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Urination after Meta

URINATION AFTER METOIDIOPLASTY WITH URETHRAL LENGTHENING

Congratulations! It’s time to start urinating through your phallus. A plug will be given to you that should be used to cap the suprapubic tube. On the date that the doctor has discussed with you, when you feel like you have to urinate, instead of uncapping the suprapubic tube and letting the urine drain, urinate through your phallus. Please do not strain or push. Urination is a process of relaxing all of your pelvic floor muscles and then your bladder will contract. You will urinate the same way you used to. If you need to, sit down to urinate, or urinate in the shower.

Your doctor will want you to check your “post void residuals”. After you urinate and feel as though you have completely emptied your bladder, remove the plug on the suprapubic tube and let it drain to see what is left in the bladder. Don’t be surprised if, at first, you notice a 50/50 distribution of urine between the suprapubic catheter and what has come out of your phallus. As you continue to try to void, more and more urine will come from the phallus. You do not have to measure your output from the suprapubic tube and the phallus, just use a ballpark estimate. When at least 75% is coming from phallus and less than 25% is coming from the suprapubic tube, it is safe for us to remove the suprapubic tube in the office. When we remove the suprapubic tube, we will give you antibiotics that will clear out the bacteria that are in your bladder from having the tube in place. It is better to wait until the suprapubic tube is removed to initiate this antibiotic treatment. Starting before the suprapubic tube is out will increase the risk of creating bacterial antibiotic resistance in your bladder.

Spraying, burning, bleeding from a suture line, movement of the suprapubic tube with a bladder contraction, and seeing blood in your urine are all very common and can persist for 3 months. You may experience a urine stream from different areas of your healing wound, such as at the base of the phallus and behind the scrotum. This is not an emergency or cause for alarm. If it’s just a few drips, please continue to urinate through the phallus and check your post void residuals. If it is a stream, then go back to emptying through the suprapubic tube instead of through the phallus.  Please tell your doctor at your next appointment. If you do experience urine leaking from a suture line, 80 to 90% of the time it heals on its own. This can take 2-3 months.  The other 10 to 20% of the time a fistula may develop. It is safe to repair a fistula 4 to 6 months after surgery. Patients often believe that placing a stitch or operating immediately will fix this problem, however, this is not the case.
URINARY LEAKAGE
This occurs commonly after urethral lengthening and is easily minimized or prevented. Many cis men have leakage after voiding which is why penis shaking in a urinal is often seen. Essentially, after urinating, urine can “lie” in the urethra and can drip if not helped along through manual compression. To expel the residual urine in the new urethra, push along its course starting from under and on the scrotum to the base of the phallus and gently milk it to the tip of the phallus. The finishing move would be a phallus shake to get rid of the remaining drips.