles-transplant.html
Preview
Dr. M●●●j K●●●r and 60 others like this23 shares
Like
Comment
Share
Dr. G●●●●●●●r C●●●●i
Dr. G●●●●●●●r C●●●●i Internal Medicine
So technically the children born from both of the twins will be siblings not cousins ?
Dec 19, 2019Like2