2 Weeks Post-Op Stage 2 (Semi-Rigid Rod & Testicular Implants)

My stage 2 surgery was on October 11th, 2016 with Dr Chen at the Greenbrae Surgery Center in San Francisco. The surgery itself went fine and there were no major issues.

TESTICULAR IMPLANTS: The right side of my scrotum ended up being a tad bit smaller than my left side and so Dr Chen had to shave down silicone-carvings-1 that testicular implant so that it would fit into the sack. Had he not done this it’s likely I would have had issues with erosion if he tried to force the full-sized medium implant in. The nice thing about the Silicone Carving implants that Crane/Chen use is that they allow the surgeon to modify and shave it down to the exact size of the tissue that they are working with. That way you aren’t limited to just small, medium, or large which is the case with any of the gel or saline filled implants – rather, you can get the perfect sized ones for your body with the carvings if the space you can accommodate falls somewhere between the factory issued sm/md/lg. The other thing worth mentioning that Dr Chen noticed while placing the right implant was that the skin was fairly “thin” meaning I could be at a higher risk for erosion on this side which was a contributing factor in his decision to shave the implant down a bit to take some of the tension off the already thin skin and smaller space. I appreciate his conservative approach and efforts to not make a risky decision even though I expressed how much I really wanted the largest implants possible and to have two symmetrical testicles. These factors weighed heavily into my decision making process when choosing an erectile implant type, but I far and away prefer having slightly uneven testicles than risking erosion and ending up with only one testicle, or even none! Ultimately though, my hope is that over time the tissue will stretch with the weight of the implant, gravity,  and by manually stretching it myself. Down the road, be that many months or years from now I think it’s reasonable to assume I’d be able to fit a full-sized medium implant in the right side as a small revision add-on while I’m having an erectile implant replacement/switch.

ERECTILE DEVICE – SEMI RIGID/MALLEABLE ROD: The model of erectile device that I had placed is called the AMS Spectra, one rod, not two. Prior to1-ams-spectra_300 surgery we had discussed doubling up on the Gortex sheath that he wraps the rod in, in order to further aid in bulking up the penis. Upon getting inside though it became clear that I didn’t have enough space to accommodate a second layer of the wrapping. So my surgery was similar to the technique he has always used when placing the rod. He also told me that he was really happy with the positioning that he was able to get and the angle at which the rod was mounted.
Everyone’s pelvic bones are angled just a bit differently, so they don’t know exactly how things will end up being mounted until they get inside and look. He said that in the OR he was able to fully bring my penis straight up against my stomach and that I had a great range of motion. However, since I woke up from surgery I have not been able to bring my penis up higher than a right angle from my body. I can make it stick straight out but I can’t

dacron
Image on right is similar to the Gortex (Dacron) used to wrap the rod

can’t bring it fully up against my belly. In the O.R. there is no swelling so it could just be that all the edema is what’s preventing me from getting the same full range of motion. However, I’m also noticing a strong tugging/tension on the underside scar (from stage one) that the runs the length from tip to base on the penis. The lower portion of the scar when I try to bring my penis upwards feels like the point of tension that is making me feel like I shouldn’t raise my penis any further. It’s also worth noting that this portion of the scar is hypertrophic (thick and raised, but clear/white in color) so it’s my intuition that this scar is what’s causing the issue and that the reason he was able to bring my penis all the way up in the OR, was because my pain from over-stretching that scar didn’t stop him while I was under anesthesia. However, Dr Chen said upon physically assessing things at my post-op appointment, that he believed it was the swelling at the pubic mound where the incision to insert the prosthesis was made (photos below) that is likely causing the current lack of mobility/tension. He told me to continue to gently but firmly test my limits for how high I am able to angle it and that he thought I should see improvement as the swelling subsides. I’m trying to stay positive while also being realistic. I truly believe it’s the underside scar that’s holding it down and I’m not sure if or how this problem can ultimately be remedied if that is the case. I don’t think it’s an issue that would inhibit sex, but it could potentially limit sexual positions and definitely already does limit positioning options in my underwear since wearing it down is the only angle it is comfortable in, pointing up is not an option. Time will tell if this ends up improving or presenting as a problem that needs correcting. One option I am beginning to mull over is potentially getting Kenalog injections along the scar which might help flatten it, but I’m not sure that it would impact it’s flexibility/stretchability at all, which I believe to be the true issue. Pre-implants I had been sleeping with my penis in an upright position to stretch/flatten this scar because I had noticed that it was thicker and almost seemed to bunch a bit from wearing my penis down all day since it’s right in the underside crease. I will continue to update about this issue as I gather more information about corrective options or as things hopefully positively progress on their own!

ERECTILE IMPLANT INCISION: I’ll be curious to see how the pubic scar on my mons from erectile-implant-incisionthe erectile implant heals as it’s about 1.5 inches below the SP scar, about 1.5 inches long and located less than one inch above the connection point/scar of where my penis is attached to my mons. I’ve had quite a bit of swelling at this site over the last two weeks. If I’m up and being more mobile (ie: cooking, driving, walking) I notice that the swelling here increases. I’ve been addressing this by icing 20 min on, 20 min off and that has helped to decrease the swelling.

SUPRA PUBIC CATHETER SCAR REVISION: This was a super minor revision and unrelated to the erectile or testicular implants. At stage one in February I chose to keep my SP catheter in for an additional 2 weeks because I had a bit of a urine leak coming from my scrotum. I chose to do this to allow further healing of the UL without the added pressure of urine constantly flowing through the healing fistula every time I peed. In doing so, I added to the amount of scar tissue that builds up around the SP tube from belly to bladder, since the longer you leave an SP in, the more scar tissue that grows around it. What formed was a thick stalk of scar tissue inside my body that ended up healing with some adhesion so that the skin at the point of the external scar does not float and move normally over the structures below it – it remains stuck . I’ve tried manually breaking up this scar tissue with massage,  but the stalk of scar tissue under the skin is far too thick. So I asked Dr Chen to break the adhesion since he was going to be “in the area”. sp-scar-revisionThe first 1 or 2 days post-op I noticed that the skin was free-floating and mobile. But after a few days had passed I tried to move the skin and it had adhered to the stalk of scar tissue below it again. I had a conversation with Dr Chen prior to surgery about the SP adhesion and I asked whether or not he would be removing the “stalk” of scar tissue as well, to which he said: no, he wasn’t going to chase the stalk because that increased the risk of damaging surrounding structures, and he wanted to be as minimally invasive as possible. We discussed this re-adhesion at my post-op appointment and he was disappointed to find out it had re-adhered. He said it was good information to know though, so that if he ever did this procedure for someone in the future he would advise them to constantly be massaging the scar early on post-op to discourage any re-adhesion of the tissues. I will probably have this adhesion broken again at some point in the future but I would only do so if combining it with other procedures. Again, it’s not a big enough issue that it causes pain or distress. I would just prefer the skin float rather than stick as it does make the scar a bit more noticeable. But still, really minor issue and not something that would equate to even being a minor complication, rather just a common factor in healing from any surgery that produces a scar -adhesion is always a possibility.

PERINEAL DIVOT REVISION: My body took a long time to heal from the revision I had back in June to remove some granulation tissue that had formed at the point of vaginectomy closure at stage one. I had a fistula (not urinary related, just a hole or opening) that had a lot of difficulty healing. When I had the revision in June it opened back up and again had trouble healing. When I finally used an antiseptic powder on this site, it miraculously closed. However, it was open for so long that it did leave me with a small divot once it finally healed. This time around this area has healed well and when he did the revision there was no granulation tissue at the site which is great! I haven’t gotten too up close and personal in that area because I’m still pretty limited in how mobile/flexible I can be. Squatting is quite painful and I try no to do anything that increases pain, as those were a big part of my post-op instructions. If it hurts, STOP – or DON’T DO IT! I have used the Columbia Antiseptic Powder a few times just to make sure that area is healing over well, but I haven’t felt or noticed any issues with it. However, it does feel like there is minor tactile difference/dip between the perineal raphe and where it connects to this revised area which is about an inch from the anus. It’s subtle but it’s there. So I’m not quite sure yet if the revision actually improved the divot or not. I thought I would include a diagram of the male perineal area which labels all the different structures as a reference point. I thought folks might find comfort in knowing that many natal males have a visible raphe/ridge that runs from the underside tip of their penis to the anus. Their bodies closed this gap in utero, whereas transmen who have phallo and opt-in for a vaginectomy and achieve this closure via an incision line really aren’t all that different from the natal male anatomy in this sense.

raphe_on_male_geniitalia_with_labels
This is not a picture of my anatomy, this is an example of a natal male.

 

PEEING W/ THE ROD: Initially it was a bit harder to urinate the a couple of days following surgeryholding-a as I’m sure I had a good deal more swelling than I do now. I was also in SOOO much pain when I stood up that once I got to the bathroom I needed to sit down to relieve pain before I was able to relax enough to pee. Sitting to pee is more difficult for me and I think it’s something about the changed angle of the neourethra with the natal urethra ever since stage one that has made it a bit harder to pee in that position. I’ve noticed it takes longer to empty my bladder and my stream is weaker when my body is bent at that angle. The differences I’ve noticed with urinating since the rod has gone in is that I prefer to hold my penis differently now. I instead of holding it in the “A” position (pre-implants) I now hold it in the “B” position. The reason for this, is the rod is now filling up my penis as much as is safely possible without minimizing the needed space for the urethra to expand and fill with urine. If I hold it like photo “A” gravity is angling the rod down and adding pressure holding-bagainst the urethra where my hand wraps around the underside and creates further pressure. I can still pee that way if I really wanted to but I can feel the urethra being somewhat compressed and it’s just more comfortable to give it the full amount of space by holding the sides or top half of my penis so that the underside, where the urethra runs is unobstructed. I meant to mention this earlier, but if the last sentence didn’t explain it and you’re still wondering, the rod is placed on the topside of the urethra… This dick-handling adjustment hasn’t been all that big of a deal. Grip “B” is not quite as instinctual or natural as “A”, but it’s a small price to pay for being the proud owner of a hard dick. Also, if I really wanted, I can easily pee without holding my penis at all since the rod really keeps it at whatever angle I put it in. But it just feels more natural to hold him while I’m peeing. And since I’m not really holding him UP exactly when I’m peeing, I’m really kind of just mostly using my thumb to guide him in the direction I’m aiming, if that makes sense.

BENDING THE ROD/STIFFNESS: The rod is actually a fair amount stiffer than I had anticipated. I messed around with the model that was in the office, but I’m sure that one has seen plenty of handling and was likely much looser for that reason. I do think that even in the 2 weeks since I’ve had it, it’s already started to loosen a bit and I’m quite happy about that. There was a palpable clicking sensation when pointing my penis in different angles. I could also hear a very soft clicking noise as the “joints” flexed into different positions, and I can’t say I found that aspect all that sexy. It made me wonder what that sensation might feel for my partner when I was inside them. I’ll have to get back to you on that one as it continues to loosen up. The good news is that I’ve talked with some guys that have had the rod in for months or even years longer than me and they reported that is did indeed go away! Otherwise the rod is easily bent and positioned with one hand. I can move it up to a right angle and even a bit higher. If I am laying down and I point it to a right angle my penis will stay pretty much at whatever angle I put it in. If I am standing it will want to lower a bit, but generally will stay close to the angle that I put it in when I take my hand away.

(GIRTH) SIZE INCREASE: At this point and there is likely still a bit of swelling along the shaft but not much, but I’ve gained close to 3/4 of an inch in girth. This might not seem like a whole lot, but slight increases in girth are much more drastic than slight increases in length, in my opinion anyway. I feel much more comfortable with my girth now. Ideally I would have landed squarely on the 5 inch mark for a nice beefy thickness, but the 4.5ish range feels like a reasonable size to me as well. I can comfortably live with that and feel satisfied.

GUESSTIMATIONS ON EASE OF PENETRATION: I honestly can’t speak from experience about this for obvious reasons. Being only 2 weeks out I’m nowhere near being able to use my guy for play yet. However, I will say that going into this, I anticipated having far less rigidity than I do. Obviously I was getting an erectile implant for the purposes of topping. But a VERY close second on that list was choosing an option that enhanced my current package and really beefed things up. From obsessively reading phallo listservs over the past decade, participating in groups, and talking with numerous guys who have had different models of the rod, I’ve heard more than a couple guys say they wished their erections were firmer and heard some guys have issues with buckling, or the tip of the head drooping over the end of the rod which was possibly placed very conservatively far back behind the glans, etc. But I must say, I’m impressed. My rod goes all the way to within one cm from the tip of my penis, so I don’t anticipate any issues with the head not being firm enough and causing issues with initial penetration. There is zero droop at the tip of my penis. The rod itself bends easily, yet gentle exploration thus far seems to look like it will be plenty firm enough for sex, both vaginal and anal. Again, I’ll have to give factual, experienced-based updates on this at a later time… for the good of science of course!

SENSATION/ORGASM: This is a big one and I almost left it out. Since the rod was placed I completely lost all sensation in my penis. ALL of it. I had the most sensation at the tip which was incredibly sensitive and a few large spots around the shaft where sensation was coming in. Dr Chen assured me that it really should come back and that it’s fairly common but that it could take a few months up to a year to come back and that it’s likely that the nerves are just in shock. I’ll be totally honest and admit that I’m pretty scared. This fear provoked me into making sure I still retained the ability to orgasm even in spite of not having any shaft sensation. I’m happy to report that all is ok. Although I don’t recommend it, since you’re risking detaching the erectile device, we do what we have to do to manage and get through these really difficult surgeries where there are of course no guarantees and a level of uncertainty even though most guys will make out ok in the big picture. I personally don’t know any men that are not able to orgasm. I know guys that don’t have much or any shaft sensation but orgasm is still possible. I won’t get too much into the mechanics of all that and exactly how it’s possible, but I’ll say that the base where my penis was fixed to my pubic mound, is HIGHLY sensate and erogenous. Actually quite a bit more so now with the introduction of the testicular implants and i believe also the placement of the rod had something to do with it. I can actually “reach” (stimulate) my original smaller buried penis easier than I could pre-implants. Hopefully the nerves are just stunned though and they’ll wake up soon. I’ve spoken with some other rod-guys and they had a similar experience. So chances are everything is fine. I also noticed post fat grafting that my sensation decreased a fair amount for a while. It makes sense if you think about it because they are jamming things down into the penis where the nerves are growing for both the fat grafting and for any erectile device, rod or inflatable.

THE BATTLE OF THE BULGE!: Ok, so I’m pretty IMPRESSED! Again, there is certainly some getting used to this aspect of having a firm penis 100% of the time and never being flaccid. BUT, I must say, I really am enjoying it so far! I feel like it’s definitely had the impact on my self confidence that I had anticipated would result immediately following stage one. Had my forearm contained a more dense layer of subcutaneous fat, I think it’s likely that would have been my experience immediately following stage one. But this stage feels really fulfilling for me because it’s finally “scratched that itch” that I’ve been desperately waiting for since stage one and just never felt like I landed on. I experienced some pretty heavy depression in February after my first surgery, I believe in large part because this basic need I had just didn’t feel met. But now I really enjoy how effortlessly I fill out my underwear and I love reaching down and feeling my full package. I can’t speak from the experience of having had the pump (since I haven’t) and being able to compare this to that. But I do believe this experience is a better fit for me, at least at this point in my life given the current erectile device options that are on the market as well as current options for insanely expensive, “permanent” (lasting up to 2 yrs) fillers to add fullness and bulk to the penis. The pump is absolutely amazing in that it allows for the more natural experience of a flaccid AND and erect penis and all the stages in between of becoming erect and filling up. I do hope I get to be able to experience that some day as well. Clearly that’s the more “natural” option for many, if not most guys that are seeking an erectile device. But with my circumstances, I really do like that even though I’ve ended up with a more modest sized penis both in length and in girth, that I appear to be a show-er now, even if there’s no growing that will be happening later on, no passersby actually know that. That’s been really exciting for me – a definite confidence booster. Here are some quick photos I snapped just to show what my guy looks like in undies. The bulge is definitely MORE noticeable with just underwear – and much LESS dramatic/obvious with shorts or sweats on over the top. Also, keep in mind that I do have some swelling still going on (mostly scrotal)… Once I get back home and have more clothing options to play with I’ll probably snap some better photos in a few different kinds of underwear and types of pants, shorts, sweats etc. and model those for you.

 

SLEEPING: It’s still very EARLY DAYS and so I’m sleeping on my back to not cause any pressure on the pubic connection point. This is pretty miserable because I’m predominantly a belly sleeper, and an occasional but much less frequent side-sleeper. I’ve done a bit of side-napping using two very fluffy pillows propping my legs apart and then propping my penis up a bit so it’s not dangling at a drastic sideways angle. But I’m really paranoid that I’m going to fall asleep and then try to roll the rest of the way over onto my belly. It’s hard to know for sure yet, but I think I should be able to comfortably and safely belly sleep in another 4-6 weeks. I am doubtful that I’ll be able to do as many belly facing yoga poses as I was able to in the past though. I can indeed see this device potentially limiting me in that sense when it comes to lying on hard or even firm flat surfaces. Being a really lean guy means that I don’t have that extra belly or thigh fat to buffer the rod that’s sticking out when lying on my stomach. Hopefully I’m wrong about this though. If it ends up restricting my mobility enough it could be the deciding factor in eventually switching to an inflatable.

THE SHWING!!!: Alright, so I am noticing a bit more movement and jiggling while I walk as the days progress. I’m sure the decreased swelling and the loosening of the joints in the rod are probably equally responsible for that. Things of course don’t flop around nearly as much as they did pre-stage two, and it’s undoubtedly a big adjustment. I enjoyed my floppy dick, but not all the time, and not all that much. I didn’t like how it fell between my legs when I was sitting or driving – I felt like it got lost down there. Of course, the lack of testicles I’m sure played a large part in that too. But overall, I wasn’t all that happy with the size of my package. I had always imagined myself having a lot more going on, even though I’m really not a size queen. Anyway, things seem like they’re loosening up a bit. I notice that it is more likely to swing left to right a bit than it is to go in any other direction when I’m walking. There isn’t much downward motion/bounce since the shaft sits firmly against my scrotum and I kind of curve him around my nuts. I wouldn’t mind a bit more of a SHWING when I walk, but I may get that over time as swelling continues to go down, and the device continues to loosen up a bit with some *ahem*, “use”.

WRAP IT UP: I think that mostly covers things for now. My next post: which is already in draft, will be an explanation of Pump vs. Rod – How I Decided. I’ve been getting that question at least daily and I figured it’d be easier to have a post to direct people too with the long-winded reasons rather than typing the cliff-notes version over and over… As always, if you have any questions please feel free to ask or make requests for specific topics to be covered. I will update on all of these topics again at the 1 month mark. I can’t promise that it will be posted exactly one month post-op to the day, but I am still aiming to get all the correct content in for the listed timelines even if they are days or weeks late to go live. Thanks for reading!

Phone Consult w/ Dr Chen Q&A (Stage 2)

The following is my best recollection from my notes following my phone consultation on August 25th, 2016 with Dr Chen regarding my quickly approaching “Stage Two” Semi Rigid Erectile Rod and Testicular implant surgery on October 11th, 2016. This is by no means a word-for-word account. Rather this is the closest I can share with you of the full extent of our conversation that makes sense to present via this type of platform. This also covers some questions that I have that are unrelated to the specifics of implants but I thought some of you might still be curious about regardless.

Dr Chen is a great guy and an extremely talented and innovative surgeon. I always appreciate speaking with him because he shares information with me that I haven’t had the opportunity to hear or learn about elsewhere. I value how receptive he is to the person he’s speaking with and how willing he is to go into greater detail when he senses someone’s desire to know more than just the glossy basics. I hope you come away with that feeling as well after reading this and learn something new today.

Me: I’ve been experiencing a disturbing dripping sensation internally at the place where I imagine the vaginectomy/colpocleisis was performed. I’m worried that this is a sign that a piece of mucosa that was missed during the initial procedure and that fluid is now building up in this space.

Dr Chen: We actually hear about a lot of weird sensations being reported within the first 6-12 months in that area. And that’s because we cut a lot of nerves in order to close up that area. You’re the first person that I’ve heard describe the sensation of wetness, whereas most others are describing the sensation of tingling or discomfort off and on. If you’d like I’m happy to write an order for a CT scan to take a closer look at that area, I’m not sure if insurance would approve it, but I’m happy to write an order for one and see if they’ll approve it because I’d be curious to see what it would show. But in general, odd sensations in this area are quite common up to around the 12 month mark since the nerves are the things that take the longest to heal.

Also, there is a technique that we used to use when creating the urethra that put the patient at a higher risk for having a urethral diverticulum. We used to use this technique because it minimized how many incision lines there are in the urethra. However, it created “outpouchings” (or side pockets) where urine could collect. It also made it necessary for a camera to be used to help guide a catheter because the the tip could caught in one of the outpouchings instead of continuing along the urethra. What we found is that very rarely, urine would pool and collect in this pocket and cause an infection. If this was the case it would require surgical correction. But we’ve only had one case where surgery was needed. However, I spent a lot of time thinking about how we could do this differently but in a safe way. Beginning August 1st, I started using a new technique. Since using this new technique which no longer creates pockets along the urethra – a catheter can now be inserted no problem without a camera! I mention this because I don’t know if these more recent patients might report a different kind of internal sensation in the first 12 months with this technique since it’s still so new.

Me: This is more of an aside question but just so I’m clear, does this mean that anyone that had surgery with the Brownstein Crane team (you or Dr Crane) before August 1st, would need a camera assisted catheterization?

Dr Chen: Yes, it wouldn’t have to be myself or Dr Crane that did the catheterization, but just as long as they used a camera to avoid those little pouches and be guided into the bladder it wouldn’t be an issue.

Me: I’m guess I’m most concerned about a situation where I might have some kind of emergency need for a catheterization but not be awake to let someone know that it must be camera assisted. If someone didn’t use a camera could they potentially damage my urethra if they tried to insert the catheter?

Dr Chen: It’s possible. I’ll say though that most health care providers are very gun-shy when it comes to new things and a neo phallus is a new thing. It’s much more likely that they would probably just automatically call a urologist.

Me: The other sensation I notice sometimes too is an odd buildup of pressure along the perineum. I’ve sort of asked around and I know that there have been some other reports of wetness sensation from other guys that have had the colpocleisis type of vaginectomy which only partially removes the lower part of the canal and then fulgurates (or burns) the remaining mucosa layer that cannot be safely removed with scissors, which would increase the risk for things like bladder, ureter, urethra, or rectal injuries. But I don’t know that I’ve heard of these same odd sensations being reported by those having a full vaginectomy, which is I guess is a more typical procedure in cases of vaginal cancer where it’s much more crucial that the entire structure be removed and thus the higher risks associated with that procedure are more warranted.

Dr Chen: The way we do it now, I’m VERY confident that I get all the mucosa. I check 2 or 3 times before I close up the vaginectomy site. The one CT scan we got for someone post-op where we used this technique I think is the only CT scan we have on record, which I believe was for a differently related reason. But I looked at the vaginectomy site to see if there was anything going on one month post-op in that area and I didn’t see anything, it was completely closed, totally obliterated. But of course, that’s only a sample size of one.

Me: I guess then I will wait out the odd sensations for now and see if that improves on it’s own. So I do have a very small divet where the hole along my perineum took so long to close/heal. Ideally I would like a flat surface rather than a dip at my perineum. I’m wondering how easily this might be revised during my implant surgery?

Dr Chen: We could. The only downside with that is that it lengthens the time of the surgery and it gets into the area behind the scrotum that’s closer to the anus which could put you at higher risk of infection of some sort. I try to do avoid that area is possible when I do these implants because that’s where a lot of bacteria lay. Now I’m not going to do anything silly like have the implant exposed while I’m doing the perineal revision. I do whatever I can to minimize the risk of infection, so the risk I think, overall is low, but it’s slightly higher when we do revisions in that area.

Me: I see what you mean, so there’s a higher risk of infection with regards to the IMPLANTATION area getting infected, not the perineal area?!

Dr Chen: Yeah, exactly.

Me: Ok, I think I’ll give that some thought then and make a final decision when I come out there to see you for pre-op and you have the opportunity to take a look at that area in person. Maybe in the meantime we can still add those tentative insurance codes to the pre-authorization just in case I decide to move forward with that procedure?

Dr Chen: Yeah, sure.

Me: So in terms of implants, I know I want the largest testicular implants that you can fit. And it seemed like you thought that I could probably accommodate the largest one. In terms of the erectile device I’m probably leaning more towards semi rigid rod than the inflatable, I’m not going to have insurance past around the December mark so I’m trying to think about what is going to give me the best shot at not having complications and also having something that’s going to last for a while. I’m not quite sure when I’ll have insurance again that would cover this. Girth is really the biggest thing for me and obviously I want an erectile implant because I want to be able to have penetrative sex but girth and fullness is really a big concern for me. All the fat grafting melted away and at about 4 or 5 weeks out it was totally gone. I was well informed that there was a high likelihood of that happening, but it was something I was willing to try. So really at this point I’m just focussed on coming up with a solution for what the best option is for giving me the most all around girth and fullness. Not even being super thick, but an all around very full appearing penis and I feel like it has kind of more of a deflated look than I want and so I’m wondering is the rod the best option in terms of fullness? I know you mentioned that the rod is about 30cc in size, what would you say the pump is when it’s fully inflated?

Dr Chen: The measurements for the fully inflated pump, the circumference is slightly larger than the semi rigid. That being said, the inflatable, we can’t wrap it in a sheath all the way to the tip, whereas with the semi rigid we are. So when we add the sheath over the semi rigid, they’re about the same size in terms of girth even though on paper it’s higher for the inflatable. I think girth-wise they’re gonna be the same but it’s basically which one are you more excited about. Is it the inflatable one that’s more natural with more moving parts and a high potential for revisions and surgery sometime in the near future? Or would you want something that’s always semi hard but has a lower chance of mechanical breakdown?

Me: I am leaning MUCH more towards the malleable rod, mostly because it’d be 100% the same girth all the time and then also I would be able to have two symmetrical testicles which feels pretty important to me… Is it possible, you said you wrap it in a gortex sheath, is it possible to layer up on that, to add more Gortex to give even a fuller look?

Dr Chen: We potentially could. I haven’t done that before but, we could. I don’t know what the performance characteristics would look like because we’ve never done that. But if it’s safe to do so we can try that.

Me: The other question I had in terms of girth and being creative and trying to find a solution for that problem because I know you have to be careful about how close to the tip you get with the rod with both the pump and the malleable, but have you thought about or has anyone asked you about using some kind of permanent filler like Juvederm as an extra or addition to the IPP to kind of fill out areas that the rod or inflatable might not reach, like the head?

Dr Chen: No we haven’t tried that. I think that’s a reasonable thought. I would think though that adding any foreign body into that area would require sticking a needle to get the Juvederm there and that then introduces a passageway for bacteria to get to that area. So, I’m not super excited about that, but that’s the main reason why. That’s the only hesitation I have for that. Bacteria.

Me: Ok, well then it probably makes the most sense to do just do the rod, layer up on the Gortex sheath if it’s safe and possible to do so, get the testicular implants, heal up, and then see where that leaves me a few months down the road once any remaining edema has subsided… In terms of how the rod is mounted, a couple of questions, 1.) Will the rod change the angle/direction of the base of my shaft, kind of making the penis come out in front of my body a little bit more?

Dr Chen: It could, for some patients it does, for others it stays the same so I can’t tell you for sure but that’s definitely a possibility.

Me: I enjoy doing a lot of yoga and I’m wondering if anyone reports issues with laying on their stomach? In terms of where the rod is mounted I’m worried that I might displace the mounting point even after it’s fully healed months and months down the road, even after I’m cleared for sex. What am I looking at in terms of mobility?

Dr Chen: Yeah, it can limit how active you can be because it’s always there. Certain positions are not good for it. Belly down might not be comfortable. If it’s not comfortable you shouldn’t do it. The biggest complication we’ve had lately is the attachment rips off the pubic bone. And that’s in guys who are unlucky that get kicked in the groin or pulled to hard, something along those lines. We’ve changed our technique a little bit as we’ve seen that. We’re now using stronger metal wire as opposed to the thick silk suture which is what we used before and usually that worked just fine. But we’re starting to use metal wire now to make sure that that risk goes down.

Me: I’m planning to take a full 6-8 weeks off of work and being incredibly sedentary and immobile during that time to ensure I don’t cause any added strain on the connection points, is it true that even going for a long walk is not advised?

Dr Chen: Yes, anything that causes discomfort. If it’s uncomfortable or painful, stop.

Me: I think those are most of my questions. I did want to also ask though about my SP scar. When I touch it and try to move the skin it feels like it’s completely adhered to my bladder? Would that be correct or maybe it’s muscle?

Dr Chen: Muscle.

Me: Is that something that can be released fairly easily? I know you had mentioned that it’s wise to let the scar mature for a year but I’m trying to finish everything up in this October surgery.

Dr Chen: It’s actually really close to the incision that I make to put the implant in, so there is a good chance that it would just be gone as a part of our procedure. But if it’s too high from where I make the incision I can easily just dissect that way and break the adhesion.

Me: In terms of making sure that I get the largest testicular implants that can safely fit, is that something that needs to be ordered ahead of time? I know a decision about erectile device needs to be made a couple weeks in advance so that it can be ordered.

Dr Chen: Nope, we have all the sizes here and I’ll put the biggest and safest ones in as possible. Safety will always take precedent, though.

          *           *           *           *           *

Well, that was pretty much the bulk of our conversation. There were a couple other minor things that I left out and will spare you, but nothing major. I will however be in the office next week for pre-op, so if there are any lingering or unique questions that anyone has that they haven’t been able to find answers for elsewhere I’m always especially eager to toss those out.

 

4 Months Post-Op RFF

***THIS IS A BACKDATED POST THAT WAS UNFINISHED AND LEFT IN MY DRAFTS FOLDER – I’M THANKFULLY FINALLY FREEING UP MORE TIME IN MY SCHEDULE AND WORKING ON GETTING THIS BLOG UP TO DATE***

Last time I updated in reference to seeking a revision for my scrotum and perineum that has a small opening, I mentioned that I had the option of going to Dr Nikolavsky in Syracuse, NY or Crane/Chen in San Francisco, CA. I had been planning on the Dr N option mostly because I live on the east coast and it would have been far cheaper to travel there. As it turns out a close friend of mine was booked for phallo last minute with Chen and I made my way out west to help him while he’s recovering. I figured if I’m going to be out there anyhow, I might as well see if I can have my revision done with Chen. It ended up working out and I’m currently scheduled with Dr Chen for June 20th, 2016.

I do believe that Dr Nikolavsky would have been a great “local-ish” (5+ hour drive from me) option and I was quite pleased with the communication and responsiveness from both Dr N and his office staff – his nurse Janice was especially helpful. All that being said, I’m pretty elated that a revision with Chen ended up being in the cards for me. Dr Nikolavsky is a reconstructive urologist, and while he quoted as regularly doing some form of plastic surgery (about 20% of his work) I feel more confident returning to a surgeon who does plastics a bit more frequently, and specifically has an eye for addressing the issues that I’m looking to have resolved, on a regular basis. Had I gone to Dr Nikolavsky, I would have only had my perineum, and the two small sebaceous pockets on my scrotum addressed. But since I’m going back to SF, I’m considering having a couple other things done as well.

Urethra: I’ve noticed since surgery that even though I’m peeing just fine, it feels like it’s taking me longer to completely empty my bladder. I also notice that peeing in a seated position sometimes is uncomfortable that I feel like I might be slightly compressing the urethra. I discussed this with Dr Crane over a phone consult a couple weeks back and he asked me how long it takes me to completely empty my bladder. I told him that I guessed it probably took less than a minute depending on how full my bladder was, but that I hadn’t ever timed it. He said that at that rate it’s unlikely I have a stricture but that we could do a cystoscopy to look inside the urethra to be sure. He mentioned that it’s fairly easy to diagnose strictures when it’s taking guys 3, 4, even 5 minutes to empty their bladder, but with what I’m reporting it’s hard to know if there truly is an issue, without scoping. If it’s a minor stricture usually they are able to just cut it with the blade that’s on the end of the scope while they are inside. Depending on the findings and severity, a foley catheter is sometimes placed during early healing. I also should mention, that the other reason I am suspecting a small stricture is that I have a very tiny bit of moisture (not enough to drip, more of an ooze) that constantly comes out of the urethra, even hours after peeing. Even when I wake up in the morning and haven’t peed in 8+ hours sometimes. I do also notice an odor with this moisture, and it DOESN’T smell like urine, at all. It actually had a bit of a fishy odor to it. Gross, I know. However, I’ve had two urine cultures done and neither showed any signs of infection or other issues. I noticed a marked decrease in the odor and a moderate decrease in the fluid passing after taking 4 Diflucan pills over the course of 2 weeks, but the issue was not completely resolved. A scope of the UL seemed like the next logical step to me in finding the source of the issue.

Scrotum: Immediately after surgery from stage one (February 4th, 2016), I had pretty dramatic swelling and bruising in my scrotum. As I healed I developed what is called an eschar on my scrotum. This essentially looked like a scab and it formed along the horizontal incision line of my sack. In early healing it looked pretty rough and I was worried what things would look like a couple months down the line.It actaully healed quite beautifully, and the skin is soft and healthy, however the incision line looks a little funky and jaged. I’m seeking to have the scar revised in an effort for it to look more seamless, right now the scar line dips down into an odd groove. I’m not fully certain if over time it would flatten out completely or not – it’s likely that it might, especially with the addition of testicular implants that will further fill out and stretch the tissue. But I feel better just revising the scar while he’s going to be in that area trimming out the little sebaceous pockets anyway.

Perineum: It’s hard to know exactly why it happened and what caused it, but I have a small opening along the perineum that started at around 10-14 days post-op and since then has been exudative – which is just a nicer way of saying that it’s been oozing and secreting fluids.  It also slightly bleeds as there is a teeny tiny opening that is technically a wound. It’s healed up A LOT since February, March, and the beginning of April when it was at it’s worst. Packing it with the Curity iodoform packing strips was tremendously helpful in aiding the healing process. However, there is a spot that continues to reopen and bleed a little. In general, the perineum is under a tremendous about of tension when going about even the most basic of daily movements and positions, especially when sitting. So this area is prime for having troubles with the incision healing. I’m still convinced that the incredible amount of fluid that was draining from my massively swollen scrotum after surgery contributed to this area opening up. Incision lines need to stay fairly dry to heal adequately and the v-nectomy area was more often than not, very wet from all the scrotal draining I had going on. It also endured quite a lot of friction from regular wiping and cleansing of the draining fluids. I really believe that this is what caused or at least contributed to the perineum opening up initially. I mention this because it’s an example of how one issue or complication could potentially cause or instigate issues elsewhere. If I could do this over I would have found some way to cup my balls better in a way that caught any drainage rather than allowing it to drip down along the perineum and then wiping it away. This is easier said than done, because I did try my best to do that at the time… Regardless, Dr Chen looked at the area and feels confident that he should be able to close the area just by using local tissue (cutting out the affected area and bringing the surrounding skin together again). I’ll be relieved when that is fully closed up.

Fat Grafting: Around the end of the 3rd month post-op I noticed that my penis had continued to have less and less of a plump feel. Immediately after surgery you have quite a bit of swelling in the penis, even when it might look like you don’t. By about 1 week post-op I didn’t think I was all that swollen. It just looked full and fabulous, but it wasn’t stiff or puffy by any means. I was pretty happy with my girth and fullness at this point. But as the weeks go by the edema slowly starts to dissipate and it’s typical for the penis to feel more and more malleable and feel like it’s losing density. It’s not exactly shrinking, it’s just that all the swelling is going away. It was at about this time that I started thinking about my options of giving fat grafting a go. I had heard from a couple others that they had great results immediately after fat grafting but that within about a month the fat was completely reabsorbed or died off because the fat cells were unable to connect to the blood supply in their new habitat which they need in order to survive. Nonetheless, I figured I would see if I could get insurance coverage for it and if so, then I didn’t see a reason not to at least give it a shot. The out of pocket cost for this procedure is around I was able to get coverage, it was denied at first and then they did a peer-to-peer review where Dr Chen talked with a doc through my insurance company and explained why the procedure was needed. Once that happened it was approved. This is essentially a fat transfer procedure, also called lipo transfer. They will take fat from my abdominal area and then use a needle to inject it throughout the entire length of the penis to give it a fuller appearance.

WRAPPING UP: I will be following up on these revisions, especially on the fat grafting because I know that is a topic of interest for a lot of thinner guys going for RFF that want to bulk up their dicks to be thicker and more full.

PHOTOS: I know I haven’t done any photo updates in a while. I’ll be adding some in probably with my 8 month update. I’m still working on backdating blogs that I never got a chance to post when I got busy after this June surgery. Thanks for reading, I’m looking forward to getting this up to date and writing about some things that I think could be really helpful for others to hear about.

30 Days Post-Op RFF Phallo

Hey fellas! Wow, so today is 30 days since surgery! It’s been a wild ride. Lots of different things I’ve felt over the past month – both emotionally and physically. There were parts of this month than FLEW by and other times that to make it a through a single hour of nighttime felt like it took an eternity to pass. Nights were the hardest for me, from day zero post-op till even the occasional night currently. I typically sleep like a baby. However, when you have a bunch of different body parts that need propping, elevating, no pressure, gauzing from leaking, etc… it’s just not conducive to deep sleep, or even much light sleep. On top of that the mind can spin into unhealthy realms at that hour of the night, bringing you to some dark places that aren’t helpful. Thankfully one of the good friends I had with me in California was sleeping in the next room over and a couple nights when I was feeling anxious, I called him to just come talk to me and help me get out of a bad head space. The other thing I utilized very often and have still been using on and off is the healing power of music. I made healing meditative playlists for surgery and I am SOOOO glad I did. It really helped me to stay positive, relax, and was also a sleep aide.

I know this isn’t an uncommon struggle, but I’ll share that I have trouble asking for help, especially when I feel like it’s an inconvenience or bother to someone else. This process was truly humbling and even though I did a fair amount of mental subduing in terms of asking for assistance (both emotionally and physically) it was a lesson in asking for and accepting help and doing my best to receive it graciously.

Ok, so I’d like to do a body scan and check in about all the different wound sites, how they are healing, if there were any issues that arose, how they were addressed and just update on what my basic mobility and day-to-day life looks like right now. There were times, especially in the hospital when they stood me up the first time, that I thought I would never be “okay” again. The pain was overwhelming and I literally felt like I had the weight of the world draped over my shoulders. Even though cognitively I knew I was going to heal, my body felt like it couldn’t possibly recover from the trauma that I had been through. I don’t say this to scare you – it’s just important to know these thoughts and feelings may arise for you – but you’ll be ok. You’ll get through it. Just relax, rest your body lots, play some soothing music, take your meds, nurture your body the best you can with healthy food, plenty of water, supplements, good company that feeds your soul, and plenty of laughter!! It’s good to talk to other guys to get an idea of timelines for how you might feel tomorrow, next week or next month. But don’t get too fixated or frustrated if/when those things don’t happen at the exact same time for you. This is your story, and it’s guaranteed to be different in some or many ways than everyone else you know – and that’s absolutely normal, so try and not worry so much… You’ll worry anyway ;o) but just keep reminding yourself that it’s all gonna work out. It always does, one way or another.

As always, I try to give an as in-depth a description of things as possible, so this is going to be LOOOONG! However, I’m breaking it up into categories, so if you’re looking for specific info you can just jump to the bolded topic of interest or check out the updated photos since the last time I posted at about 2 weeks post-op.

GENERAL MOBILITY AND DAILY ROUTINE: I’m doing pretty well. Wednesday the 2nd I went with a friend to some doctor appointments since we both had phallo a few days from each other. When we were leaving one of the doctors offices on the 3rd floor, my friends used the elevator and I felt inspired to use the stairs. I sprinted down and beat them, by a LOT! I’m not bragging, I’m relieved!… I’m a runner and I’ve missed the endorphins from running and the feeling of being able to move my body quickly. This actually felt like a monumental accomplishment. First, because it was only like a 1 or 2 on the pain scale (tender scrotum). Second, because I was remembering back to being in the hospital and them standing me up on day 4 and how absolutely helpless I felt. I thought I was going to return to my bed and melt into it for the rest of my life. Not true!!!… My personal goals since returning home have been: 1.) that everyday I will go on at least a 15 minute walk with our dog in the neighborhood 2.) that I get in my car and do at least one thing out in the community. Be that to run an errand, get lunch, pick up mail, sit at the beach, get groceries, see a friend, or go for a joy ride… There are other more basic goals I have set for myself but mostly they are around nutrition, personal hygiene and wound care. It’s crazy how long it takes me to brush my teeth, prep my body for a shower (waterproof donor arm), take the actual shower, dry off, apply lotion and ointments, arrange gauze for draining areas, re-dress forearm, take supplements, and eat. That process alone is long and exhausting, but crucial to things healing well and to maintaining good mental health. You might not feel like getting up and showering, but once you do you’ll feel like a new man.

FOREARM (FLAP DONOR SITE):

  • Xeroform: I had heard a couple of guys say that they were changing their Xeroform twice per day. I got it in my head that more was better and at about day 7 I switched to changing the dressing more often because it seemed a bit dry and as though it might be sticking to the graft and pulling it away from the wound bed a tiny bit during dressing changes. My arm started to get a little too moist and I think this possibly exacerbated the issue I was having because the graft was too moist to really dry out enough to attached to the arm. It didn’t cause any lasting issues from what I can tell, but I just mention this because in this case more doesn’t equal better. If your surgeon suggests changing it twice a day, do that. But if they say only once, it’s better just to listen to them. Everyone’s wounds heal different, some are naturally more wet or dry than others and this could be a reason someone else was instructed differently than you. So don’t assume, ask your surgeon.
  • Swelling in Hand: My hand has had a bit of swelling here and there but nothing major. I was instructed by my hand therapist to gently massage and rub the swelling and fluid across the back of the hand in the direction of the “bridge” since that is the only part of the forearm that where drainage is capable of happening. This does help. You can do the same thing with your fingers if you have swelling there. Just gently start at your finger tips, encircle the finger with your other hand and slide it down towards the web of your hand. This will encourage fluid to make it’s way towards the bridge to drain. The back of my hand feels a bit tender, kind of like a bruise when I press on certain areas. Also, I am continuing to have some hypersensitivity in a “V” shape along the back of the thumb on the hand. I have been instructed by my hand therapist to desensitize the area by touching and rubbing it. The instinct here is to avoid touching the area because the sensation is awful, but it only gets better if you retrain the nerves. This is my hand today, at 30 days post-op:

hand

 

  • Strength in Hand: The strength in my hand is probably the best thing I have going for me in terms of my forearm. I probably have 30 or 40lbs of grip strength, just within the hand and that would be in terms of pulling straight traction at the wrist. Lifting something up sideways that would need more wrist flexion or stability is more like 5 or 10 lbs, that’s much harder.
  • Flexibility in Wrist: Passive (or unassisted) ROM (range of motion) is fairly limited. Turning from palm up to palm down while keeping the elbow stable at my side I probably have 80% of my ROM back. Active (or assisted) ROM, I can use my left hand to aide in the turn get it to 100%. Flexing the wrist forward and backwards is the hardest right now. Passive ROM is about 20-25% right now. Active ROM is about 40-45%. I do believe it will get back to 100%. Based on the multiple other wrist surgeries I’ve had (aside from the wound itself) my hand and wrist aren’t really acting all that differently than they have with the past surgeries, which is encouraging.
  • OT & Rehab: Again, in my experience with past wrists surgeries, and this one is proving the same, you really have to push through the discomfort and pain in order to reach your pre-surgery state. If you just wait till it doesn’t hurt before you start to push yourself, the scar tissue is only growing and forming adhesions to the tissues under the skin. Early and somewhat aggressive (or maybe persistent is a better word) exercises and use of the hand, wrist, and elbow will serve you much better in the long run. The first thing I did when I woke up from surgery (seriously, even before I looked at my penis) was start moving my fingers and clenching my fist the best that I could. I really do think that this has it’s benefits in quicker and “easier” recoveries. Your hand/arm isn’t going to feel good regardless of when you start to use it. But as the saying goes, the only way out is through.
  • Slough: I had what is called “slough” on my forearm. I had been worried that underneath this tissue was raw open skin. The split-thickness graft that Crane uses is 1/100th of an inch – that’s insanely thin. So I was having a hard time imaging that there could be anything left of the graft underneath of the slough… I couldn’t have been more wrong. The first photo was taken after I had peeled one tiny piece of the slough off, but the majority of it remained intact. I was really worried about all the dark spots:

slough

However, Dr Crane instructed me to wash my arm gently with a mild cleanser like Cetaphil and to remove the slough. The following is what my forearm looks like after having removed all the slough that would come off. I ended up very very gently using tweezers to remove the pieces that were loose:

healthy

It’s actually pretty amazing. I was shocked. Healthy pink graft!! This is just a great reminder when things are looking rough. Don’t judge a graft by it’s cover. Here are some photos of the underside of my forearm:

The edges of the graft are really well adhered to the healthy tissue around it. There are some areas that have started to blend in quite well and other areas that will be there within a few days I would imagine.

border

This border where the two different splint thickness grafts were sutured together is having a bit harder of a time but it’s doing way better since I stopped the Xeroform and it’s had time to dry out and adhere better. Still, this is the roughest part of my arm right now. There are few spots that are a touch on the moist side, so when I apply moisturizer to my graft I make sure to avoid those areas as to allow them to further dry out:

stitch line

The Leash: This area has been interesting. I feel like I have an unusually long leash compared to some other guys I’ve seen. My incision travels past my elbow. I never asked Crane why this was the case with me. I’m guessing that the place where my artery branched was just at a higher placement than other guys. If that were the case you would think I would have been able to have an extra 1.5 or so inches in length in the phallus, but this was not the case:

leash

I am having some reoccurring swelling along the right side of this incision line on my tattoo. This has been temporarily remedied by gently pressing and rubbing along the right side of the incision, starting closest to the graft and encouraging the fluid to move down the arm. However, it pretty much comes right back. I do have some adhesion along the this incision already and I think normally the fluid would drain straight down but I’m guessing that the adhesion is limiting this draining function. In the meantime, I am continuing with massage to encourage the draining. This photo really captures just how dramatic it looks at times:

bulge

 

THIGH (SPLIT THICKNESS GRAFT SITE): Xeroform finally completely fell off at 3 weeks. Since then I have been using Eucerin on my thigh whenever it dries out, this is usually about 3-5 times per day. It’s really itchy, but the lotion does help some with this. It’s the most itchy when I go too long without applying a moisturizer. The color changes drastically depending on if I am sitting or standing and how cold I am. Historically, during early scar healing, if I’m cold, my scars turn purple. I feel like this usually lasts a solid year for me, but sometimes longer. The purple can be quite dark but as soon as I warm up it turns pink again. I’m not having any issues with my thigh aside from the annoying itching. But itching is a really great sign, because it’s a symptom of healing. So all good things on this front.

thigh

PHALLUS: I have had zero necrosis! My phallus has really healthy tissue, and an excellent blood supply! Incision line on the underside is clean and skin colored with no more scabs. I can still make out a line of sutures that are intact along this incision line. Everything is healing extremely well and I could probably gently pull the sutures out but I definitely won’t be doing that. I haven’t been picking at anything. I’m just letting my body dissolve stitches and scabs at it’s own rate and when they fall out/off that’s great. At day 10 post-op I was walking around the house a fair bit and letting my phallus hang. I was moving slowly and the tension from him hanging was not intense. However, all of a sudden I noticed there were drops of blood trailing where I had been walking, I had had a thick scab that was plugging the tip of my urethra that Crane told me not to worry about removing. I was scared it might heal the UL shut, but he told me that it was normal and best to just try and ignore it. This scab must have dislodged itself and all the drainage that had been waiting to escape through the phallus came pouring out at once! Good times! This mild to moderate bleeding continued for a solid 3-4 days. I was worried about it and emailed Crane. Again, he reassured me that this is normal and was not cause for alarm. It did eventually stop. Currently,  I occasionally have some drainage that barely even drips, it’s more of an ooze and it’s usually a cloudy or light light light pink color, no dark blood anymore. Sorry, I know. None of this is pleasant to hear about but it’s just all part of the healing process. Another thing I’ll mention in terms of the phallus is that depending on how you place him he will get weird creases or wrinkles. More than a few times (because I can’t feel him yet) he’s been in some crazy weird positions and when I unwraped him from all the ABD pads, he looks pretty funky and crooked. He’s taken the shape of whatever odd position I had him packed away in… But DON’T worry, he won’t stay like that. Let him air out and stretch his legs and he’ll be back to normal shape in no time!

GLANSPLASTY: I had my glansplasty done as a second stage. I mentioned the reason in other posts but I’ll state it again, because people keep being confused about why I didn’t have it done at the time of the initial surgery (which most people do who go to Crane/Chen). I had scarring from an incision because of a surgery when I was 9 yrs old. Pre-existing scarring puts you at a higher risk for necrosis and graft loss because scar tissue doesn’t have the kind of healthy vascularity that regular tissue does. And poor blood supply is really the leading cause of necrosis. So I was really vocal about wanting to wait to do the glans as a later procedure, even if they thought it might be ok to do during stage one. So my glansplasty was done at the Greenbrae Surgery Center, which is in the same building as Crane/Chen’s office, the entrance is just on the other side of the building. This procedure was done at 15 days post-op by Dr Chen. He was great and I felt really comfortable with him – he has an excellent bedside manner. I absolutely recommend him, I think he’s just as skilled as Crane. There’s no doubt his waiting list will quickly grow to the length of Crane’s in no time. I talked with him in pre-op about what I wanted for my glans and showed him a picture of the outcome I was aiming for. He was happy to oblige. Initially I was told this procedure was going to be done under local anesthetic, but they gave me the option of propofol which is essentially like general anesthesia, you are asleep and you don’t remember anything. I selected this option. When you wake up from surgery there is no dressing or bandage on the glans, they don’t use a bolster like some surgeons do around the ridge of the corona. There was very little blood and just some bacitracin that had been applied to the glans. When I got home I laid down for a few hours and when I went to get up to unplug my catheter, I noticed my glans started bleeding. I was applying pressure with an ABD pad but I wasn’t really able to stop the bleed. During this time I was in contact via email with Chen. He instructed me to apply point pressure to the area where the bleed was happening. I did this and I was able to stop bleeding eventually for 1 hr. then after standing up again it returned. I applied pressure holds again and was only able to stop bleeding for 1 min. This continued from Friday, starting probably 5 hours after the procedure, till early Monday morning when I called Chen and told him that it just wasn’t working and that I needed to see him. In hindsight, I wish I had been more vocal about the amount of bleeding I was having and the difficulty with stopping it. I don’t have any doubt that I would have received in person assistance much sooner. It was an easy fix and I could have spared myself a lot of worrying and at least 20 ABD pads that I bled through over the course of 2.5 days. Chen asked if I could make it to CPMC to meet him. I figured he was going to need to cauterize something, and he said occasionally they do need to do that but almost all of the time a pressure hold does the trick. The reason they try to avoid cauterization is because you are compromising vascularity, which makes sense. He brought me to a free exam room across from the North tower at CPMC and did two pressure holds using the tip of a bandage and a gloved hand. The first pressure hold was directly on the spot where the bleed was, I had also been pressing there. The bleed did not stop. He then said that because of how they fold the skin over, the location to press on can be a bit away from where the blood is coming out. SO, he moved his finger about 1 cm above the exit spot of the blood and held that for 1o min and VOILA! It clotted!!! He had me walk around the room to make sure it didn’t unclot. After this I had no issues. Such a simple fix, wish I had known the magic spot to press days earlier… For me, one of the hardest thing with this surgery has been asking for help, even from medical professionals whom I know it’s their job to help me. Please don’t feel bad about speaking up and getting your needs met. If you need to, have your caretaker speak up for you.

GLANSPLASTY DONOR SITE/INCISION (right side of groin): Zero issues, steri-strips still on at 15 days post-op. I gently removed them today. No swelling, pain, or infection. Healing perfectly. I can already tell this incision is going to be pretty much invisible. It’s WAY thinner than my hookup incision. This is what it looked like immediately after the steri strips came off, even before washing it:

glans incision

SCROTUM: I am continuing to drain very small amounts of fluid everyday along a small opening along one of the incision lines on my scrotum. Initially I had very severe swelling and bruising, so the draining is actually needed in order to allow the scrotum to expel the residual buildup of fluid. Each day my scrotum gets a little more malleable and softer/deflated, this is a good thing. From the time of creation, it’s an empty sack, but initially it looks REALLY full because of the swelling. In the beginning you think: damn, I’m not even going to need testicular implants. But the swelling will decrease drastically over time. I did mention it a couple weeks ago but I’ll mention it again, I developed what is called an eschar along the scrotal incision line, it looked like a thick black scab. It was in the shape of a cross. Initially it looked pretty rough, especially when I had all the bruising as well. My scrotum was so bruised it looked black. As of last week the eschar had completely fallen off and 100% of my bruising is gone. So my scrotum truly looks nothing like it did initially. My whole sack is 100% pink now and just has that small opening where it’s continuing to drain fluid. I do have a small urine leak at this juncture. Crane is pretty confident that when it eventually stops draining and closes up that the urine leakage will likely stop as well. For this reason I requested to keep my SP in for longer to aid in healing so that urine wasn’t flowing through it and I wasn’t having to press on it after peeing to fully clear the UL of urine and then clean and pat it dry after peeing each time. There is no data proving that it actually helps to keep the SP in for longer, it’s just my gut instinct and Crane was on board with my plan. When I get down about still draining and the small leak from that area I just go and look at photos of my scrotum from 3 and 4 weeks ago and see how drastically I’ve healed in that time frame. I’m really hopeful that another month of healing is going to land me in an even better space. I do recommend taking daily or regular photos for this reason, even if you don’t show anyone and they are just for yourself. They can be great aides in seeing if your are developing any issues and also when you feel like you aren’t making any progress.

PERINIUM/VAGINECTOMY SITE: Initially for the first 10 days or so my vaginectomy line along my perineum looked amazing. However, at about 10-14 days post op I noticed that I had developed a small hole, a little smaller than the size of a Q-tip head at the mid point between where the lowest point of my scrotum hangs, and my anus. Although there is no way to know for sure, I’m wondering if the constant wiping of fluids draining down onto this area from my scrotum, and the regular cleansing with wet wipes of the drainage, if the glue that was used on the outer layer of this incision closure was wiped away and encouraged the hole to form. During my post-op appointment, Crane felt confident that it is going to either close or fill in on it’s own and told to me keep it clean and dry. It does look like it might be filling in from the inside out but it’s an area that is really hard for me to closely inspect, even with the handheld mirror I have. There might also possibly be a little drainage continuing to come from this area, I’m not sure though. And if that is the case, it’s unlikely to close until the draining is finished.

NERVE HOOK UP INCISION (left side of groin): The incision line is clean and healing very well. At day 10 when I was up and walking around, the same day I started to have the bleeding dripping out of the phallus, I noticed that I had some swelling and firmness bulging a bit next to the incision line. This lasted for about 2 weeks. Had it continued to grow and get worse it could have been a hematoma that needed to be addressed, but because it was just a little swollen it wasn’t reason for concern. There is a bit of swelling still present next to the incision line, but it’s definitely decreased over the past couple weeks. Most of the sutures are still present as well. The scabbing has decreased by about 75% and much of it is just healthy skin with the sutures still sewn in. 100% of the sutures that were used throughout my entire surgery were dissolvable:

hookup

SUPRA PUBIC CATHETER: I had my original supra pubic catheter switched out for a clean catheter at 27 days post op. At my first time peeing on day 18, I was already voiding more than 75% of my bladder, but because of the small leak, as I mentioned above, I requested to keep my SP in for some additional time to see if it might hasten or help the scrotum along with it’s healing. Most people get their SP’s out at around 3 weeks with Crane/Chen if there are no issues. Had I not requested to keep it in, Crane was going to remove it at my last post-op appointment, day 20, since it was safe to do so at that point with me easily emptying my bladder through my phallus. Make sure to keep up with cleaning around the entry point to your body. The hole that they create that accommodates the tube in your belly is called a stoma. This hole will want to try to heal around the tube and create little scabs. Once or twice a day, gently clean these scabs from the edges of the skin and from the outside of the tubing. It can be helpful to place a very wet and hot (be careful) washcloth around the entry point for 5-10 minutes to moisten the crusties before removing them.

SP

I really can’t advise strongly enough for guys to order a couple stat locks for your SP. They did put one on me during surgery that I woke up with, but they didn’t have anymore to give me. The hospital only had them as part of an entire catheter setup, and understandably weren’t willing to open a kit just to give me the stat lock that they would need for the kit. Because of the added tension of the collection bag that was attached to the tube in the hospital, the stat lock fell off by the time I left the hospital. But you can get a lot more life out of them when you’re plugging your SP and not using a bag that’s constantly pulling tension on the adhesive. These stat locks can easily be found online for purchase. Order a couple well before your surgery, shipping times can be a week easy. Using tape to secure your SP is a drag. Stat locks are well worth the 6 or 7 bucks that they cost:

stat lock

Urinating: Two suggestions… Make sure you get a couple “graduate” containers at the hospital. These can be helpful for a few different reasons. First, you will need to know if you are voiding at least 75% of your bladder through your phallus before it’s safe to remove your SP and have you only voiding that way. Graduates can be a great way to measure if you are doing this. I was also peeing in one and held one between my thighs to see exactly how much I was leaking through my scrotum. I’m glad I did this because it can be deceiving to just eyeball it. The other thing it’s good for is just peeing into if you have a bit of an unreliable stream at first. Lots of guys spray or shoot off in crazy directions at first. I noticed that my stream was really straight but towards the end of emptying my bladder it shoots to the right a bit when the pressure starts to weaken. Usually this is a result of lingering swelling along the UL and should reduce or completely resolve itself once your swelling has subsided.

I am currently only peeing out of my phallus one day a week to see if the small leak I have is reducing at all. I will continue to do this through this week or possibly next week and then completely remove the SP even if the leak is still present.

Graduate

 

That’s it for now. I’ll probably update again at 6 or 8 weeks. Take care.