Urethral Lengthening/Urinating
I was given the green light to try urinating out of my phallus on the Friday following my second post-op appointment. I must admit I was pretty nervous. I knew this would reveal any fistulas (holes from the urethra to the outer skin), strictures (blockage in the urethra from scarring) or any other complications. And, I thought it might be painful. At this point, the majority of my pain has been confined to my arm and I was unsure how bad it would feel to try to urinate out of something that was still healing.
I woke up on Friday morning at 8am ready to go. In preparation, I put a chux pad on the floor thinking that (a) it would keep the floor clean if I were to spray or leak anywhere and (b) it would be noticeable if I were leaking out of a fistula. I decided to sit on the very edge of the toilet and hold my penis above a graduate container so that I could measure how much urine came out. I thought that since it was my first time, sitting would help with the muscle memory and it would let me relax a little more. Toni had reminded me that the trick is to relax and let go and that some guys feel like they need to push it out and that keeps them from going. I closed my eyes, repeated a mantra in my head of "relax" and it flowed right on out!!!!! SUCCESS!! My dick works! And bonus - NO LEAKAGE.
How did it feel? Other than a huge fucking relief?! I felt sore where I imagine the neo-urethra connected to my original urethra and it was the most bizarre experience to see it flowing out of the tip of my dick, but that I couldn't feel it. It's like, "I can see this is happening, but I can't feel it happening." Really really wierd. The color of the first few seconds of the stream was a bit orange, which I imagined was some blood in the urine and when I looked into the graduate cylinder, it looked like there was a lot of slough floating around in it. It kinda had a granulated appearance.
I emptied about 150cc's of urine into the graduate cylinder and then emptied the rest from my bladder into the second container. A whopping 325cc's were left! That's a lot and I only had 4.5 days to flip that ratio around to ensure I'd get my SP catheter out. I needed to be consistently peeing about 2/3rds to 3/4ths of my bladder out of my urethra. Naturally, I kept a chart. Here's a line graph I made out of it - the green representing urine from my urethra and the red representing the remaining urine I had to empty from my bladder. The goal was to have a consistently large gap between these two lines and to keep the red line from peaking above the green.
The key takeaways - After the first pee, I was pretty easily able to hit the ratio I needed with some exceptions. Usually, the longer I waited between urinating, the more urine there was remaining in my bladder, which was most noticeable duringthe first pee of the day. l got in the habit of drinking a lot of water and "practice, practice, practice" :) I continued to have that granular looking pee on and off for a few days and once or twice had the orange blood-tinted urine at the start, but overall it was quick to normalize.
I was pretty confident that I would not have any fistulas as it seemed from the experiences of other guys that they were noticeable from the first pee. Since they are incredibly common, I expected that I'd either have a fistula or a UTI, but it looks like I'm at least in the clear for the former for now.
There are two more things that I'll add before moving on. The first is that within a day of peeing from my urethra I started getting pain where my SP catheter was coming out of my pubic region. It felt really sore and that hadn't been the case before. I assumed that it would eventually bother me, but this was more achy than I expected. At one point I decided to completely empty my bladder from my catheter (not marked on graph) and that fixed it! I'm not sure if there was pressure built up that was causing the pain or what, but it didn't come back. The other thing I'll mention is that on the second night of peeing I heard and felt a "pop" coming from in my urethra behind the base of the penis. The next time I peed about an hour later some blood was in my urine. I'll admit, I freaked the hell out! I posted about it online and some guys said not to worry and that it could be a suture coming loose and at this point they were starting to dissolve anyway, so it probably wouldn't be an issue. I couldn't stop thinking about it and texted Toni the next morning. She said it'd probably be fine and it was. But, boy did it scare the beans out of me.
Last Post-Op Appointment
I felt really good going into my last post-op appointment with Dr. Crane and Toni since I was urinating so well, appeared to have no fistulas, and my energy was slowly coming back. I had to pee before coming into the office, but wasn't sure if Crane wanted/needed to see it. FYI - he doesn't. I snuck out of my appointment to run to the bathroom. *Face palm* The good news, I dropped my pants and his reaction was priceless. "Wow! You ended up with a nice big dick." Then goes on to say that when it heals I should send a photo to his admin staff to put on the website, if that's something I'm comfortable with. Um...hell yes! I was proud of my dick to begin with, but that was a wonderful affirmation that it's coming along. (Keep in mind, it was still fairly swollen.) While we were talking, I overheard a guy in the room across the hall, so I asked Dr. Crane if he was doing a phallo consult with someone else and offered to show that guy my penis if he was up for it. I never had the chance to see a post-operative dick in person and felt like it was the least I could do for another trans guy trying to figure out if this was the next right step for him or not. Dr. Crane and Toni were pleased by the idea and I got to meet another trans guy with my pants around my ankles. Ha ha. I could tell he was happy to have the opportunity to see the goods before making his decision.
After my show-and-tell I got the last two staples taken out of my arm, got my dressing changed, and had the SP catheter taken out. It was an odd sensation, but Toni described what I'd feel before taking it out, which helped me be chill about it. The process was over in seconds after a snip and a tug.
I had a handful of questions for them, too:
1. Can I start sleeping on my side? (I'm a side sleeper) Yes as long as it doesn't hurt and you're not cutting off circulation to your phallus.
2. Do I need to keep using the arm brace? Nope.
3. When can I start exercising? 6-8 weeks Post-Op.
4. When can I masturbate or have sex? 2-3 weeks from now.
5. Should I be concerned at all about traveling or going to a much colder climate? Nope. Just don't drive if you're on narcotics.
Ongoing Maintenance
I'm still keeping my dick propped almost the entire day, which is helping with the swelling. I can tell because it's slightly more flexible. I started wearing loose boxers regularly this week. I got sick and tired of wearing nothing and it helps me feel better. It is hard to wear anything that compresses and it's clear that none of my briefs will fit again. My dick is too big to squeeze into that little area. I'm changing my dressings and the top graft on my arm is still healing way behind the rest of my arm. I'm able to shower without covering it and clean it with Cetaphil. I hold my arm out of the water and after soaping it up, I rinse it by letting the water drain down my arm first and trickle onto the wound. I'm not supposed to have it directly under the stream. Toni says it'll take at least another 2-3 weeks to heal. Bummer.
I'm also back on narcotics after trying to wean off them. The night after I went from a low dose to just Tylenol I woke up with horrible pain in my arm. It was aching and throbbing and I decided to go back on the low dose for the remainder of the week and through 30+ hour drive home. I learned my lesson when I had my metoidioplasty and tried to go off narcotics during the drive - it sucked. You never realize how all of those little bumps small movements can make you sore. We made the 30+ hour drive home in 5 days (returned last night) and I had no problems with pain or the drastic change in temperature. Now that I'm home I'm going off the narcotics. *Fingers Crossed*
I had my last OT appointment my final day in Austin and got some new stretches and movements for hand therapy that I hope to put in a more comprehensive blog post. I have a very limited range of motion in my wrist although my finger movement is great. It was also suggested that I start wearing a compression glove on my hand to reduce the swelling, which will help with movement and decrease the nerve pain I'm having in my thumb. They didn't have my size (medium) at the OT clinic, so I ordered it on Amazon and it arrived today. It feels really good to have on and Toni told me to wear it 24/7 if I can stand to.
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