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. This is to reduce the chances of having to have a bowel movement in the hospital when patients are still required to lay in bed.

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

• Locations:

  • Surgery will be at CPMC Davies hospital with an average 5 day hospital stay. The main entrance, if you are facing the parking garage, is down and to the left and near the ER. 

  • Postops will be at 45 Castro St Ste 121 (across street from main hospital). The main entrance, if you are facing the parking garage, is to the right. The clinic is on the first floor to the right of the elevators.

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Advice from former patients: 

• Post Phalloplasty Patient: "This is a typically longer, more intense, more difficult recovery than you will likely have ever experienced before. As such, it's very important to plan accordingly. It is inadvisable to pack heavily. While you will spend 5.5 weeks with us, 1 week will be in hospital and the remaining 4 will be spent in an acute recovery phase. You don’t need an outfit for every day. You need 2-3 shirts, 2-3 pairs of loose-fitting shorts, 1 pair loose-fitting pants, 1 hoodie, (in winter a raincoat and an extra pair of loose-fitting pants) socks, shoes, and several hand towels for use as a washable bolster for elevating your penis. You will be required to be laying around your residence, elevating and ventilating, you will not be wearing pants or underwear to do so. You will be given mesh underwear in the hospital and may purchase more (unfortunately called mesh postpartum underwear) from Amazon.com. You will only need to wear mesh underwear on your postop days. Otherwise, at home it is ideal to be pants free, elevating and ventilating. You may wear slightly loose boxer briefs as early as 1-2 weeks after surgery. Once you are home, you can start wearing “real” underwear, but that is not allowed in the first 4 weeks following hospital discharge. With this in mind, please pack carefully. People often find it enjoyable to bring a laptop, and/or gaming console. As stated, you don’t need to change clothes multiple times a day, or even every day. A few changes of clothes that you can wash as needed is all you will want. While packing, please focus on the day you go home. You will still be recovering, may be easily exhausted, and may have some impaired mobility. Pack for that experience."

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Housing

• You will be best served by using Air BnB or similar short-term rentals, or extended stay hotels. San Francisco has a law in which you can only stay in a hotel room for 20 days, and have to move rooms on the 21st day in a regular hotel, which can be a real difficulty when you’re not feeling up to lugging your stuff around a couple weeks post op. Kerri Naslund Monday is a local realtor who helps our patients by renting some of her Air BnB properties at a below market rate cost. She has a limited inventory, so she may not always have something open, but it’s always worth checking in with her first at kerri@mondayteamagents.com.

• Quest House II is a new shared rental/recovery home option in Oakland run by a former patient. This is a good option is you have a need for social support. Caregiving is not included and you will need to bring your owner carer/ hire someone to assist. https://questhousesf.org/

• Caregiving through www.t4tcaregivers.com or Queer Care SF https://www.instagram.com/queercareinc/?hl=en

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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.

  • Rolls: Kerlix rolls work well for wrapping the leg and arm. When unrolled and fluffed, it acts as a soft “bean bag” to support the phallus in your underwear.

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

  • We don’t want the scrotum and penis 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.

  • Do not use after surgery as prolonged use may lead to other skin problems

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

• 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.

  • Prunes, prune juice, and dried apricots may also be effective.

• Medications:

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

  • Pain meds: many 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.

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DAY OF SURGERY

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• Hospital admission:

  • When you arrive at CPMC Davies, check in with the admissions office and you will be escorted to the preoperative holding area. Here, you will change into a hospital gown and a nurse will check your vital signs, 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. Afterwards, most patients will go to the 4th floor along with their belongings. Please avoid bringing valuables to the hospital.

• Right before surgery:

  • You will meet the anesthesiologist and see your surgeons in the preoperative holding area and confirm 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. 

  • You can expect to here an "ocean wave" sound from the doppler device listening to your blood flow.

  • Once you are more awake and alert, you will be transfered to your room.

  • In your room, you may be connected to a heart monitor, blood pressure cuff, wound vac machine, and oxygen monitor. A heating pad is placed on the surgical site.

  • You will have leg compression devices to help prevent blood clots.

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HOSPITAL STAY

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• Duration: average of 5 days

  • First few days, you will be checked on every 1-2 hrs​ to make sure the tissue is getting proper blood flow.

  • No food the first day in case emergency surgery is needed and the surgeons have to take you back to the operating room.

    • Emergency surgery is rare and most patients are able to eat after an intensive 24hr monitoring period.​

• Pain management: early on, you may have a "pain pump" known as a PCA (patient controlled analgesia).

  • The PCA machine allows you​ to medicate yourself by pushing a button when you experience pain. Please do not be concerned with using this too much since you will be closely monitored by your nurse. If you are not getting adequate pain control, let your nurse know so they can notify the doctors and coordinate adjusting the dosage and/or type of pain medication. 

  • When you are eating/drinking, oral pain medications are preferred and the PCA will be discontinued. You may still ask for IV pain medication for breakthrough pain despite being on oral pain meds.

• After several days, most patients are transfered to another hospital bed and will no longer need to be checked on every 1-2 hrs. On postoperative day 4, patients will be assisted into a chair. On postoperative day 5, patients are asked to walk with assistance. 

• Discharge is typically day 5

  • The drains in your scrotum and groin will often be removed.

  • An arm splint will be placed on day 4 or 5 and hand therapy instructions will be provided by the hand therapists.

  • You will get your prescriptions; details in the postop instructions.​

  • The nurses can help with providing instructions for incision care and extra dressings and urinary drainage bags if needed.

  • It is helpful to ask for extra supplies like dressings, mesh underwear, and urinary leg bag. 

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RISKS

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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 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, partial or total flap loss, and other risks that are not listed but can uncommonly occur.

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Phalloplasty is irreversible surgery. 

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IMPORTANT NUMBERS:

415 - 565 - 6136  for arm, leg, groin or penis concerns

415 - 481 - 3890  for scrotal, catheter, perineal concerns

Call either number for general concerns

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