Phalloplasty and Urethra Lengthening (aka Urethraplasty) Procedure - Personal Article
***Make sure you come home with antibiotics***
Definition of a catheter: A catheter is a tube that is inserted into your bladder, allowing urine (wee) to drain freely. The catheter tube is attached to a drainage bag (a catheter bag), where the urine can be collected.
How a catheter works: Catheters are usually inserted through the urethra (the narrow tube that connects your bladder to the outside). The catheter is kept in place by a ball filled with saline that sits against your bladder wall. This can cause bladder spams.
What is the Procedure?
After phase one, Phalloplasty, a skin-tube urethra (created and placed during the first phase of phalloplasty). After phase one (a minimum of six months between procedures is a common healing period) they make an incision in your scrotum and connect the urethra in the phallis is connected to your original (but lengthened) urethra. It is a short procedure. After the procedure you will have a catheter inserted and you will have it outside of the hospital from two to six weeks (time varies from clinic to clinic). Where it will most likely be removed by your primary health care provider. The catheter is used to protect the new urinary tract as it heals post- operation.
Wearing boxers and loose underwear can help you feel more comfortable while the catheter is in. While more tight underwear such as boxer briefs and briefs are better for after your healing period to help keep your phallis from creating a potentially unwanted bulge in your thigh of your pants.
Findings and Advice:
Bladder spams can be an irritating and annoying type of pain, more annoying than painful. They come and go randomly, but they are something to be aware of.
I was in surgery for about an hour and a half for this particular part. Then, about the same amount of time in the OR (Operating Room) care unit. When I was in there, they offered to let me go as soon as I was wide awake and completely responsive. I received a [intramuscular] shot of morphine. I have a habit of getting sick (vomiting) if I get the entire dose at one time. So I informed the nurse that I get extremely neausous with the full amount of morphine and I was told to do it in two doses. The nurses were nice, they did what I asked. They gave me half then about 20 minutes later gave me the other half. Since I had to take the pain medication, I had to stay an extra 45 minutes. Where as if you don't need anything for pain you can go back to your room after a few minor "tests" of your body and mind.
I know you want to get out of that room, but take your time and rest. Take the pain medication if you need it.
Do not let your pain get over a 7/10 on the pain scale. Once you get to 7,8, or above, you can have a hard time getting comfortable.
Do not try to tough out the pain at any stage. If you are in pain, let a medical professional know.
Ask your surgeon any and all questions you have. They talk to you for a reason. They want you to be informed and heal properly.
Try to have someone who can be around a lot to look after you for a few days after the procedure.
You may have a wound between your phallis shaft and your scrotum. That is where they went in to connect the new and preexisting urethra. (At least for me)
Watch for signs of infection, and if you are concerned, go to the Emergency Room, call your clinic, or whoever provides you Healthcare. (red, irritation, heat, puss, a bad smell, ect.)
If you are leaking from your catheter, speak to a health care professional. Leakage can be a problem if the catheter isn't placed right. Catheter Info
The type of catheter they most likely will use is called: Long-term indwelling catheter: The catheter is passed through the urethra and left in place. This time can range from two to six weeks before it may removed. Surgerons times may vary, average I see is about three weeks. Mine, they wanted six weeks.
WASH YOUR HANDS ALWAYS AS IF YOU HELPED YOUR FRIEND DISPOSE OF A DEAD BODY!!!
The catheter can be in from two to six weeks. This is a long time with a catheter, so be prepared mentally.
You will need some extra catheter bags, hand sanitizer (multiple bottles), medical tape (something easy on your skin), non-scented body wash, some antibacterial wipes, a plastic leg covering from a medical supply store (if required), ice packs, boxers (plain, loose fitting boxers while you have the catheter in) maybe something to put to protect your mattress if you want to, big comfortable sweatpants (get or have at least five pairs to rotate through), a number to your clinic, all of your medications given and taken as instructed, make sure you get antibiotics!
Dripping after you are healed is normal for even cis men (usually its only a few drops)
I drip if I don't shake enough or take my time
How to reduce leakage, dribbling, and general mess:
After passing urine, wait for a few seconds to allow the bladder to empty
Place the fingertips of your hand on your mid taint, behind the scrotum and apply gentle pressure also slight pushing of your pelvic mucles may help
Keeping the pressure in the mid line, gently but positively draw the fingers forwards towards the base of the penis under the scrotum
This pushes the urine forward into the penile urethra from where it can be emptied by shaking or squeezing in the usual way
Before leaving the toilet, repeat the technique twice to ensure that the urethra is completely empty. Source
I do the last step at least three times. I also take time between the three attempts. I will let my penis rest with gravity, I do a slight push, then I can almost feel if anything is left or not. Always do a couple security shakes.
Pro-tip when urinating standing, use the pocket in your underwear, try not to pull your phallis over your waistband (usually you pull your boxer wistband down and flop your phallis over. This is okay to do by all means, but it does work against gravity and makes it more difficult to completely empty. So my recommendation is to use the pocket in your boxers. Just undo your zipper and button (or if you have sweats or something you have to pull them down, but make sure the waistband doesn't touch your shaft or even try to hold it lower than your scrotum. I kind of use my remaining fingers to block my waistband from touching me in sweats or something without buttons or zippers
It gets easier to pee if/ when your pump is implanted. Since you are always slightly pumped (most models of pumps require a pump at all times (min) ask your doctor about your oumping situation, the booklet clinics tend to give out dont always give you all you need to know), there is enough rigidity (hardness/stiffness) to keep your urethra more straight). I found my penile implant really helped with my urination and being able to completely empty my bladder. It also allows urine to flow more freely when I do urinate. This isn't to say before your pump you will have issues, more you have to support your phallis as you urinate a lot more to keep that tract straight. If you get penile implants, for example, you can pee with no hands. If you do with no implant, you may pee on yourself because there is no rigidity, but I'm sure there is someone out there who can and more who will be able to. Like I said, all of our bodies are different
Gravity is your friend
No sex (even anal) of any kind for usually at least 6-8 weeks
Try to relax
I can feel awkward peeing in a urinal with someone next to me because I shake more than I feel is socially typical. Comfort is a big factor in peeing in general. I have anxiety about going to the bathroom in public, I usually use a stall if I can. It's not a big deal.
You can still get pleasure and have orgasms in this state. I do not recommend trying to do penetrative sex, but this is a good question to ask your doctor
I had a lot more sensation after I was healed.
I find that it's easier to wear underwear that is more supportive, eg., Boxer briefs, briefs, pocket underwear. You don't shrink a lot when you're not erect, so you have more to tuck away than the average cis man. I find boxers and loose fitting underwear can cause an unwanted bulge in one inner thigh or the other when wearing especially sweatpants and jeans.
Wearing the above kind of underwear can reduce mess after your catheter is removed and drippage as you learn as well. You're probably gunna pee down your leg as you learn.
Carry a extra pair of underwear with you when you go somewhere, before your catheteris removed as well. If you are learning and you make a mess, you can have a clean pair of underwear to put on. It's not fun sitting in pee soaked underwear...
Wear dark pants at first (hides if you have an accident)
There is a huge learning curve, you don't expect it, but it's not as easy as it seems to hit the target when you stand to pee, and learning to be patient and effective at emptying your bladder.
It is ABSOLUTELY NORMAL TO URINATE SITTING DOWN!!! I did a small survey in a Facebook group for males (i was actually impressed it had over 200 votes, plus over 100 comments in total). Many comments and votes say it's perfectly fine to sit peeing and many people have different reasons. Mine is I want to play on my phone, plus sometimes my feet are tired... It's normal to sit.
Be careful with your urine bags and always ALWAYS have extra urine bags ON HAND/ AT YOUR CURRENT LOCATION!!! And no a plastic ziplock baggie will not do. Trust me.
Have tons of hand sanitizer around the house and bathroom, antibacterial soap, unscented soap (for your body), and make sure that you keep your hands and valve on your catheter always sanitized.
If you feel pain in your member or bladder or anywhere inbetween, go to the Emergency Room, if you feel hot go to the E.R right away. Better to be safe than sorry.
Keep hand sanitizer literally on the back of toilet so it is convenient.
Even with the catheter in, you feel the urge to urinate. I found that I could ease the feeling for a bit if I "urinated" in my usual position (I found sitting to be most comfortable)
You are going to be very tender and sore
Swelling will go down
Make sure you stay clean and dry. Especially where your wound is.
The doctor who does a lot of the work during this phase of surgery is called a urologist. So research them as well as your surgeon. You want every member of the team of your entire procedure to be great at what they do.
Do not try to remove the catheter yourself. You will not be successful. If you are having issues go to the Emergency Room, clinic, or whoever provides proper health care to you.
Do not take any chances with infection. Hands clean, valve sterilized and closed, urine bag attached properly and tightly.
Wait to shower until you are instructed to.
Try to shower as often as they tell/let you. You want to stay clean to avoid infection. Of course you also don't want to overdo it.
Showering with a catheter is a challenge. I found that the plastic covers made for covering wounds/bandages/ etc. Depending on what your surgeon says, you may not have to cover your catheter bag at all. Be sure you ask your clinic!
When you are showering, be super mindful you have a catheter. Any tugging or too much movement can hurt and possibly affect your healing. So be gentle. Also, be careful when washing the tip of your phallis at this stage.
Dry your wound/ pubic area by patting dry and not wiping. Be gentle.
During my showers, I would use medical tape to kind of keep everything (tubing) in one place.
Your catheter may not come with anything to hold it onto your leg. While catheters i noticed usually come with a soft elastic band with snaps that you'd tie to your leg. If you dont recieve that in the clinic, ask a nurse if they can give you some dressing mesh and ask if they can teach you how to make a pocket you can tie to your ankle (that's what I did, the elastic band would slide down my leg). There may be other options for holding your catheter. I do not recommend anything that would cut off blood flow to your leg and/or something that restricts or affects the functionality of your catheter.
Be mindful of your catheter at all times.
If you are going insane with the feeling of having to urinate, try looking at your unit and tell yourself "I don't need to pee, I'm fine. I will not mess myself". It especially helps when I would sit on the toilet as I did this.
Shave your inner legs if you have to, because you will want to tape the tube to your leg, at least in the shower. This helps so you don't pull/tug it. Trust me again. Pulling/ tugging on it even slightly by accident is not a good time.
Always double check to make sure your valve is closed, leaving it open is a welcoming hall for viruses and bacteria directly into your bladder
I know that catheter is going to drive you mad, DO NOT TUG ON IT!!! I tugged (because it was making me not comfortable), and it actually moved the catheter out of place. This caused me to be urinating directly through my new urethra before it could have been ready. It was actually really painful (burning). So please do not tug, go see your medical professional if you are feeling very irritated and/or uncomfortable. Sometimes, the [catheter] line needs to be "flushed" (flushed: when they "rinse out" the catheter system with saline water).
Take your meds as instructed, especially your antibiotics. If you have to take meds at certain times or time intervals, set alarms, tell someone. For many antibiotics, timing matters and is a huge factor in how well they function
Do you feel yourself pee when you are completely healed? - Yes, I can feel it, especially when it's been cold outside
Do you feel yourself pee with a catheter before the swelling goes down? - For me? No, your bag just fills up. But contrary to what I always think (everytime i have a catheter think "i dont have to get up to pee for awhile, niiiice", im always wrong), it does make you uncomfortable as in feeling like you have to urinate constantly. That's a lot thanks to the bladder spasms.
Here are the sources I used:
https://www.healthdirect.gov.au/catheter-problems
https://cranects.com/urethral-lengthening/
I will post my story another day. I want this information to be heard and sink in first.
If you have any questions, or concerns please feel free to send an ask or email.
If you'd like anything added, or you have questions about this. Also feel free to contact me.
Stay Golden Everyone ✌️ 💙 💜
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I’m 3 years post phalloplasty and I realized I’ve never really made a post about how things are going. Phalloplasty is a hard surgery to talk about because, bottom line, it’s not part of common conversation to talk about yo dick. That being said I think it’s really important for me to talk about this procedure to help break stigma and misinformation— both inside and outside of trans and non-binary communities.
I had ALT phalloplasty, glansplasty, scrotoplasty, no urethral lengthening (UL) with vaginectomy. This means that tissue from my thigh was used to create my penis, my urethra was not extended or moved (so I don’t stand to pee) and my vagina was closed. I feel like this detail is important because this is one of many variations for this procedure and what I opted for/out of were decisions made according to trade-offs between personal benefit and risk.
I opted out of UL because I do not tolerate catheters well and, due to my very active lifestyle, was not willing to risk longer term catheterization or bladder spasms which would impede my quality of life. This risk, for me, outweighed the benefit of standing to pee.
I opted for ALT knowing that I would likely need debulking (which I didn’t end up needing but opted for anyway out of preference). Debulking is a procedure to make the penis less girthy as ALT phalloplasty is more girthy because of the nature of tissue on the thigh. I chose ALT because, first and foremost, I did not want scarring on my forearm. My ALT scar is covered by clothing most of the time which I appreciate. I also chose ALT because I have skinny forearms, which wasn’t ideal for forearm phalloplasty (RFF).
Vaginectomy, for me, was a no brainer. I have never used or connected with that part of my body so I wanted it gone.
Glansplasty is a procedure to make the glans (head) of the penis and was a short procedure done after my initial stage of surgery. I may get it redone but I’m still undecided on that. Scrotoplasty creates a scrotum, I was ambivalent about this procedure but have grown to more appreciate it over time.
I am considering further surgeries: erectile implant (which creates the ability for the penis to “get hard”) and testicular implants (fills to scrotum with testicle implants). But I’m undecided and want a break from surgery while I finish my degree and focus on work. I’m also considering phalloplasty tattooing to help enhance the contour and coloring to make it appear more like a cis penis.
Whew! Lots of info, right? These are big procedures completed over multiple stages and are very unlike chest surgery, hysterectomy and other surgeries I had completed prior. When I was first considering this surgery I didn’t know there was flexibility in terms of tissue donor site and UL. I waited to have this surgery and am so happy I did because the information I gained from research and consulting with professionals and folks with lived experience was so valuable.
Was surgery hard? Yes. This surgery was the hardest thing I’ve ever been through. I’ve never been so uncomfortable for the first 2 weeks after recovering. I had to re-learn how to walk. I couldn’t sleep. Peeing hurt… but would I do it again? Yes. It was worth it for me but I can’t underscore enough that that doesn’t mean I didn’t have moments where I felt regret while recovering because post op depression is a thing and I was in pain while adjusting to a new body part that was also a healing surgical site… LOTS going on there!
3 years on I feel really at home in my body. Just having a penis is such a comfort to me in ways I didn’t anticipate. I’ve had a feeling my entire life that I was missing a body part and this was it. The quiet gender euphoria of just sitting and feeling my body and for once feeling complete in that is something that’s hard to articulate.
I’m thankfully back to full mobility and got back to full mobility about 3 months post op. I was grateful for this since a long term recovery wasn’t what I wanted. There are still weird twitches, pains and feelings, especially around my donor site (thigh) from time to time but nothing that inhibits me. Just interesting when it happens (usually when weather gets colder?).
What is one thing I would want to go back and tell myself before surgery? Well:
Your penis will feel HEAVY. Like it will fall off. It won’t fall off and your body will adjust to the weight in an area you didn’t have it before. Until then it will feel like you need to hold it at all times.
Hopefully this helps someone as an overview of what an experience with this procedure may look like. Again, my goal is to put information out there and have frank conversations— because it’s these same things that greatly benefitted me in my surgery journey.
Finally— my inbox is open for anyone that has questions. I am in a privileged position to feel safe talking about these things and I feel comfortable doing so. Not everyone does, so please don’t assume that this invitation applies to other folks who have accessed surgery unless they say so.
Thank you for reading :)
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