# Penis “En Bloc”: From Reproducible Harvesting to Transplantation in a Cadaver study

## TL;DR

This study shows that harvesting a whole penis with its key blood vessels and nerves is feasible and reproducible in cadavers, potentially expanding the use of penis transplants.

## Contribution

The study introduces a reproducible technique for en bloc penile harvesting with preservation of critical vascular and neural structures.

## Key findings

- En bloc penile harvesting with preservation of vascular and neural structures was successfully performed in 13 out of 15 cadavers.
- Transplantation of the harvested graft was anatomically achievable with appropriate anastomoses to recipient vessels.
- The technique could potentially expand the clinical applicability of penis transplants.

## Abstract

An “en bloc” penile harvest, including the internal pudendal artery to its origin, is technically feasible. A graft using such a transplant appears to be feasible and would allow for preservation of the recipient vessels commonly used in phalloplasty procedures.

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.

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.

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.

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.

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.