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Scrotum surgery leaves Las Vegas man 132 pounds lighter

Wesley Warren Jr., the 48-year-old Las Vegas man whose emotional and physical struggles with a 132-pound scrotum drew international attention, has undergone successful surgery to remove the mass, according to the California surgeon who led the team that performed the nearly 13-hour procedure.

Dr. Joel Gelman, who heads the Center for Reconstructive Urology at the University of California, Irvine, said this week that on April 8 he and three other physicians, including plastic surgeons, donated their expertise and operated on Warren. The mass caused by the condition, known as scrotal lymphedema, had grown to 132 pounds in less than two years.

“There are a lot of shows about makeovers, but this is a real makeover,” Gelman said Thursday of the procedure that saw surgeons cut away simultaneously on the grossly enlarged protective sac of skin and muscles that contained Warren’s testicles and penis. “He’s basically a new man.”

Attempts to reach Warren — released earlier this week from the hospital and recuperating in housing near the medical center — were unsuccessful.

Warren, who also has blood pressure problems and asthma, had long spoken of his fear of dying during an operation. Dr. Mulugeta Kassahun, Warren’s Las Vegas urologist, told him if there was major bleeding, it might be impossible for doctors to save him.

“I’d say we put that fear to rest,” Gelman said. “I still haven’t lost a patient or a testicle (in patients with problems similar to Warren’s).”

FOLLOW-UP

How long Warren, who is on disability, must remain near the hospital has not been determined, Gelman said. “There is a lot of follow-up to do.”

Kassahun said one major factor in Warren’s rehab is “how well skin grafts take” in the penis and testicle area. “There’s a lot of pain after removal of tissue and skin grafting,” he explained.

Gelman, who noted this was the largest mass he’s ever removed –– he sliced off others of more than 70 pounds –– said he and his team didn’t have trouble cutting together because there was a few feet in length between the growth’s top and bottom.

“We had to make several different incisions at the same time to get to the testicles and penis without damaging them (their functionality),” he said, stressing that some of Warren’s own skin was grafted from his body to cover his penis and testicles.

Complicating the surgery, Gelman said, was Warren’s severe anemia –– “his blood count was almost half of what it should have been” –– and he had breathing difficulties, part of which could have been brought on by his size.

Warren, who’s 6 feet tall, weighed more than 500 pounds before the operation, the surgeon said.

Still unexplained is why or how Warren developed his condition. Neither common cause in the United States, a hernia or fluid accumulation between the testicle and skin, was responsible for the mass. He also did not travel to Africa, Asia, Central America or South America where a mosquito-spread parasitic infection commonly causes the condition. Kassahun has largely discounted Warren’s theory that bumping his testicles in bed with his own leg caused it in 2008.

“I have no idea why he developed it,” Gelman said.

Hospitalized for two weeks, about a week of it in intensive care, Warren was on a ventilator for several days, which is standard procedure, hospital officials said, for someone who spends several hours under anesthesia.

“He was able to get up, walk and start physical therapy within a week of surgery,” said John Murray, a spokesman for University of California, Irvine Medical Center.

Murray said physical therapy largely consists of stretching and walking exercises that ensure that Warren is mobile.

PSYCHOLOGICAL RECOVERY

When Warren walked in Las Vegas, he did so with the uneasy steps of a toddler. With each step, he sounded like someone breathing in the last quarter-mile of a marathon. Wearing a hoodie upside down to cover his scrotum –– he needed a safety pin and belt to hold the sweatshirt up.

At home, Warren often sat in the living room of his near downtown apartment with his scrotum atop a milk crate as he watched TV. Because his penis was buried deep inside his scrotum, he was unable to control his urination.

He said he longed for the day when he could have a normal relationship with a woman or hold a job. Often, he said, depression filled his life.

Much like Victorian England’s Joseph Merrick, whose life with severe deformities became the subject of both the play and movie “The Elephant Man,” Warren concluded in 2011 that to escape his life of “hell” he had to allow himself to be exhibited.

When he agreed to be interviewed by the Review-Journal that year, his plight captured the attention of more than a million readers around the world through the newspaper’s website.

He told of how doctors at the University of California, Los Angeles said he’d need $1 million for surgery.

Though he obviously enjoyed himself on shows that included shock jock Howard Stern’s and Comedy Central’s Tosh.0, Warren said it was a mistake to assume he was resisting offers of surgery — including from TV’s Dr. Oz — because he enjoyed his newfound celebrity.

People have sent money to him for a procedure. How much is unclear. Warren won’t say.

He signed a contract with a British documentary team that was on hand to film his recent surgery.

Gelman had offered many months ago to donate his surgical expertise to Warren, which Las Vegas urologist Kassahun told Warren would be a good choice: “We haven’t had people do that surgery in Las Vegas or in Nevada, and it really hasn’t been done that many places safely other than at Dr. Gelman’s.”

FEARS OF DYING

But Warren didn’t take up the offer until recently.

“I’m still worried about dying on the table, of bleeding out,” he said last year.

The surgeon stressed that he and the surgical team donated their expertise to not only help Warren, but to also help others with similar unusual conditions realize there is hope for them — that they need not suffer in silence and be incapacitated for life.

Gelman said people can go to his website at www.centerforreconstructiveurology.org to learn about treatment possibilities for scrotal lymphedema.

While Gelman said he does fewer than a dozen such surgeries each year, it’s unknown how many U.S. men need them.

“Too often, men across the country are told nothing can be done,” he said. “Unfortunately, I hear that in phone calls quite often.”

Gelman said he and his team went ahead with Warren’s operation even though they did not get authorization from Nevada Medicaid to pick up his in-hospital care.

“Our people just didn’t think it was fair to have him endure a cancellation,” he said.

Nevada Medicaid has so far denied coverage for Warren’s in-hospital care.

UC Irvine health officials said they are reapplying. A spokesman for Nevada Medicaid on this case was unavailable Friday.

“I just think it’s terrible that Nevada isn’t handling this the right way,” Gelman said. “When there’s no expertise in a state to handle something, it doesn’t seem right that Nevada can’t pay the hospital when the doctors work for free.”

Contact reporter Paul Harasim at pharasim@reviewjournal.com or 702-387-2908.

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