Stage 2 – Surgical Prep

~((( JUST A REMINDER: While these prep instructions may reflect the instructions of other surgeons and teams, these directions are specific to patients having any form of implant surgery (erectile and/or testicular) with Dr Crane & Dr Chen. )))~

There is some body preparation needed for stage two RFF (Erectile & Testicular Implants) however it’s very different from the body prep that is needed prior to stage one. There is no need for a bowel prep this time around!!! Hooray!!! However there are two things that were not required for stage one that are required in preparation for implants.

Prophylactic Antibiotics – Two mornings before your surgery you start an antibiotic called Bactrim. It’s a twice daily 10-day course. My surgery is on the 11th, so I start the antibiotics on the 9th which allows 2 full days doses and then one pill the morning before surgery.

Hibiclens Soap or Chlorhexidine Gluconate Wipes – This is an antimicrobial soap or wet wipe that can drastically reduce your chances of acquiring a surgical infection. You’ve got a couple options depending on which you’d prefer to use. Keep reading for additional info that might help you decide between these options.

What is Chlorhexidine Gluconate? Chlorhexidine Gluconate (CHG) is an antiseptic that helps reduce bacteria that can cause infection MRSA. Sage’s 2% CHG cloths contain FDA-approved formula that stays on your skin where it’s needed most. Ordinary bottled CHG soaps require rinsing in the shower. With Sage 2% CHG Cloths, none of the bacteria-fighting ingredient goes down the drain.

Further reading comparing the two if you’re a nerd like me —>  GEEK OUT

You can find SAGE Cloth wipes HERE

The Hibiclens soap you can find at any drug store, large grocery store, or Amazon.

EXTRA SKIN PREP & CLEANSING INSTRUCTIONS FOR THE TRULY OBSESSIVE (this is a 5-day prep pre-op and was not required by my surgeon but is by some other teams and for some other procedures) I don’t know that I’d use the CHG for 5 days prior, but the instructions to use a thin layer of Mupirocin (Bactroban) just inside the nose is a really good preventative, even if only applied the night before and morning of surgery – as staph likes to live inside the nose.

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The following are other items/supplements I chose to add into my recovery regime.

Homeopathic Remedies: I used these remedies for stage one as well and figured it couldn’t hurt to add them in for stage two. The suggested dosage is 5 pellets, 3x per day for each of the remedies. NOTE: 1.) Don’t touch them with your fingers (it affects the potency) tip the bottle upside down and twist the cap… 2.) Let them dissolve under your tongue, chewing/swallowing exposes them to stomach acid which affects potency… 3.) Take them one at a time, don’t dump all 3 different remedies under your tongue at once, again this can, you guessed it, affect potency.

Arnica Montana(30c): Helps with bruising, swelling, and pain

Staphysagria(30c): Helps with the healing of surgical wounds

Graphites or Thiosinaminum(30c): Helps reduce scar tissue.

 

Ice Packs (Thera Pearl): I bought two of these rectangular ice packs in preparation for surgery because I’m anticipating lots of swelling, especially in the scrotal region. I found them on Amazon as “add-on” items. They also come in a round option as well, which I imagine would probably be great for balls!

 

Mesh Underwear: Always a good call for a few days when things might still be oozing and bloody. You can also ask the nurses in the recovery room after surgery if they’d be kind enough to send you home with a few pairs, they’ll usually oblige.

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X-Top for Men: These are incontinence sheaths designed specifically for men. You can visit their website and request a sample of each of the three absorbencies to be sent to you absolutely free! The reason I thought to get these was because post erectile implant, while you’re still healing it’s advised that you not milk and shake the penis after peeing, or at least do so with extreme caution as this aggressive movement could cause the mounting point at the pelvis to break away. I figured this might be a good option to use that would protect my clothes and absorb odor. They are pretty pricey though,  so I only got the 3 free samples. Toilet paper will do just fine after I use up these freebies.

 

Edibles (Pain Management): I’ve historically had a REALLY difficult time stomaching any type of narcotic,deb483f7-5131-4b50-a3ca-dcb33f8a702f even with the use of antiemetics. For this reason, in addition to wanting to try something more natural, and because I heard more than a few guys suggest it, I decided to try edibles. If you’re not familiar, think weed brownies. The location where I’m staying in California is about a 4-hour drive from Oregon where they have legal recreational use of cannabis. So I took a drive up there to pick some up. The hope is to be able to strictly use edible THC and CBD to manage pain post-op and completely avoid nausea.

 

COLUMBIA ANTISEPTIC POWDER: I had SUCH good luck with this miracle powder completely healing a hard to heal wound in the past. I decided to have a minor revision on my perineum again and I wanted this close by to use prophylactically. If you are combining your implants and/or erectile device with any kind of perineal revision or procedure, I really can’t recommend this powder enough. Some wound beds need moisture to heal but the perineum is different, it needs to be kept dry.

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FLEXIBLE TAPE MEASURE: Also, really unrelated to recovery, though it could be used to track swelling. I brought a tape measure to see just how much girth the gortex and erectile rod will truly end up giving me.

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Stage 2 Pre-Op w/ Dr Chen

On October 6th, I had my pre-op appointment with Dr Chen. I thought I would do a rundown on some of the questions that we discussed at my appointment. It’s been a little over two weeks since I met with him about these topics and I didn’t write down too much in the way of notes afterwards, so I’m just doing my best to recall what I can and going off of the list of questions that I had prepared before meeting with him. Here they are:

Me: “Is the semi-rigid rod MRI safe?”

Dr Chen: “Yes, it won’t cause any problems.”

Me: “Will I set off metal detectors?”

Dr Chen: “No”

Me: “Are you familiar with the “no-touch technique”?

(SIDE NOTE: If you’re curious about what this technique is you can check out this link “No-Touch Technique“, in short it’s a draping method used to prevent direct contact with skin (which harbors bacteria) thus reducing the risk of infection during implant surgery).”

Dr Chen: “Yes. What we do is similar and in some ways and actually takes more extensive steps for cleansing the body. The body is cleansed multiple times, even inside the urethra since it’s skin, the body is draped multiple times, we changes gloves and gowns at different points during the surgery. Once we make the incision and create the area for the erectile device a solution is poured into the space and allowed to sit in order to cleanse the area while we change gloves and gowns and prepare the erectile device to be inserted.

(SIDE  NOTE: I wish I had taken notes on exactly what he said in regards to this explanation because it was the most detailed explanation of anything that he’s given me to date. He literally told me step-by-step exactly what they do from the time I was put to sleep up until the last suture is placed and they are finished with surgery. It was at least a 4-minute detailed explanation and really made me feel confident that extensive efforts are taken to prevent the risk of infection – which is a much higher risk with this surgery than any of the others).”

Me: “Do you prescribe antibiotics prophylactically for implant surgeries?”

Dr Chen: “Yes, we prescribe Bactrim which is started 3 days before surgery (technically 2 days, but you take your 3rd day’s dose the morning of surgery). It’s a 10-day course taken twice daily.”

Me: “Do you have any photos or a piece of the Gortex sheath laying around in the office that you use to wrap the semi-rigid in?”

Dr Chen: “Yes, I have some in the other room, one second:”

SIDE NOTE: Unfortunately, I accidentally deleted this photo from my phone, sorry guys. So I’ll have to describe it to you. As soon as I saw this material it reminded me of a Chinese finger trap for some reason, probably because of its tubular nature with an opening at both ends. It was dry and a bit stiff. But inside the body it would be moist and more flexible. It had the texture of a thick woven mesh and was an off-white color as I remember. The semi rigid rod is placed inside the sheath then the ends of the  Gortex material are folded tightly over both ends of the rod and then sutured down securely. It’s my understanding that the sheath is what makes it possible to suture this whole device to the pubic bone, otherwise they would need to puncture the actual device and thread the metal sutures through it which I imagine would eventually cause weakness and breakdown within the device. You have to remember that these rods were designed to be inserted and encapsulated with the corporal cavernosa structures which natal penises have two of. Since neo phalluses don’t have those erectile bodies, suturing this device to the pubic bone is the current work-around for this incompatibility.”

Me: “I’ve heard many guys report that in order to reduce the risk of erosion that very conservative measures are taken, whereas the tip of the erectile device is placed about an inch back from the tip of the penis. I understand that this drastically reduces the risk of erosion but that in addition it causes the head of the penis to kind of droop over the end of the erectile device. This drooping reduces the amount of usable length for penetration (even if only by a little) as well as making it a bit more difficult during insertion since the head of the penis is so squishy. How far back will you be placing the rod?”

Dr Chen: “We should be able to get it quite close to the very tip of the phallus, usually within about 1 cm. Safety is always the top priority though. ”

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Those were the main questions that seemed relevant to share with you guys. Next post will be an update from the actual surgery itself.