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PRE-OP INSTRUCTIONS
Phalloplasty

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.

  • Location: surgery will be at CPMC Davies hospital with an average 5 day hospital stay; weekly postop care will be at 45 Castro St Ste 121 (across street from main hospital) with your surgeons.

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.

  • Hospital admission:

    • When you arrive at CPMC Davies, check in with the admissions office and you will be escorted to the Ambulatory Surgery Unit. Here, you will change into a hospital 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. 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 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. 

    • 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, and oxygen monitor. A heating pad is placed on the surgical site.

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

HOSPITAL STAY

  • 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 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.

 

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.

  • 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.

  • 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 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.

This surgery is considered irreversible. 

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