Your Hospital Stay

Plan to stay in the hospital for at least 5 days after your surgery.  

For example, if your surgery is on a Monday, you should plan to stay through Saturday.  

You may need to stay longer if the surgery team has any concerns that require you to be cared for in the hospital. For example, you may need to stay longer in the hospital if you have:

  • infection,
  • phallus blood flow issues,
  • bleeding, or
  • you have a hard time eating or drinking because of nausea, pain control problems, or other issues.  

Your surgery team will discuss all plans with you.

Managing Pain

You will have a “pain button” or patient controlled anesthesia (PCA) button. This will let you control delivery of pain medicine when you need it. 

Days 1 & 2 in the Hospital

  • After your first 24 hours in the hospital you’ll slowly be given a diet to make sure you are not nauseated.  
  • You will be given sequential compression devices (SCDs) on your legs, which gently squeeze your legs and help prevent blood clots.  
  • You will be given a daily aspirin to help prevent small clots from forming at the blood vessel connections to your penis and groin area.
  • You’ll start taking home medications as soon as possible, depending on what these medications do.

Days 2 & 3 in the Hospital

For the first 2-3 days after your phalloplasty, you will stay in a special hospital unit where you will be checked on every 1-2 hours.  

The surgery and nursing team will check your phallus (penis’) color, capillary refill, temperature, and doppler signal.

A doppler machine will be at your bedside and is attached to a wire that ultimately is attached to a probe around the blood vessels that supply your penis. The doppler and frequent exams help your team make sure that your penis is getting enough blood flow. This helps us make sure that if there’s a problem with your phalloplasty, we catch it early and act quickly.

You won’t be allowed to eat or drink for the first 24 hours after your surgery. This is because you may need to return to the operating room in the case there’s a problem with your phalloplasty.  

We hope these frequent checks help you feel comfortable and that you’re getting the care you need.  

Blood Flow & Phalloplasty Surgery

Your penis will be elevated on a special dressing to make sure that blood flow isn’t blocked. As you can tell, blood flow is extremely important for a successful phalloplasty. We take great care to make sure your new penis is getting the blood flow it needs.

Days 3—5 in the Hospital

3 to 5 days after your surgery, you’ll be transferred a less acute surgical unit where you’ll be checked on less often.  

On day 5:

  • Your skin graft VAC dressing will be removed and then redressed with Xeroform gauze, kerlix gauze roll, and your splint
  • Your groin and scrotum drains will be removed
  • The doppler wire will be cut
  • You will be given supportive underwear (you can bring your own, but it must be OK’d by the surgery team to make sure it’s adequate)

You will be allowed to walk with assistance. Physical therapy may be involved in your care to help with this transition and give suggestions to help you get around. 

Urinating With a Catheter

A suprapubic catheter (a tube placed through your skin above your pubic bone and into your bladder) will drain your bladder for the first few weeks after surgery. The urology members of the team will manage this catheter. 

There will also be a red catheter in your penis which will hold your new urethra in an open position. Your surgical team will remove this catheter before you leave the hospital.

Drain Care

  • Your scrotal drain will usually be removed before you leave the hospital
  • The Penrose drain will usually be removed from your groin area while you’re staying in the hospital
  • The VAC dressing will usually be removed on post-op day #5
  • IV catheters will be removed before you leave the hospital

When Can I Leave the Hospital?

You may be discharged from the hospital when you meet discharge criteria:

  • Your penis looks healthy and your surgery team doesn’t have any concerns
  • Your pain level can be managed by making medicine by mouth (oral medicine)
  • You’re not too nauseous, and you can eat and drink enough
  • You can walk without needing help

What Prescriptions Will I Need After Leaving the Hospital?

You will be sent home with prescriptions for these medications:

  • pain medications
  • stool softeners
  • anti-nausea medications
  • antibiotics
  • aspirin for one month (then stop)

Supplies you may wish to purchase ahead of time:

  • Xeroform 5”x9” gauze, box of 50: can be found at specialty pharmacies or on Amazon (around $45/box)
  • Kerlix gauze bandage 4½ x 4⅛ yard rolls x 6 to 12 rolls: same as above.
  • Bacitracin-zinc ointment

How to Take Care of Your Penis, Scrotum, & Skin Graft After You Leave the Hospital

How to Take Care of Your Penis

Do these things to care for your penis after you get out of the hospital:

  • Keep your penis in an elevated position: Use your penis elevation dressing we gave you when you’re in bed, just like you did in the hospital
  • Support your penis at all times. Wear supportive underwear when walking (just like in the hospital)
  • Do not bend, kink, or sit on your penis
  • When sitting, don’t flex your hips more than 90 degrees. Do not sit with your thighs against your chest because this can squeeze the blood flow to your penis.
  • Rub bacitracin ointment to the cuts (incisions) on your penis twice a day
  • Watch for any changes in your penis’ color (purple, pale, red, etc.), temperature (hotter or cooler than you have felt in hospital), swelling, or drainage

Sex With Your Penis

Do not use your penis for any sexual activities until your surgeon says it’s safe and gives you permission. This includes no oral, vaginal or anal insertion. 

How to Take Care of Your Scrotum

  • Rub bacitracin ointment to the cuts (incisions) on your scrotum twice each day
  • Watch for any redness, drainage, or developing dark areas on your scrotum. Let your surgery team know if any of these things happen; they could be signs of infection or poor blood flow.  
  • It’s OK to get your scrotum wet in the shower.

How to Take Care of Your Skin Graft

Weeks 1 & 2 After Getting Out of the Hospital

Do these things every day:

  1. Remove your old dressing
  2. Look for any blisters or skin graft lifting off of your tissues
  3. Cover your skin graft completely with a single layer of yellow Xeroform gauze
  4. Then gently wrap your hand and forearm with Kerlix gauze roll
  5. Then replace your splint

Don’t get the skin graft wet until your surgeon tells you it’s okay (usually week 3).

Week 3 After Getting Out of the Hospital

If your surgeon okays it, you can stop arm dressings and leave your skin graft open to air.  

Start massaging any large scars on your forearm and groin.

It’s OK to start using a water-based moisturizer and gently rub it over your graft. Don’t shear your graft. Follow your surgeon’s instructions if your graft isn’t completely healed.  

How to Take Care of the Skin Graft Donor Site (on your thigh)

  • The area where the split-thickness skin graft was taken is usually covered with yellow Xeroform gauze.
  • When you go home, leave the Xeroform dressing on your leg open to the air (don’t cover it with a bandage or cloth).
  • Don’t put any moisturizers, creams, medications, or water on it, and DO NOT REMOVE THE DRESSING!! (it will bleed).
  • The Xeroform will become incorporated into a scab over the donor area. It will then peel up from the edges as it starts healing. You can trim the edges with scissors as needed, and they will eventually fall off on their own.  You can also use a hair dryer with low or no heat for 10 minutes twice a day to help dry the Xeroform/donor site.

As the Xeroform dressing is trimmed away at the edges, you can put a water based skin moisturizer to the uncovered areas to keep the new skin moist. You should rub lotion on the whole area after the dressing falls off. 

The area will look pink/purple at first, but over the course of the next 6-12 months your skin will become lighter colored, and look more like the skin around it.  It’s not unusual for the skin graft area to look slightly less or more pigmented than the surrounding skin, even after it’s healed.

Your Catheter

  • Your surgical team may remove your neo-urethra catheter before you leave the hospital
  • Your suprapubic bladder catheter will stay in place, to gravity drainage bag (leg bag)

Showering & Physical Activity After You Leave the Hospital

Showering

  • Keep the forearm skin graft dry; use a bag to cover it when you shower
  • Sponge bathe for the first week after you get out of the hospital
  • After one week, you can wash your penis gently with warm soapy water, and pat dry. Don’t submerge your penis, scrotum, groin area, or arm in water until your surgeon tells you it’s safe. No baths, hot tubs, swimming, etc.
  • The skin graft on the penis glans area may get wet after one week home, along with your penis
  • Generally, you can get your arm skin graft wet during week 3 of being home from the hospital

Physical Activity

  • Support and elevate your penis (as talked about above)
  • Get physical therapy for your hand/forearm (as noted below)
  • Don’t lift anything heavier than 5 pounds with your arm that had the skin graft
  • Don’t flex at your waist more than 90 degrees
  • Walk at least 4 times each day, for at least 10 minutes
  • Make sure you are urinating through the suprapubic catheter/leg bag system
  • Make sure you are moving your bowels at or close to your normal bowel habits (narcotic pain medications can cause constipation). Stay hydrated, and use the stool softeners we gave you to help prevent constipation.

Physical Therapy For Your Hand

  • Keep the splint that the hospital gave you on your hand until your hand therapy follow up appointment (2 weeks after you get out of the hospital). It’s OK to move your fingers, but don’t lift anything heavier than 5 pounds
  • Week 2-3 you’ll start working with a hand therapist to improve your range of motion at your fingers and wrist. Hand therapy usually lasts for 2-4 weeks, but depends on your progress.
  • Find a list of certified hand therapists in your area by visiting the Hand Therapy Certification Commission website
    • Click on “CHT Directory” and enter your zip code

Things to Watch For & When to Call Your Surgical Team

  1. Change in penis’ color, temperature, girth (this could be a sign of a problem with the blood flow into or out of your penis). If this happens, it’s very important to call us as soon as possible—Call the Main Hospital number at 801-581-2121, and ask for the “Plastic Surgery Resident On Call”)
  2. Increased swelling in your groin
  3. Your temperature by thermometer under your tongue is more than 100.40F (380C)
  4. Feeling “chills”
  5. Difficulty breathing, or pain with taking a deep breath
  6. Leg swelling or pain
  7. Groin swelling or increased pain
  8. Feeling light headed or “fainting”
  9. Your suprapubic catheter isn’t draining (Call the main University Hospital number at 801-581-2121, and ask for the “Urology Resident On Call”)
  10. Any questions you have about your care