Right around the time of your surgery you will be admitted to the clinic. You are usually admitted to the clinic one day before surgery. Be prepared to stay in the clinic a few days after surgery, after which you will be able to return home shortly.
THE DAY OF YOUR ADMISSION
If you are undergoing penile inversion vaginoplasty there are no dietary restrictions. You may eat normally on the day before your admission and are allowed to eat and drink everything until 0:00 pm.
If you are undergoing colovaginoplasty you need to follow a strict liquid diet. This means: the morning of the day before surgery a normal breakfast at home, a light lunch at 12:00 (for example, tea and biscuits) and once you are admitted to the clinic you may only drink clear liquids such as tea, coffee without milk (sugar is allowed), lemonade, clear fruit juice and clear broth without chunks. Chewing gum is allowed, however do not swallow! Licorice or sour balls are not allowed. Two hours after lunch you will also start drinking 3 liters of Klean-Prep®, used for its laxative effect.
In the evening you will get a Fraxiparine shot to prevent thrombosis. You will get this every day during your stay. In the evening you will also get an enema to empty the rectum. The rest of the evening can be spent in your room at your own discretion.
If we have any doubts whether you actually stopped smoking, we will administer a urine test before surgery. If you fail the test, your surgery will be canceled.
THE DAY OF YOUR SURGERY
On the day of your surgery you will have to remain sober. You may drink a sip of water up to 6 hours before surgery. You can take a shower in the morning. You need to remove the hair in the area of the pubis up to the anus. The interval between hair removal and surgery may not exceed 6 hours.
We will inform you when you can go to the operating room. You will receive a surgical cap and gown. You are not allowed to wear underwear or socks under this surgical gown. You need to remove all jewelry, piercings and dentures or dental plates.
DAY 1 AFTER SURGERY
The policy after penile inversion vaginoplasty with or without skin grafts and after colovaginoplasty is the same. You should have bed rest right after surgery. If possible, you may sit up straight. You may also lie on your side with a pillow between your legs. The plastic surgeons will visit the patients on a daily basis. They will take a look at the wounds. You can also ask the doctor some questions. As of today you will have a regular diet.
Personal care is done in the bed. If necessary you will be assisted by a nurse. As of today the nurse will clean your wound with a disinfectant. This is done twice a day. You will receive pain medication and movicolon, a medication to get the bowel movement going. We will take some blood on day 1 to establish certain ranges in the blood.
DAY 2 AND 3 AFTER SURGERY
Your wound drain(s) will be removed (after consulting the doctor) if the drainage of blood and wound fluid has stopped. We will start to disconnect the urinary catheter, during the night as well, to train the bladder. You do this as independently as possible. If you underwent colovaginoplasty we will take some blood again on the 2nd & 3rd to monitor the infection parameters in the blood. During these days you may try to take a shower and if necessary go to the toilet.
DAY 4 AFTER SURGERY
On day 4 after surgery you are allowed to sit on a chair next to your bed. If your bowel movements have returned again you may stop using movicolon.
DAY 5 AFTER SURGERY
During his morning visit the plastic surgeon will remove the urinary catheter and any tampon that might have been inserted. This is followed by an examination of the vagina with a speculum (also called duckbill). Within 6 hours after the catheter has been removed you should have urinated a reasonable amount spontaneously. Once you have passed urine a second time we will scan the bladder to check if it is completely empty. If your bladder is not completely empty, the catheter will be inserted again and only be removed a week later. After the catheter has been removed we will prescribe antibiotics twice a day for 5 days.
The nurse will teach you how to rinse your vagina. You must rinse twice a day with a Betadine iodine solution, given to you by the nurse. The nurse will also teach you how to do dilation using the dilator set purchased before the surgery. See also the paragraph on aftercare: dilation. In principle, you may go home when you perform the rinsing and dilation of the vagina properly and you are able to urinate properly. The doctor will give you a sign when you are ready to go home.