Catheter Removal & Continued Healing

Let's see... as of today I am 9.5 weeks post-op stage 1! Since I plan on sharing this blog in a Facebook group later I'll give a quick recap - you can also read through my previous posts for more detailed information.

Surgery: Stage 1 metoidioplasty with urethral lengthening (buccal graft), initial scrotoplasty (VY variation), mons resection, no vaginectomy. 

Date: November 17th, 2021

Surgeon: Dr. Miriam Hadj-Moussa, Urology Department at the University of Michigan, Ann Arbor.

Me: trans, queer, have a cis woman longterm partner and am polyam (primarily interested in relationships with men/masc people of all genders), white, mid-twenties, short & relatively thin, on testosterone for 4+ years, top surgery 6 years ago with second emergency surgery due to a large hematoma. No other known health conditions currently. Physical job, very active. I generally don't do front hole penetration (never been that pleasurable or exciting for me) - though very little dysphoria around having a front hole, and interested in gestating in the next few years. 

Pre-surgery goals: having genitals that look more "external" and can be cupped in my hand, having pee come from the tip of my penis (ideally being able to stand to pee, but less of a priority), no more labia minora, penis moved up to more of the front of my body rather than between my legs.

Pre-surgery fears: urethrovaginal fistula (very possible with UL and no vnectomy), loss of sensation, not liking the overall look of my genitals.

The story: Overall, surgery went quite well. I ended up staying in the hospital for two nights rather than one, because I fainted several times when trying to change from a laying position to a standing position. My stats were normal, they ran an EKG and bloodwork which were normal, and it went away on its own about 36 hours after surgery so I was discharged two days after my procedure (diagnosis: "anesthesia reaction"). I haven't had any problems with that since. I was discharged with a suprapubic catheter attached to a bag to remain in place for at least four weeks (most likely was 6-8 weeks, even from the beginning), I never had a foley.

I stayed in Ann Arbor for about two weeks after surgery in an AirBnB. I had my first post-op appointment a week and a half after surgery, then drove a few hours to my parents' home where I stayed for the next two weeks. I went back to Ann Arbor for my second post-op and VCUG, which went well at the time. Immediately following the VCUG I peed again and noticed a second stream coming from my natal urethra. That slowed a bit over the next few days, but was still a trickle/drip from that area every time I urinated. I was instructed to switch back to using the SP catheter for four more weeks to allow my urethra to rest, but I was able to use a flip/flow valve rather than needing to reattach to a bag. I also started using topical estrogen again - I tried the cream for a few days but it was a mess and felt like it was making the environment too wet, so I then switched to the vagifem (lovely name) insertable tablets which are AMAZING and so much better than the cream for me. I used them everyday for the first week, then every other day for two weeks, then twice a week. I'm still using them ~1-2x per week and plan to for the foreseeable future.

So now we are all caught up to my most recent post! I'll start there. After four more weeks of (hellish) catheter peeing (8 weeks total after surgery), I tried peeing on my own again. I got nice and hydrated, worked on my deep breathing, and found that there was no longer a trickle/drip coming from my natal urethra - 100% of my stream came from the tip of my penis. Fuck yes. I was thrilled, but also didn't want to get my hopes up after just one test because of what happened last time. This time when I tried it was verrrry painful and burned a lot, which is what I had heard from others but not experienced during my first round of peeing four weeks prior. It got better each time I peed, and I tried drinking more water to stay on top of my hydration since that seemed to help.

I continued peeing from my urethra for 24 hours and then told my surgeon and checked in about getting my catheter out because I was having worsening bladder spasms (I peed my pants a few times because of how hard my bladder was spasming, and worried that the intensity was going to negatively impact my healing). Peeing continued normally, and I made an appointment with my local urologist for the next week to get my catheter out. 

Getting my catheter taken out was a bit of an ordeal. I wish I lived close enough to my surgeon to have it done there, but it would not have been worth a flight just to get the tube pulled. I have a local urology clinic, which is very lucky because I live pretty rurally. They were very confused about why I had a catheter and why it was supposed to be removed rather than changed (asked me repeatedly if I was sure it wasn't a foley, yes I was sure), but we figured it all out eventually. My appointment was pretty simple - the doctor had me explain what I had done (which was awkward, but fine) and then he agreed that it seemed like the right time to remove the tube. I removed my pants and underwear and laid on the table. He gloved up, cut the single stitch that was holding the tube in place, deflated the internal balloon using an empty syringe, and then started tugging. And kept tugging. And tugged in different directions, and said "Hmm, seems like this thing doesn't want to come out!" which was quite alarming. I was trying to relax but my bladder was freaking out and my abdominal muscles were tightening in response, which I don't think helped the situation at all. He kept working at it for about 30 seconds and then it just popped right out (seemed like a bit of a surprise when it did, lol). He put gauze over it and taped it on, told me to expect a little blood and urine coming out for the first 24 hours but that it should begin closing relatively quickly. I didn't really get a good look at it but I imagine it was pretty gnarly after being in my body for over 8 weeks! Presumably, it was so difficult to get out because my body had tried healing around the tube and that tissue didn't want to move.

The catheter site was a little sore for a few days, nothing worth taking ibuprofen for though. It bled enough for the first 48 hours that I kept a bandaid over it because I didn't want it getting on my clothes, but was scabbed over by the third day. At this point, almost a week later, the scab is getting smaller/softer and it's clearly healing. I can feel a little firmness underneath the scab where it's healing internally. 

The day after I got my catheter out I had a weird peeing situation where my stream was very slow/weak, and at one point was just a drip. I was horrified that I had somehow randomly developed a stricture and wasn't going to be able to pee. As I was dripping, I shifted a little and it became a normal stream again. Very odd. I'm guessing that there was some tissue came off when the tube came out and was floating around in my bladder, so was passed through my urethra. Things have been relatively normal since then - my stream sometimes feels slow, but if I'm well hydrated it's no issue. I think I need to adjust to my pee having a slightly longer distance to go through before it exits my body, which will naturally slow things down. My stream is a bit of a mess - I haven't yet figured out how to hold things to make it spray less, and sometimes it randomly veers to the side. I figure this will improve with time and as swelling continues to go down. 

I'm still anxious about popping a hole in my urethra where I had the dripping before. I'm taking things one day at a time, staying well hydrated, peeing when I have the urge to go, and still drinking my Miralax to make sure there isn't too much pushing in that area. I don't know when that anxiety will go away, but for now I'm considering every week a big milestone. 

Overall, my body still doesn't feel totally healed. I feel good for the most part, and my daily activities are pretty much all back to normal. But most of my junk is still sore if I touch it too firmly, and I still feel like I need to be careful with everything down there. I have a suture line down the middle of my scrotum which connects up to my shaft and makes my penis feel a little tethered down, though I believe that will improve as the skin softens up over time. My mons resection scar is pretty hard and very pink, but seems to be staying closed at this point. 

Every time I write up an update I'm like "wow, that's a lot." It is a lot. This surgery was probably the biggest undertaking I've had, and I bought a farm last spring so that's saying a lot. I'm looking forward to things continuing to feel more normal and comfortable, which just takes time. And then I'll have stage 2 to look forward to sometime in this coming year! Unsure when yet, because of aforementioned farm, but within this calendar year is the plan. I will be going back to Michigan sometime in March for a follow-up with Dr. Hadj-Moussa and to talk more about stage 2, which I'm excited about. For now, maybe I'll do another update at three months? Or if something else happens, which it very well could. As always, feel free to comment any questions, or reach me IRL/on Facebook if you know where to find me! Also planning to upload pictures on TransBucket in the next month or so, which should be pretty identifiable as I don't think there are any other Hadj-Moussa patients on there. xoxo