GENERAL

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• Exercise/diet: exercising regularly and eating a healthy diet will help your postop recovery and promote overall good health.

• Bowel preop: clearing the colon/rectum before surgery.

• Constipation: defined as not having regular bowel movements (example: one large bowel movement per day is expected); very common after surgery.

• Smoking: any form of inhaled drug (like cigarettes, marijuana, vaping, including but not limited to nicotine free smoking) may lead to an increased risk of complications; failure to comply with avoiding smoking may lead to cancellation and rescheduling of your procedure.

• Assistance: it is helpful to have someone with you during your recovery.

• Showering: Shower the night before and the morning of surgery with an antibacterial soap such as Hibiclens®, Dial® or Lever 2000®. Take special care to cleanse your genitals. Wash your hair the night before surgery. Do not apply deodorant, powder, or lotion.

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DAY BEFORE AND DAY OF SURGERY

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• No food/drink eight hours before your surgery.

• Do not chew gum or suck of hard candies during this 8 hr period (these stimulate stomach secretions that can make surgery unsafe).

• No alcohol/smoking the night before surgery.

• Take your regularly prescribed meds with a sip of water (anti-depressants, blood pressure meds, anti-anxiety meds, thyroid meds, etc) unless otherwise instructed.

• DO NOT TAKE (unless otherise instructed by your surgeons): 

  • diuretics, oral hypoglycemics, or insulin on the day of surgery

    • special case: Ozempic/Wegovy (stop at least 1 week prior)

  • blood thinners (like coumadin, plavix, advil, motrin, ibuprofen, ASA) for 7 days before surgery​

  • Tylenol and Ativan are safe to take even on the morning of surgery with a sip of water.

• Day of arrival:

  • When you arrive at the hospital or the surgery center, check in with the admissions office. Here, you will change into a gown and a nurse will check your vital signs, paperwork, obtain your surgical consent, insert an IV, and assist with other pre-surgical activities​

  • Your belongings will remain in the unit until surgery is finished. Avoid bringing valuables.

• Right before surgery:

  • You will meet the anesthesiologist and see your surgeons in the Preop Holding Unit and confirm/review the surgical plans and answer questions.​

  • Patients may be asked to empty their bladder or remove glasses/dentures/jewelry (ear rings) before being transported to the operating room.

• Right after surgery:

  • You will be moved to the recovery room for about an hour. As you wake up from anesthesia, you will be monitored closely by the recovery room nurse.​

  • You will wake up with oxygen in your nose and a urinary catheter.

  • Your family cannot visit you in the recovery room, but they may be given updates on your status. 

  • Once you are more awake and alert, you may leave the surgery center or hospital; if you need to stay in the hospital, you will be transfered to your hospital room.​

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SUPPLIES

 

• Dressings: the list below has the most commonly used dressings for postop care​​

  • Gauze: 4x4 in gauzes work well; they are the right size for placing behind the scrotum and between the scrotum and penis. Expect 1-2 x per day changes for about 4 weeks.

• Underwear: slightly loose boxer briefs work well to hold the gauze in place

  • We don’t want the genitals compressed or smashed in underwear. We want it gently supported with gauze and/or washcloths inside the underwear.

  • Alternatively, mesh disposable underwear may be used and the facility will provide this before you leave.

• Ointments: aquaphor or vaseline is helpful for wounds that develop

• Hibiclens: it is important to reduce the amount of bacteria on your skin prior to surgery.

  • Shower with Hibiclens 4% (aka chlorhexidine gluconate) starting 1-3 days prior to surgery. Avoid the head and face.

  • If allergic, use an alternative antimicrobial soap.

  • Avoid use after surgery

• Bowel Prep: one bottle of magnesium citrate (8-10 ounces); start at 10am the day before surgery.

  • Not required if​ vaginectomy is not needed/desired.

• Constipation prevention: begin regular use once you leave the hospital

  • Miralax powder tends to work best out of all the over-the-counter constipation meds. Use as directed to start; on occasion you will be asked to use it at an off- label dosage of 2-3 x per day to help with constipation.

  • Hydrate well by drinking 2-3L of water per day.

• Medications:

  • Nausea meds: not required; may be ordered if requested or desired.

  • Pain meds: most patients report good pain control with tylenol with or without ibuprofen with narcotics for breakthrough pain.

 

Please note that this is not a complete list and is generalized for the average patient. We recognize that each patient will have individualized needs and therefore will require specific items not present on this list.

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RISKS

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General Surgical Risks: Bleeding, infection, anesthesia complications, pain, transfusion, blood-borne disease, sepsis, medication reactions, positioning injuries (numbness/weakness), MI, CVA, VTE/PE, pneumonia, rhabdomyolysis, nausea, ileus, atelectasis, and death.

 

Procedure-Specific Risks: Need for secondary/revision surgeries, life-long medical surveillance, urinary incontinence, hematuria, bladder spasms, post-void dribbling, damage to adjacent structures (vessels, nerves, bowel) requiring repair, abscess, fistula and stricture formation, urethral injury, prolonged catheterization, total or partial flap loss/necrosis, and permanent loss of sexual sensation or function, as well as unsatisfactory aesthetics or function, loss of sensation, and other risks that are not listed but can uncommonly occur.

 

Irreversibility: The patient explicitly acknowledges that this procedure is irreversible and that "reversal" procedures are morbid and cannot restore baseline anatomy or function.