DEFINITIONS

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• Fever: elevated body temperature; if greater than 101°F, notify your surgeon

• Rash: new red spots that develop on the skin

• Constipation: not having regular bowel movements (example: one large bowel movement per day is expected)

• Infection: surgical site that has redness that spreads beyond the incision line combined with increased pain and tissue swelling and/or pus

 

GENERAL INSTRUCTIONS

 

• Activity: Avoid any activity or position that puts strain or tension on your incisions.

  • Examples: sit ups, pull ups, compressing the glans

  • Pain is the body’s way of telling you a certain movement or position may inhibit healing; listen to your body and limit those positions and movements.

  • Walking is encouraged (about 1 hour per day; example: six 10-minute walks); check the surgical sites to make sure pressure/tension isn't applied on the incisions while walking.

  • No jogging for 6 weeks; start slowly and gradually increase to your pre-surgery cardio routine.

  • Avoid sexual activity for 6 weeks.

• Return to work: for desk dominant jobs, many can return to work when their pain is well controlled (usually 1-2 days after surgery). For jobs that are strenuous, 6 weeks off may be more appropriate.

• Diet: eat normally whenever your appetite returns. Water is a good drink choice.

• Showering: may shower in 2 days; no baths/pools for 6 weeks.

• Underwear: When wearing underwear, it may be more comfortable to have gauze over the incision. Slightly loose boxer briefs tend to work well. You will typically have mesh underwear after surgery.

• Genital positioning: position the penis and scrotum in a comfortable spot; it’s different for everyone.

• Driving: Do not drive while taking pain meds; therefore, don’t drive yourself until you are completely off pain meds.

 

SURGICAL SITE CARE

 

• Incision: closely observing the incisions and avoiding certain activities will help it heal.

  • Avoid putting tension on the incision.

  • Frequently, patients are provided mesh underwear with gauze; this can be removed and/or discarded a few hours later or the following day.

  • There will be steri-strips or purple skin glue around your groin incision; this will slowly peel in 7 days and can be removed in the shower at that time.

  • For the skin graft behind the glans ridge, a yellow gauze with ointment (xeroform) is used and should stay on for 5-7 days; if it falls off earlier, carefully replace a new xeroform dressing or gently apply ointment like Aquaphor, daily for 7 days. Avoid rubbing the graft.

    • After the original dressing is removed, continue to use daily ointment or the dressing for 7 more days; after 7 days, apply ointment daily.

 

POSTOPERATIVE CONCERNS

 

• Infection: redness spreading beyond the incision combined with worsening swelling and pain, and sometimes fever (defined as higher than 101°F) are consistent with infection; notify your surgeon immediately. If you notice chest pain or lightheadedness with these symptoms, call 911.

• Pain: this is very common and should stay about the same for a few days and gradually improve thereafter. It is not normal if the pain progressively worsens without any activity (that is, pain not brought on by any particular activity).

• Constipation: very common after surgery especially when needing to take pain meds regularly; make sure to take miralax or other stool softener while you are on pain meds.

• Drainage: it is expected/normal if it is a small amount of slightly blood-tinged yellow fluid. It is not normal if it is bright red blood or cloudy and cream colored, or if there is a large continuous volume with no improvement.

• Bleeding: occasional spot bleeding from the skin edges is expected and should stop with time; sometimes holding pressure (like holding your finger after a paper cut) over the incision for 5 minutes is required. If there is any concern or the bleeding does not stop, contact your surgeon.

• Graft: behind the ridge (anatomically called the corona), the skin graft may blister or bleed at the edges. If bleeding is dark and small volume, this is expected and should resolve within a week. If bleeding is bright red, hold pressure as indicated previously. Sometimes a blister may also form; these may pop or get absorbed over time. These areas will slowly slough, and as this area heals with new skin, it may require an additional 2 weeks of wound care (applying ointment daily, keeping it clean).

• Wound: if this occurs, use ointment like aquaphor on the wound and apply it 1-2 x per day. 

• Phallus: bruising is common and quickly resolves. Sometimes the phallus may feel cold. To reassure ourselves and ensure that there remains good blood flow to the phallus, squeeze your phallus gently and see if the color returns within a few seconds; it almost always does.

 

POSTOPERATIVE MEDICATIONS

 

• Take over the counter Tylenol 1000 mg every 6-8 hrs for baseline pain control. This will likely be needed for 3-7 days.

• Tramadol 50mg tablet: pain medication; take 1-2 tablets every 6-8 hrs as needed for breakthrough pain.

  • Over the counter ibuprofen 200-400mg is acceptable for further pain control if needed.

  • Take it with meals. Ibuprofen may be taken at the same time as Tramadol and Tylenol since they are not in the same class.

  • Side effects*: itchiness, constipation, diarrhea, nausea, sweating, insomnia; liver problems (when acetaminophen is included)

• Miralax: stool softener to be taken while on pain medication; 17g by mouth daily (mix powder with liquid of your choice)

  • Side effects*: nausea, gas, drowsiness, stomach ache, loss of appetite

• Bactrim (trimethoprim/sulfamethoxazole): DS by mouth, twice per day, for 7 days (take only as directed)

  • Side effects*: itching, rash, diarrhea, nausea, headache

  • If allergic to this or sulfa drugs, can substitute with  another antibiotic like Augmentin, Clindamycin, or Ciprofloxacin

 

*This is not a complete list of all the side effects that may occur with these medications. Getting side effects are infrequent; the side effects named are the more common ones for those who do experience side effects. Please call the office if you have any questions about your medications. Definitely notify us if you notice a rash that started soon after starting a new medication. If you notice shortness of breath or difficulty breathing after taking a new medication, call 911 and/or go to the nearest emergency room. You may be having a serious allergic reaction to the medication.

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Call office or your surgeon for fevers, chills, redness and pus from the incision, or pain not controlled with pain medication. If after hours, call the office phone number and leave a message; urgent messages will be relayed to the surgeons. If you feel it is a medical emergency and need immediate help, call 911 and/or go to the closest Emergency Room.