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PRE-OP INSTRUCTIONS
Metoidioplasty

GENERAL

  • 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 penis and genitals. Wash your hair the night before surgery. Do not apply deodorant, powder or lotion.

DAY BEFORE AND DAY OF SURGERY

  • 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 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 (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 CPMC Davies or the surgery center, check in with the admissions office and you will be escorted to the Ambulatory Surgery Unit. 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. Please avoid bringing valuables.

  • Right before surgery:

    • You will meet the anesthesiologist and see your surgeons in the Ambulatory Surgery 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 some urinary catheters and drains.

    • Your family cannot visit you in the recovery room, but they will 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 because of the nature of the surgery, you will be transfered to your hospital room.

 

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: in general, slightly loose boxer briefs work well to hold the gauze in place

    • We don’t want the scrotum 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: in general, 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.

  • 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.

  • 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 tramadol 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.

RISKS

Risks of surgery in general include bleeding, infection, anesthesia complication, pain, transfusion, blood-borne disease, sepsis (severe infection), medication reactions, positioning injuries including numbness or weakness of an extremity, heart attack, stroke, blood clots in legs or lungs, pneumonia, rhabdomyolysis, nausea, ileus, atelectasis, death.

 

Risks of our surgery in particular includes infection, need for further treatment(s), need for life-long surveillance, incontinence, hematuria (blood in the urine), bladder spasms, post void leakage, damage to surrounding organs (blood vessels, nerves, muscles) necessitating immediate or delayed repair, abscess, fistula and/or stricture formation, injury to the urethra, prolonged need for drain or urinary catheter, unsatisfactory aesthetics or function, and other risks that are not listed but can uncommonly occur.

This surgery is considered irreversible. 

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