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Phalloplasty – In the Hospital

What to Expect in the Hospital

Note:  The following information was collected from postoperative patients. Your experience may differ. The day of Surgery is called Postoperative Day 0.  The day after surgery is called Postoperative Day 1, etc.

Day 0:

After your 8 hour operation, you will go to the recovery room, possibly to the ICU (Intensive Care Unit) on the 4th floor of CPMC Davies Campus. You will be connected to many of things:

  • Oxygen — by nasal prongs or a mask
  • An I.V. – an intravenous catheter to deliver fluids and medication
  • PCA (Patient-Controlled Analgesia) Pump – This is a button that you can press with your finger while lying in bed.  It is connected to a bag that has pain medicine in it.  When you press the button, pain medicine goes through your IV and into your vein, so you get pain relief within a minute.  You can press the button as often as every 6 minutes, as needed for your pain.
  • Suprapubic Catheter – a catheter that comes out of your bladder directly through the skin of your lower abdomen.  The catheter drains your urine into a bag that hangs on the side of your bed.  The catheter has a small balloon that has been inflated inside your bladder to keep it in place.  There is also a stitch next to the catheter on your skin that helps secure it in place. Do not attempt to remove this.
  • Doppler – a device that measures the blood flow going through your new phallus.  This makes a whooshing sound like “white noise” that you and your nurses and doctors can hear 24 hours a day to assure there is good blood flow right where you need it.  (The doctors and nurses will also periodically use a hand-held Doppler for the same reason.)
  • Drains – used to drain fluids from the areas where Dr.Crane operated.  A variety of drains may be used, but all serve the same purpose. Do not attempt to remove this.
  • A finger monitor – this constantly monitors your blood Oxygen level.
  • A heart monitor – this is an EKG, which gives constant information to the nurses about your heart function.
  • A splint – if skin from your forearm was used in your operation, you may have a splint on your arm to keep you from bending your wrist or moving your fingers excessively.
  • SCDs (sequential compression device) – you may have elastic stockings and/or pressure wrapping on your legs, to help prevent blood clots from forming.
  • Wound Vac – this increases the ability of the skin graft on your donor site to heal
  • Leg Wrapping – xeroform yellow ointment infused gauze covers your skin graft donor site on your thigh; the wrap will be removed on postop day 1 and the xeroform will act like a giant scab; it takes about two weeks to peel off as your skin heals.

Days 1-2:

You will stay on the 4th floor as you begin to recover.  The nurses will check you every hour initially, less frequently as you get farther out from surgery.  Dr. Crane and the doctors of the Microsurgery team will visit you daily.  You will stay in bed the entire time, though you will be encouraged to wiggle your toes and feet.  You won’t eat or drink anything during the first 24 hours in case you need to go back to the operating room emergently.  Once 24 hours have passed, however, your diet will be gradually advanced from clear liquids to full liquids to solid food.  The nurses will care for your surgical sites, bathe you, and take care of all you needs.

Day 3-4 (approximately):

Transfer out of ICU 4th floor to the 3rd floor.  You may still be confined to bed at first.  As you will not have been out of bed for several days, your legs will be weak, but by day 4, you will be encouraged to get out of bed, first to a chair, and then you will walk with assistance.  While in the hospital, you will still have frequent nursing checks and Doppler checks of your phallus, and will be transitioned to oral medication in preparation for leaving the hospital.

Day 5 (approximately):

Date of discharge. Once you can walk and take all your medications orally, you will be discharged from the hospital, but you will need to stay in the San Francisco area for several weeks for follow-up visits and to be nearby in case complications arise.  Your scrotal drain, urethral drain, and internal Doppler device will be removed. The suprapubic tube/catheter stays for 2-3 weeks and will be removed at your 2nd postoperative visit in clinic (Greenbrae). Your arm will be wrapped with a splint by the hand therapy team and they will give you instructions on followup either with them or with hand therapists closer to home. You will see Dr. Crane and a doctor from the micro-surgical team for follow-up visits, and may have other visits depending on which donor site(s) were used for your surgery.  Because you will be receiving narcotic pain medication, you may not have a bowel movement while in the hospital. It is important to take a laxative like Miralax (over the counter) for as long as you are on pain meds to avoid constipation. The goal is 1 bowel movement per day.