Basically, it went well. I had the surgery 12 days ago. Below, I will go through the process step by step to this point. In following posts, I will provide more updates on my progress. If you have any questions, please ask them in the comments section following this post, and I will answer as best I can. If you have trouble making that work, and I don’t expect you will, send me an email at Nealprosthesis@gmail.com .
I chose Dr. Eid to do my surgery. His office is in Manhattan, NYC. My wife and I flew up there a week ago last Monday. Luckily, we were able to stay in a hotel directly across the street from the surgical center where the surgery took place.
The next day, a week ago last Tuesday, was the morning of the surgery. Of course, I was not permitted to eat or drink anything after the previous midnight, except for a sip of water to take my normal morning pills, and I had had a light dinner. For the previous few days, I had been taking baths with a special surgical soap, and using a stool softener as recommended by Dr. Eid. The anesthetics that you use after the surgery are very constipating. The stool softener mitigates that. I had one fecal impaction earlier in my life. Believe me, you DON’T want one
My surgery was scheduled for 7:30 AM, and we were asked to show up at 5:30 AM. I was actually happy about that because it meant that I didn’t have to go so long without food or water before the surgery. Also, it meant that the surgical team would be fresher, and not tired from a day of previous surgeries. The surgical center was very efficient in getting me checked in, and all of the people there went out of their way to make the process as comfortable as possible.
Soon, I found myself in a surgical gown being wheeled into the surprisingly small operating suite. Also, at that point, an IV had been installed in my arm. I was anesthetized by use of a spinal, and then a temporary general anesthesia, which meant that I “slept” through the procedure. First, I was moved from the gurney onto the surgical table. Then I was asked to bend forward so that my head was close to my knees. Finally, I felt a local anesthetic being injected into my lower back, followed by the spinal itself being injected. All in all, that process was not much more painful than any other injection, it was just delivered into an “odd” place. The general anesthesia was added to my IV, and I immediately went to sleep.
When next I woke, Dr. Eid immediately told me that the surgery had gone well, and that there had been NO complications. If he had been closer, I would have kissed him (see my previous posts about my earlier complications). I was moved to the recovery ward. I still had an IV in my arm, and I had very little pain. I was told that I would remain in recovery until I could move my legs and feel my butt, and had a pain level below 4 on a 1-10 scale. I immediately tried to move my legs and feel my butt. I could do neither! It is a very interesting and upsetting feeling to “send a message” from your brain to your feet saying, ”Toes wiggle”, or something like that, and nothing happens. It’s like telling a cup of coffee to move. I put my hand on my butt, but my butt couldn’t feel it.
When I had thought about this type of surgery, before it happened, I had expected the pain to be similar to the pain I had when the nasty boys grabbed my testicles or kneed them when I was a kid. That has not been the case. I've had some pain from the incision itself in my scrotum, but that has not been too bad. Also, as you will read below, I've had some pain because the skin of my scrotum, and earlier my penis, are somewhat swollen and sensitive. Other than that, I have sometimes had a dull pain in my groin.
The majority of the pain that I felt in the first 1-3 days after the surgery has been a burning sensation as if someone had put a torch on the front of my scrotum. Later, when I could look at my scrotum, I could see that the 3 stitches and incision in my scrotum were covered with what looked like the kind of instant glue that we all use in our homes. I could also smell the solvent in that glue, even 2-3 days after the surgery. When I discussed this with Dr. Eid, he told me that I was correct, and that a very similar, but surgical quality glue had been used. It turns out that these incisions on the scrotum tend to ooze blood for a few days after the surgery. That blood, on the outside of your scrotum, in that warm moist environment, is a great medium for the growth of germs. One of the most likely, and dangerous possible complications after penile implant surgery is infection. So, Dr. Eid had just started using this glue to seal the incision so that the blood could not ooze out and cause trouble. And it didn’t. I pointed out to Dr. Eid that this glue, or more likely, its solvent, could be causing the irritation and strong burning that I felt. He agreed that this was a possibility, and said that he would check that out and move to a different glue/solvent if that one was causing problems.
Normally, people are able to clear the spinal medication from their bodies in an hour or two after surgery. It took me from 9:30 AM to 3:15 PM to be able to move my feet, stand, and feel my hand on my butt. At about noon, as feeling began to return, my scrotum became painful, primarily with the burning sensation mentioned above. I was being asked continuously to assess my pain level. Finally, I was given some Percocet. By 3:15 PM I was finally ready to leave the recovery area. There seemed to be some administrative problem, however. For some reason, they were not able to move me to the discharge area, even though I asked several times to be moved. My pain level was also increasing. Finally, at 4:50, I called nurse over and told him that if he couldn't get me moved to the discharge area in 10 minutes, I wanted to speak to the head floor nurse. At 5 PM I was finally moved to the discharge area. I was placed in a lounge chair with wheels for the move, and while down there. Normally, that would have been very comfortable, but in this situation having my legs and my torso raised by the chair, above my groin, caused blood to flow to the area of the surgery, which greatly increased my pain level. Doctor Eid had told me that I needed to be lying flat, and that was not what this chair was doing.
Throughout the day, my blood pressure had been high. In the middle of the afternoon, they gave me something to lower it, and it did, for a while.
When I got to the discharge area, I found a very competent and friendly nurse who was doing her best to deal with me and three other patients. The result, however, was that I continued to be delayed there. Since my pain level was increasing, or perhaps because of the pain medication they were dispensing, my blood pressure went back up and I got nauseated. When the nurse saw that, she correctly pointed out that I wasn't ready for discharge, and I was rolled back up to the recovery area again. I continued to have bouts of pain, throwing up, and high blood pressure until 9:30 PM. I need to point out that have been diagnosed with high blood pressure, but it is also normally well-controlled by my blood pressure medication so that it usually reads as normal, and I had taken my normal blood pressure medication that morning. Pain can also increase blood pressure, as can some anesthetics. I continued to request pain medication, and each 4 hours I had been given more Percocet. For the most part, the Percocet had been ineffective. Finally, I pointed out to the anesthesiologist on duty in the recovery area that medical science should be able to better handle my pain, he gave me some Fentanyl and, which helped some, but not enough.
He also pointed out that I was in a day surgery facility, and that while they normally closed at 9 PM, they would be able to remain open until 10 PM, at which point, if I was stable and not throwing up, and with a reasonable pain level and blood pressure, I could be discharged to my hotel. But, if I was not stable, it would be necessary for them to call an ambulance for me and have me moved to a nearby hospital where I could wait on a gurney in the emergency room until I was stable. I told him I thought that was unconscionable, and that if it was necessary to move me to a hospital, I should be immediately admitted to a room. He issued me some Dilaudid. In any case, the Dilaudid began to work and my blood pressure and pain decreased enough for them to discharge me.
After I got to my hotel room we had a snack and I went to sleep with no other major complications. At that point I also had a thick dressing around my scrotum and penis, all of which was packed into a large jockstrap which the hospital had issued me, and which was in place when I woke up from the surgery. The next two days I remained in bed in the hotel as much as possible. I was still also attached to a catheter until Thursday afternoon when my wife and I took a cab a few blocks to Dr. Eid's office, where the catheter was removed.
This time, the catheter was not nearly as troublesome as it had been in the past. See my previous posts. I attribute this to keeping the tube covered with Vaseline where it entered my penis, and remaining in bed as much as possible. I also think that Dr. Eid use a smaller diameter catheter than the previous physician had.
We had planned to fly home that Thursday, but it was obvious that I was not ready to spend that much time dealing with planes and airports, so we extended our stay at the hotel and changed our reservations, which cost $1,000.00, and returned home the following Sunday.
My flight home, while UNreasonably expensive (don’t fly American Airlines), was reasonably comfortable. I had made arrangements with the airline for wheelchair support at all the airports. This is a free service that the airlines provide, and it was well handled and very helpful. In most cases they provided a wheelchair and an attendant to push it. In one case, they provided a tram which picked me up as I got off the plane, and moved me to the connecting gate.
Since I have arrived home things have continued to improve. I have had some significant bruising on my penis and scrotum, but this has faded greatly over time. I have also had some swelling of the skin of my scrotum, and it is sensitive to touch. I am sure from what Dr. Eid has said, that my surgery was more complicated than most, because first he had to remove the old single flexible implant before he could install the new one. This is probably why I had more bruising and swelling than most of Dr. Eid’s patients. The skin of my groin and scrotum was very dry as a result of the surgical soap used prior to the surgery. Normally, the skin of the groin and scrotum are a little oily and slide around a bit as we move. In my case, the skin has been dry and unwilling to slide. Since that skin is also very sensitive now, this has sometimes been quite painful. As a result I have applied a very thin layer of Vaseline based triple antibiotic ointment to the base of my penis and the groin areas where my scrotum meets my groin and legs. This has allowed those areas to slide against each other more easily. Be very careful to not apply anything near your incision unless told to do so by your physician.
Immediately after the surgery, for the first 48 hours, the doctor asked me to keep ice on my groin to help prevent pain and swelling. To do this we put ice in Ziploc type bags and then put those bags inside of socks, which we then applied to my groin. They were very useful for preventing pain, and decreasing it if it occurred. The only problem that we had was that the bags, after a while, all seemed to leak. Finally we sealed all of the seams with packaging tape. I suspect that duct tape would have worked even better, but we couldn't get any. Three days post op the doctor suggested warm baths twice a day for 20 to 30 minutes each. They were also very helpful, and I think they were useful in reducing the swelling and bruising. That said, my groin did seem more painful after I left a bath for an hour or two. As a result I have begun taking Oxycodone before each bath, and that has solved the problem. I also occasionally used ice between the bathes.
Doctor Eid has wanted me to maintain my penis pointed up toward my umbilicus (belly button) for two weeks after the surgery, and to wear a jock strap, which was supplied to me at the surgical center for this time, to help keep it there. See the hints below about the jock strap. This is done so that the scar tissue that forms during the first week would form properly for an erect penis. As I wrote above, the implants are substantially, but not completely, pumped up. As a result of the fact that the implants are not completely pumped up, my penis wants to bend and not stay in position pointed up. The material of the Titan implant is very substantial, and where the implant bends, it gets wider, with points at each end of the bend, just like a garden hose would if you bent it. I have done my best to keep it pointed as the doctor wanted, but 10 days post op I noticed that the inside of my penis, where this bend was sometimes occurring, was getting very sore. At that point, I decided to not wear it pointed up that night. The next morning I called Dr. Eid’s office and talked to his associate, Dr. Cohen. Doctor Cohen said that since I was having this problem, it was OK for me to not continue to wear the jock strap or keep my penis pointed up. The problem had been that while my penis was swollen, the fluid they had left in the implants was enough to keep my penis pointed up, but as the swelling has gone down post op, it would be necessary to pump more fluid into my implant to keep it up, but my scrotum is not ready for pumping yet. As a result, the best thing for me was to just let my penis hang down.
At this point, I can easily feel my new pump in my scrotum, but it is difficult to locate the release valve on my new Titan‘s pump. I am hoping that this will be easier as the swelling decreases in the skin of, and inside my scrotum.
My penis seems to be about the same length that it was before the surgery. Remember that I already had a single flexible implant in there on one side. For more information about that, see my previous posts. The diameter of my penis now is much larger than it has ever been. I attribute part of this to swelling from the surgery, and to the new double implant that is inside of it. Dr. Eid left the implant substantially pumped up so that now my penis appears to be about half erect and points down at about a 30° angle to horizontal. He said that this will decrease some over time.
Next Tuesday, when I am two weeks post op, I will see my local urologist who will evaluate my progress to this point, and remove my stitches. It looks like I have three stitches in my scrotum. If anything else significant happens there, I will do another post about that. It is expected that I will be more healed up one month after surgery, and at about that point I should be able to pump up my implant, and soon be able to use it. I’ll post about that too.
One other complication that I have had with this surgery is that my penis is numb on the bottom from the base of my penis to about 1 inch from the end (glans). Doctor Eid says that this is temporary, and that normal sensation will return in a few months. Apparently, this type of numbness in this part of the penis is unusual, and probably results from the bouncing around inside the penis that the penis undergoes as the implant surgery takes place. The nerves for the penis are routed along the top of the penis, and this area was not directly disturbed or cut by the surgery.
So far, I am very pleased with the surgical process, and the appearance of my penis. If I can get the pump sorted out, which should be easier as the swelling goes down, it looks like we will be having a lot of fun.
I think that the pain and throwing up that I experienced, and the unusual time I had to spend in the recovery area are unusual. I think they were caused by my body being so long in getting rid of the spinal block; and because of the administrative problems in the day surgery unit, and the anesthesiologist in the recovery unit in the evening. I will address those problems to the director of the day surgery unit, and to Dr. Eid. I expect that those problems can be quickly resolved.
What have I learned?
I will never again have surgery at a day surgery center. If a complication occurs, I want no more talk about being moved in an ambulance to another hospital’s emergency room, and being left on a gurney possibly for hours in the emergency ward, while they take their time sorting out what to do with me, and whether or not to admit me. I have discussed this with Dr. Eid’s staff, and they have assured me that they will talk to the surgical center to insure that this problem never happens again, but the only way I can ensure that it doesn’t happen to me again is to not allow myself to be in that situation again.
Having your penis in a jockstrap for hours on end is uncomfortable. One thing which makes it less uncomfortable is to wear some nice soft boxer shorts UNDER the jock strap and to pull the legs of the boxer shorts out under the leg holes (and straps) of the jock strap. (I know, that is not much of a fashion statement.) That way, the straps of the jock strap, and the edges of the front of the jock strap, are not digging into the swollen sensitive tissue of your groin. Also, have a couple of extra jock straps so that you have others that you can change into as they get dirty. Remember that your penis and scrotum will be swollen. You need a jock strap with a lot of cloth in the front part of it, which will hold all of this swollen equipment. These are hard to find.
Also, after you are no longer required to wear a jock strap, you still will not be comfortable for a while wearing just jockey shorts (briefs), or boxer shorts. For one thing, your swollen scrotum will still be uncomfortable without support, so boxer shorts will not work well. Your penis will be as long “flaccid” as it will be erect, so that it won’t fit inside jockey shorts unless it is pointed up toward your belly button, but it won’t stay there with out being pumped up, and you won’t be able to do that for a few weeks. What I found worked best was to do my old trick and wear boxer shorts under jockey shorts, with the legs of the boxer shorts pulled out of the legs of the jockey shorts.
No matter how macho we are, we all worry about pain. I have written a little about the character of the pain for me of this surgery above. But what about the amount? Sometimes when you are walking you will get a sharp stone in your shoe. If it is big and sharp enough, you will want to do something about it immediately, but you won’t fall down on the floor crying about it. That is the case for this pain. The first day is the worst, then it decreases as time goes by. I haven’t had any pain medication for the last two days, and I am 12 days post op. The pain at the surgical care center was caused by the pain pills I was given not being effective, and probably by the glue. It was unpleasant, but I could handle it, and so can you.
Doctor Eid and Doctor Cohen are and were available to me 24/7. This is invaluable. As you go through this process, problems and questions are inevitable. It is wonderful to be able to contact them and get the answers you need when you need them, not a day or two later if at all. Their nursing and clerical staff are also available, and VERY helpful. Finally, Dr. Eid is one of the major experts on penile implants in the world. My revision surgery was complicated, and I think he has done a wonderful job of it. As nearly as I can tell, working with penile implants and revisions is all he does, and he is an expert at it.
