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location:  Transition  >  Bottom Surgery  >  Belgrade, Serbia Surgery I wrote this primarily to document my personal surgical experience. I'm sure I explained my experience to a level of detail that most others would not be interested in, but I still wanted to make it available in case it could answer any questions someone might have. Therefore, I have made suggestions on how to use this write-up most effectively. How to use this write-up:     1. Use the Edit --> Find function to search for key words that relate to what you are looking for; or     2. Forgo reading the document and see if what you are looking for is in the Timeline. Saturday, June 16, 2007 - 3 Days Pre-op The airport van service picked us up at about 1:00 pm, and after picking up two more parties, we arrived at Boston Logan Airport around 2:30 pm. My mother's flight to Boston was arriving at the same time so we met her at our departing gate. Right by the gate there was a currency exchange office where exchanged 1,172 USD to 800 Euros, mostly to spend in the Paris airport since Serbia uses Dinars, not Euros. They did not have Dinars at this exchange office so we figured we'd get them in Paris or in Belgrade. Then we all got something to eat at the airport restaurant, and soon it was time to board our 5:35pm Air France flight to Paris. Even though the flight was almost seven hours, it didn't seem nearly that long since they had individual TV and movie entertainment for every seat. Sunday, June 17, 2007 - 2 Days Pre-op We arrived in Paris at 6:15 am, local time. The Paris airport was basically just navigating through a clusterfuck of people. We needed to get to a different terminal, and because we had so much time between flights, we were going to walk. But somehow we ended up in a large group of people waiting for the bus that goes between terminals. Tons of people trying to jam in to a small bus - not fun. Maybe it was just a heavy-travel day, but even so, if you have time, I'd suggest walking between terminals instead of taking the bus. Our Air France flight from Paris to Belgrade left Paris at 9:35 am and arrived in Belgrade at 11:50 am, local time. By this second flight, we were all extremely tired, because to our body clocks it was 6:00 am, not having slept the night before. When we arrived in Belgrade, we presented our passports to customs agents, claimed our bags, and walked through the "Nothing to Declare" line. Right before the exit to the outside, there is a currency exchange office so we exchanged 750 USD to 44,317 Dinars (the Serbian currency), certainly not hoping to spend it all, but wanting to be ready for anything. When we walked outside, there were many people waiting for their loved ones. I spotted a man holding a sign with my name on it, and he introduced himself as Marko, one of the doctors on the Belgrade team. Marko took me, my fiance Moly, and my mom first to the Police Station to register. Apparently, registering foreign visitors at the Police Station is required, but it doesn't really mean anything - it is a requirement left over from the former-communist government - now they still collect the information but don't do anything with it. Marko then took us to the apartment. The apartment is very nice and very clean inside. There are three floors - on the first floor, there is a half-bath, kitchen, kitchen table with four chairs, a three-seater couch, two chairs that match the couch, cable TV, and dial-up internet access. The second floor has a full bath and one of the bedrooms. In this second-floor bedroom, there is a large closet they keep medical supplies, towels, sheets, etc. in. Stairs to the third floor open onto a rectangle-shaped area with a single bed, double bed, desk and chair, and half bath. The apartment does not have central air-conditioning, but each floor has a separate air conditioner that can individually controlled. Since it was Sunday, the Maxi supermarket right across from the apartment closed at 3:00 pm, instead of the normal 9:00 pm. By the time we had gone to the Police Station and checked out the apartment, it was already 2:15 pm so we made a quick run to get some groceries. Most items we had to deduce what they were through the pictures on the product. The grocery store is small but has a good selection of fresh fruits and veggies, a wide selection of meats, and mostly stocks the other basic pastas, crackers, and breads. Even though we tried our best not to, we spent the rest of the evening napping. Despite this, I don't think any of us had any trouble sleeping that night. Monday June 18, 2007 - 1 Day Pre-op The other person having surgery (the day after me, I'll refer to him as L) arrived at the apartment in late morning. Then Marko took me, Molly, and L to the clinic (BeoKlinika) to meet the anesthesiologist Dr. Korac and have some bloodwork done. The clinic is very nice, most likely one of the nicest buildings on the inside in the area since it is only a couple years old. The first floor is where they draw the bloodwork, and many strangers were in the waiting area. Despite the non-smoking sign on the first floor, the room smelled strongly like cigarette smoke. We checked in with the head nurse and then headed upstairs. The upstairs main area and offices did not smell like smoke at all. However, the air system must have been rigged so the air from downstairs went through my bathroom, because my bathroom smelled heavily of cigarette smoke. I had to keep the door closed at all times, and it was difficult to spend any significant amount of time in there without feeling like I was smoking one myself. We met the anesthesiologist Dr. Korac, and L and I took turns meeting with him. He discussed the anesthesia process and asked if I had any questions. They induce you with an IV anesthetic and oxygen by mask. Then they intubate you. At the end of the surgery, they give you a drug to block your memory of them extubating you. He said they prepare blood products in advance in case you need them, and if you do not use them, they dispose of the blood. He told me the blood they use is from either the UK or the US, not from within Serbia, and the blood has been screened in the normal manner for diseases, including HIV and the Hepatitises. After I was done with my questions, we both signed a paper that just said he had explained the anesthetic procedure and gave me a chance to ask questions. After L had his turn with Dr. Korac, we all went downstairs to get our blood drawn. Then, Molly and I hung out at the cafe next door while Marko brought L to the Police Station to register. They came back to pick us up, and we all returned to the apartment. That night we mostly relaxed and watched TV, getting ready for the big day. Tuesday, June 19, 2007 - Surgery Day Marko arranged for a taxi to pick up me, Molly, and my mother from the apartment around 10:30 am and bring us to the clinic. When we arrived at the clinic, we checked in with the head nurse and were showed to my room. The nurse asked me if I had shaved my genital area, and I had not. We had actually brought 4-blade razors and shaving cream for this very purpose, but since no one had told me that I needed to do it, I assumed they were planning on shaving me once I was under anesthesia. But instead, they wanted me to shave beforehand, and the nurse brought in a small pack of razors and some shaving cream. So, five single-blade razors and about 45 minutes later, I was bald from about an inch under my bellybutton to halfway down my thighs, bounded by my hips and the middle of my leg. I shaved my entire genital area, including around my anus and about three inches on either side. Although this seems like a rather large area, post-operatively I realized I should have shaved both butt cheeks as well. I think the original shave job was adequate for the surgery, but I have been blessed with rather hairy butt cheeks, and honestly the most pain occurred when they pulled the bandage tape off of the butt cheek part that still had hair. If I were to do it over again, I would definitely shave both butt cheeks to avoid that excruciating pain. My surgery was scheduled for 2:00 pm. At about 1:30 pm, Dr. Miro, Dr. Korac, and Dr. Marta, and Marko came into my room, and Dr. Miro asked me if I had any questions. After answering my questions, Dr. Miro and I signed a similar document to what I had signed the day before with Dr. Korac, stating he had explained the surgical procedure and gave me a chance to ask questions. They also had me sign something for the clinic, which was written entirely in Serbian. Dr. Marta said she would translate it for me word-for-word if I wanted, but I just said I would sign it as it was normal hospital paperwork. A little while later, a nurse came in and gave me a surgeon's gown (I guess they use them as regular "Johnnys") to put on and some slippers. I took off all of my clothes, put on the gown and slippers, and said goodbye to Molly and my mother. They led me through the preparation room, into the surgical room, and sat me on the surgical table. I was so nervous, I didn't even notice who was in the room, except for the anesthesiologist who was standing right by the table. He had me lay down and pulled the gown to my waist, exposing my chest and both my arms. He started an IV and took off my glasses for me - it was nice they let me wear them into the surgical room, that has never been the case before in my experience. I noticed a nurse standing with a filled syringe standing at my IV, and I assumed it was the induction drug. The anesthesiologist put a black mask over my nose and mouth; he told me it was only oxygen. He must have told the nurse to push the induction drug right then, because the last thing I remember before the surgery was noticing the black tube connecting the black mask said "Anaesthetic"... The next thing I remember is the anesthesiologist repeatedly saying my name and telling me to open my eyes. As soon as I opened my eyes I felt them extubate me. You are not supposed to remember extubation, so I must be more tolerable to the anti-memory medicine or something. I remember him saying, "Keep breathing, keep breathing," and then thinking to myself Oh shit, I'd better keep breathing because I'm now extubated - if I stop breathing there is now no way for them to breath for me. Ah, the benefits of being in the medical field. He put my glasses on me so I could see, then they wheeled me into my room and transferred me to my bed. The surgery took about five and a half hours. At midnight, all four doctors came back to the clinic to check on me. Ever since I had come out of surgery, I had been repeatedly telling the nurse that I had to pee. I had the strongest urge to pee, it was unbelievable - and logically I knew that I didn't really have to pee because I was connected to a catheter bag through the suprapubic catheter. But my bladder kept telling me that I had to pee! When the doctors got there at midnight, the nurse told them that I was feeling that way, and she had tried compressing my bladder externally. The doctors told me that it was a normal feeling, and my bladder was just getting used to having the suprapubic catheter in it. The first night post-op was definitely the hardest. They kept me on an EKG machine all night that beeped so loudly right next to my head with the rhythm of my heart beat. Sometimes, when it felt like I had just fallen asleep, I would be jolted awake to the sound of the machine flat-lining. The first time it happened, I was so scared, because it sounded like I was flat-lining, but there I was, startled awake! It must have just been the machine, because I heard it happen to L the next night. A nurse sat in my room at the foot of the bed the entire night and would periodically take my temperature and blood pressure or connect something new to my IV. Every couple of hours she would also put saline in the stint in my new urethra in my penis to keep the buccal mucosa wet. Wednesday, June 20, 2007 - 1 Day Post-op I woke up in the early morning to Marko visiting me and asking me how I felt. Compared to the magnitude of the surgery itself, I was not in very much pain. Still, I was in a lot of pain. My balls hurt a little, but what really hurt was my lower back and tailbone, because I had been lying on them for so long without moving. He removed one stitch, I'm not sure from where, which hurt like hell. Later in the morning Dr. Miro and a visiting doctor came to see how I was doing. They noticed that I had a small hematoma on the tip of my penis. Dr. Miro punctured it to drain the blood, and that hurt like nothing else I have ever experienced. Dr. Miro said, "Believe me, it is good you are feeling this." How true, but he was sticking a needle into the glands of my penis! I'm glad he did though, because it resolved in about a week. They let me start drinking water, and was encouraged to drink a lot of water, but to do it very slowly. That day I later was given some chicken soup with a little bit of pasta in it. I had heard that the food in the Serbian hospital is not very good, but in my experience it was actually quite good. They made me stand up and take a couple "penguin steps" while they changed the bed. I was so scared of vomiting, since I had a very bad vomiting/passing out experience after my chest surgery. This time, although I felt very weak and light headed, I managed not to pass out or vomit, much to my relief. My room was directly off of the preparation room - in other words, in order to even get to the preparation room and then to the surgery room, you had to go through my room. So it was basically Grand Central Station when there was another surgery, or when someone needed something from the preparation room. There was also a window, which was nice, but the combination of the two made it very difficult to get darkness and quietness in the room. I'm extremely sensitive to light while I'm sleeping (and sound if I'm sleeping lightly, as I was in the clinic) so the constant turning on and off of the overhead lights was stressful for me. Also, they play music in the hallway during the day and late into the night. My door was commonly left open, and I had to constantly request that the nurses close it so I could try to block out the sound so I could sleep. I'm not going to lie - the room was not comfortable for me due to the light and business. I know that L's room was not connected to the surgical suite and his window blinds were always very dark (I'm not sure they even opened) so perhaps if you are a light sleeper, it may be better to try to avoid the room I had. Even though the room sucked, all of the nurses are wonderful and attentive. My room was especially Grand Central Station on this day, because L was having his surgery. He had come a couple hours before his scheduled surgery time (also 2:00 pm - they make it for that time because to our body clocks it would have been 8:00 am) and visited in me in my room. Molly and my mother were there too, so we talked for a little while and watched TV. Soon it was time for him to go into surgery, and Molly and I napped and watched TV for the rest of the evening. After L's surgery was over, Dr. Miro and a couple of the other doctors came into my room to change my bandages. As I mentioned before, taking the tape off of the area on my butt cheeks that still had hair was more painful than any other part of the bandage changing. I learned that they put in a drain just below your balls on one side to drain any blood (I presume from the vaginectomy). They checked to see how much blood I was draining, and there were only a couple drops. They had wrapped my actual penis with a compressible, elastic bandage so they changed that as well as all of the gauze surrounding my balls. Then they put the giant strips of medical tape back on, the ones that were so painful to come off. The whole process hurt a ton less than I expected it to - besides the tape coming off - so, as ridiculous as it sounds, don't forget to shave your butt cheeks. I had also woken up with a total of three IVs, all in my right hand. The nurse asked me which one hurt me the most, which was the one at my elbow, and took it out. I continued to receive IV antibiotics a few times per day. I had to ask for pain medication, and it was given through the IV directly or was injected into the fluids they were giving me by IV. Since I had had some food that day, they let me take a Percocet by mouth in the evening. At the end of the evening, they took me off IV fluids, but left in the two remaining IV lines. Thursday, June 21, 2007 - 2 Days Post-op The second morning I woke up with a horrible migraine. The bright lights in the room and the music in the hallway were just killing my head. Nothing seemed to make it go away. I think it was a combination of lack of the normal pain medication they had been giving me (which was just an NSAID) and the fact that I essentially hadn't had anything to eat in at least 12 hours (they had taken me off of IV fluids the night before). Once I got something to eat, my headache got significantly better, and from then on I tried to make sure I had a Clif Bar on my bedside table just in case and began asking for the NSAID drug instead of taking the Percocet. Besides my headache, the second day was rather uneventful. For breakfast I had best chicken sandwich from the restaurant next to the clinic, for lunch a cheese and tomato sandwich, and some soup and mashed potatoes for dinner. My room was Grand Central Station again, because there was some other urological surgery taking place. Molly and I watched a lot of TV and took naps on and off. My lower back and tailbone were extremely painful from having continuous pressure on them. Getting up and walking around was the best remedy for this pain, albeit temporary relief. The nurses were all very encouraging about getting up and walking so I walked across the hall to visit L to sit and talk with him for a while. When I saw the anesthesiologist later that day, he asked me if I had gotten up. I told him I walked across the hall to visit L, being all proud of myself, and he warned me not to walk too much, because you can change the position of the testicular implants. So that was all the walking I did that day. I slept slightly better that night, because Molly had figured to put a pillow under my knees and not to put the bed all the way flat, which alleviated the stress on my lower back/tailbone and kept my hips at a comfortable angle. Still, my back was very painful and it was difficult to adjust myself into a new position. I found that I tensed by legs a lot to keep them in certain positions, then would suddenly wake up to my legs jerking or falling out of position. So, needless to say, sleeping wasn't the easiest. Earlier in the day I had told one of the nurses that the IV in my wrist was very painful, and it had gotten to the point where I couldn't bend my wrist at all. So the overnight intern said he would take it out at midnight, which he instructed the nurse to do. After getting that IV out, my hand felt much better. I did continue to receive IV antibiotics a few times a day. Friday, June 22, 2007 - 3 Days Post-op The third day post-op was probably the most uneventful hospital day. By this time, I was just so tired of not sleeping and being in the clinic that I felt like I was going crazy. I was really looking forward to going back to the apartment the next day. The nurse and another doctor changed my bandages. I think I was more prepared for what kind of pain to expect (from taking the tape off) so it wasn't as bad as the first time. I got up and walked to see L again, but chose to remain standing in his room, because my tailbone and lower back were hurting so much. The nurse had tried to get me the same awesome chicken sandwich for breakfast, but she said the cooks weren't at work yet and she would get it for me for lunch - so I had cherry pastries for breakfast instead. Lunch was the chicken sandwich, and they gave me options for dinner: pizza, hot dog, or sandwich. I chose pizza, because you really can't go wrong with cheese on bread. Saturday, June 23, 2007 - 4 Days Post-op Finally it was time to go back to the apartment! They gave me a cheese sandwich for breakfast, and I anxiously waited for Dr. Miro to arrive around 10:00 am. When he got there, Dr. Miro changed my bandages (again, making me wish I had shaved my butt cheeks) and gave us some paperwork and the photos of my surgery. The nurse unhooked me from the catheter bag and put a glass stopper at the end of the suprapubic catheter. I got dressed for the first time, in a T-shirt, boxer briefs, and scrub pants (which was the ideal outfit since it was loose and lightweight). The nurse gave me one last dose of IV antibiotics directly into the IV, then took the IV out. After hobbling down the stairs like an old man, Marko, Molly, my mother, and me all piled into Marko's car, and he took us to the apartment. They had offered for me to take my first shower at the clinic, but I decided I wanted to wait and do it at the apartment later. I slept for most of the day, but we did manage to give me a shower, which was rather difficult and exhausting. In the second floor bathroom at the apartment, there is a large, jetted bathtub. There is no hanging showerhead; you have to hold the showerhead up yourself if you want to stand under the falling water, as in normal US showers, leaving only one hand to soap yourself. Since I needed to have one hand on the wall or tub at all times to stabilize myself, showering by myself would have been a very interesting and difficult adventure. Molly did all of the work, and I can't imagine what it would have been like without her, having to bathe myself that day. I was also able to brush my teeth for the first time since surgery, which felt awesome. However, due to the sutures in the side of my mouth, I couldn't open my mouth very much and it was very difficult to brush the teeth on the side of the incisions. Everything was pretty much fine, except my suprapubic catheter started to become very painful and irritating. We had switched the glass stopper for a clamp, and whenever I would clamp or unclamp it in order to void, I would have one extremely sharp, but very fast, pain where I would have estimated my old urethral opening to be. Since there was nothing I could do to prevent it, I just grit my teeth and hoped it would eventually stop. I also began the post-operative oral antibiotic regime (Augmentin 1 gram 2x per day, Levaquin 500mg 1x per day), which is continued for seven days. After seven days, you change to only Augmentin 1 gram 1x per day until you begin voiding through your penis. Sunday, June 24, 2007 - 5 Days Post-op I was excited to see that L came back to the apartment. When he brought L back, Marko took a quick look at me and said that everything seemed fine. It was so nice to be out of the hospital and sleep next to Molly. Also, I began eating anything I wanted, not just limiting it to soup and sandwiches. The painful irritation in my suprapubic catheter got a lot worse. Instead of just feeling the spasming when I clamped or unclamped the tube, I began feeling it at the end of emptying my bladder. So, I would open the clamp on the suprapubic catheter, and urine would start to come out to empty my bladder. It would empty extremely slowly, which I know is normal. I would stand there for a couple of minutes (a long time to be emptying your bladder!), until I would feel the spasming and intense pain where what felt like the end of my original urethra. The spasming would cause a pulsatile motion to suprapubic catheter, as if air bubbles were trying to get in from somewhere. Obviously, I have no idea if this was exactly the case, but this is just what it felt like. Monday, June 25, 2007 - 6 Days Post-op Molly helped me with another shower, which at best is quite an adventure. You can't get the suprapubic catheter wet where it is stitched to gauze at the point it enters your body so I had to hold a towel there the entire time. My belly was so distended with constipation, it was hard to keep the towel right up against my body. But after the shower I felt a lot better and certainly much cleaner. Marko came to check on us in the afternoon. I told him I was worried about the appearance of blood in the stint in my new penis so he gave me and L a needle and syringe for us to rinse it out with saline. He also instructed me to remove the old blood around my penis and sutures with wet cotton balls or swabs in the shower. Although they said I could get my penis and balls wet (no soap), I hadn't gotten them wet at all, because anything that touches the stint in my penis makes it very painful. So we cleaned it out with the cotton swabs and saline instead. I also told him about my painful voiding experience, and he said that the suprapubic catheter must have ended up in the neck of my bladder, which is what would cause my bladder to spasm. He said that when they insert the catheter into the bladder, they have no control over where it ends up - sometimes (if you're lucky) it ends up in the bladder lumen and not touching the bladder walls; if you're unlucky it ends up in the neck of the bladder, which contains the neurons responsible for initiating bladder contraction. He smiled and said, "Guess you're not one of the lucky ones." Oh well. I continued to have the intense pain at the end of emptying my bladder through the suprapubic catheter. That night was a really bad night for this especially. Molly and I were lying in bed, watching a DVD, when the entire catheter began pulsating, correlating with the pain inside. I tried to just tell myself that it was due to the suprapubic catheter being in the neck of my bladder, as Marko suggested, but it was so painful and making me crazy that I vowed to get it checked out at some point if it continued once I returned home. Tuesday, June 26, 2007 - 7 Days Post-op Exactly a week post-op was very relaxing and nothing too remarkable happened. Probably the most exciting thing that happened was that it hailed a couple times in the middle of a thunder storm. None of the doctors came to the apartment, and I continued to have the pain at the end of emptying my bladder. I had been pretty constipated since coming home from the clinic so we took out the big guns for constipation: Miralax. Wednesday, June 27, 2007 - 8 Days Post-op Still, my major concern was my continued pain at the end of voiding through my suprapubic catheter. Marko came to check up on us late that evening. He said everything looked great, and I told him I was still being very bothered by the catheter. Marko said he had talked to Miro about my problem, and Miro had offered to take the stitches out that were holding the suprapubic catheter in, pull it out a little, then readjust its position to see if that would help. I said I definitely wanted to purse that. I took another shower, and this time, I got my balls and penis wet a little. I had been told not to use soap yet, so I didn't. Also, I noticed that the swelling around my mouth stitches had gone significantly down, and the only part of swelling left was that closest to my lips, probably because that is the place that moves the most when talking, eating, and smiling. Thursday, June 28, 2007 - 9 Days Post-op For some blessed reason, I was able to actually sleep though the night and into the late morning. Marko called around noon and said he would have a cab ready to pick us up at 2:00 pm to bring us to the clinic. At the clinic, they first did an ultrasound of my lower abdomen to look for any hematomas or residual bleeding due to the vaginectomy. I had a very small hematoma (estimated at 2 cm), which they said was common and would be OK. They then took the stint in my penis out, which was only painful at the beginning, because there was a lot of dried blood around the stint on the tip of my penis. I was astounded at the length of the stint: 17 cm! They thought I was crazy when I asked if I could keep it; I felt like it would be a great souvenir, plus I felt like I earned it! Because I had been having so much pain in my bladder, Miro filled the balloon in the suprapubic catheter inside my bladder, then they ultrasounded it to see where the end of it was sitting. The ultrasound showed that it actually was not in the neck of my bladder, but instead it was sitting to the side. I hadn't had any of the bad twinges of pain, so Miro suggested that it may have actually been the stint in my penis that had been causing the pain. I agreed to leave the suprapubic catheter in place, and see if the removal of the stint would solve the problem. Miro also put some saline down my new urethra, and they did not see any fluid leaking anywhere at that time - a good sign for avoiding fistulas. I was also instructed that I was now allowed to "shower normally," meaning I could now get the suprapubic catheter wet and use soap on my balls and penis. After L had his appointment, Miro, Marko, Marta, Vladimir, Molly, me, L, and L's friend all went out to lunch. They treated us to a very nice lunch (and we had leftovers for dinner!) and some good conversations. They are all so passionate about their jobs and the magnitude to which they help people is unbelievable. Sitting for so long in the car, at lunch, then in the car again on the way back to the apartment was extremely challenging, but it hurt less than I had expected. Part of that was probably because I was on pain medication and part was probably because I was so happy to be out of the apartment and into the outside air and sun. When we got back to the apartment, I emptied my bladder and was worried I was still going to feel the spasming pain. Unfortunately, I still felt the pain, but it wasn't quite as bad as before. Also, I hadn't had any random pains, which was a good sign. I hoped that still feeling it after emptying my bladder was just because it had been irritated for a week and would go away with time. Friday, June 29, 2007 - 10 Days Post-op Miroslav the taxi driver took us on a tour of Belgrade from 9:00 am to 2:00 pm. We saw a bunch of old churches, government buildings, and the Kalemegdan fortress. We walked around Kalemegdan a lot, probably more then the 100 meters I was supposed to be walking per day, and by the time we got back to the apartment I was very sore and exhausted. Molly and I took a nap, which I had been avoiding doing during the day since I was having trouble going to sleep at night, but this time I just couldn't keep my eyes open. The pain in my bladder continued as the day before, still there but now I had it only at the end of voiding, as opposed to also occurring randomly throughout the day and night. Luckily, since I got the stint out of my penis, the pain at the end of voiding was not as sharp and was more of an ache. I was finally able to take a shower normally, being able to get the suprapubic catheter wet and use liquid dial soap on my balls and penis. Saturday, June 30, 2007 - 11 Days Post-op Miroslav the taxi driver came over in the morning and brought us breakfast - he is so nice and thoughtful! This was the last day of taking the current antibiotic regime (Augmentin 1 gram 2x per day, Levaquin 500 mg 1x day), and I began the second antibiotic regime (Augmentin 1 gram 1x per day until beginning to void through penis). We hung around watching TV and packing our bags until Marta came over to collect our passports to sign us out at the Police Station. Marta also examined me, and said everything looked great. I had some crusted blood around my new urethra on the tip of my penis, which I had previously briefly attempted to get off but had then decided to leave alone. She wet it with some saline and removed some of the crusted blood, but some of it was really stuck on so she told me to try to get it off in the shower. She squirted some saline into my new urethra to clean it out and to see if it was leaking anywhere. She did not see any sign of leakage, which is a continued good sign for avoiding fistulas. I showered normally again, using liquid dial soap on my balls and penis. After the shower, I was able to remove the crusted blood that was left inside the tip of my new urethra, that Marta had tried to remove earlier. Just the simple act of showering makes everything much more sensitive, to the point where I cannot close my legs as much as before the shower. Also, it made me much more tired, illustrating the fact that recovery is definitely still in process. Sunday, July 1, 2007 - 12 Days Post-op Marta and Vladimir picked us up from the airport at 11:30 am to take us to the airport. At the airport, Marta walked us in, helped us check in, exchange our remaining 23,401 Dinars to 396 USD, and get to the security checkpoint. That means we spent about 350 USD on groceries, taxis, and tourism for the entire two weeks. Going through security wasn't nearly as difficult as I had thought it was going to be, but we had to do it twice (once to get to the gates and another time at our actual gate) so that was rather annoying. We also had to go through Passport Control, where they took the registration card we had gotten at the Police Station when we checked in - so be sure to save that! We were in a hurry to make our flight so it was hard to walk at a normal-to-fast pace, as I had been walking at a rather slow pace since surgery. Our flight was delayed in boarding so the most difficult thing was standing up for so long - it really made my balls hurt. I hadn't taken any pain medications before we left the apartment, which in retrospect was definitely the wrong decision. I would highly suggest taking some pain medications before leaving for the airport, to make sure you aren't in excruciating pain if you have to wait around for a while before boarding. Marta had warned us not to request a wheelchair in the Belgrade airport. Apparently, a guy who had the same surgery asked for one before, and airport security required a doctor at the airport to give him a physical exam to make sure he was fit to fly, resulting in him having to delay his flight for two days. It wasn't really that much walking in the Belgrade airport, but I would make sure to leave plenty of time - we were a little late and rushed, which made it even more difficult to walk in order to make our flight. While we were in Belgrade, my dad had called Air France to make sure there would be a wheelchair waiting for me in Paris and in Boston. Having the wheelchair in both airports was key. I would definitely advise requesting the wheelchair, because it spared me from walking all over the Paris airport, and it also got us to the front of the Passport Check and Security Checkpoint lines right away. In addition, they moved us between terminals in a private wheelchair-accessible van, instead of through the tram that was crowded with tons of people. We had tried to request the bulk-head seats (first row, with more leg room) so it would be easier to keep my legs apart. They tried, but they couldn't give us those seats, so instead they gave us seats A and C, leaving the middle seat B empty. That was very helpful. Apparently, when you request a wheelchair, you automatically are given priority for such requests so I would definitely suggest making the most of it. I wore boxer briefs and very loose pajama pants to fly, which in my opinion was the ideal outfit. The boxer briefs kind of hold everything in place without too much restriction or rubbing on sensitive parts, and the very loose pajama pants were good because they allowed me to keep my legs apart wide enough to minimize pain. I also kept my two donuts that Miro had made for me with me at all times; sitting on them in the plane was extremely helpful since it is difficult to recline in airplane seats enough to be in the most comfortable position. The Boston airport would have been where we could have exchanged any remaining Euros for USD, but we did not have any Euros left. We had gotten 800 Euros on the way to Belgrade, but the apartment had come to 798 Euros (at 50 Euros per night, plus 14% tax). Sunday, July 8, 2007 - 19 Days Post-op Ever since the surgery, I hadn't been bleeding at all. However, I started bleeding from the stitches between my balls, right where the vaginectomy was, and it continued for a couple of days so I emailed Marta. It appeared as if the stitches tore, leaving a hole that just continually dripped blood. Marta wanted me to email photos to her. She said that I should just wear a pad, and it should stop in a couple of days. I was very nervous about bleeding so much, especially because it just kept coming and didn't seem to want to clot. But I wore a pad and tried to keep gauze between my balls to help it stop bleeding. Thursday, July 12, 2007 - 23 Days Post-op I noticed the bleeding between my balls had stopped. Even though I was skeptical that it would stop, I luckily only was bleeding for about a week total. I guess Marta was right, and it did heal up on its own! Sunday, July 15, 2007 - 26 Days Post-op I voided for the first time through my new urethra. I had heard that many people spray when they are first voiding, instead of having a single stream of urine. So I decided to just pee standing in the shower for the first time to prevent any mess. I did spray at first, then it turned into a single stream. It burned a lot, between my balls, probably because of the acidity of the urine on the new urethra. At the end of voiding, I dribbled urine mixed with blood for some time so I decided just to wear a pad to prevent it from getting on my underwear. Also, it felt like there was urine left in the urethra after I was done voiding, which wasn't painful, it just felt like moving liquid between my balls. The next time I voided the same day, I had a little bit of pain around the suprapubic catheter, both externally on the skin and internally where my bladder sits. When I voided again that night, I felt that bladder pain a little more. This same time I had a bowel movement, and then I reflexively tried to void again. This time, when I was trying to void when my bladder was basically empty, there was so much pain and the urge to void was not going away. I began to panic because it felt like I had to pee so badly, but I knew my bladder was empty, and there was so much pain inside my bladder. Literally, it was more painful than any part of the surgery so far. That night, I decided to just use the suprapubic catheter to empty my bladder in the middle of the night, because I was afraid of it happening again. Wednesday, July 19, 2007 - 29 Days Post-op I had an appointment with a local pediatric urologist (I had already had a consult with him a couple months before surgery). He had suggested doing a voiding cystourethrogram (VCUG) before removing the suprapubic catheter, just in case I had a fistula or stricture that necessitated leaving it in a little longer. The VCUG was scheduled for 9:00 am, and my appointment with my doctor was at 9:45 am. The VCUG test involves technicians putting contrast dye into the bladder (usually by catheterizing the native urethra, but in my case they just put it through my existing suprapubic catheter) until you feel like you need to void, then taking a series of radiographs (at a rate of two per second) while you urinate. As you void, the contrast dye exits your bladder and flows down your urethra, thus highlighting on the monitor where exactly urine is flowing when you void, allowing them to see any strictures, fistulas, diverticula, or other abnormalities. After they put the contrast dye into my bladder via my suprapubic catheter, they raised the table so I was in a standing position and the x-ray area was positioned around my lower abdomen. They gave me a plastic male urinal and told me to urinate when I felt comfortable. Urinating for the past couple of days had caused a fairly painful burning sensation, mostly between my balls, so I was nervous about how painful the VCUG was going to be. However, urinating the contrast dye was not painful at all, probably because it wasn't as acidic as normal urine, which was relieving. The most difficult part was managing my post-voiding dribble so it didn't run down my legs, all over the floor, or on the technicians. We then went upstairs to see the urologist. He said that the VCUG showed that my urethra looked like a good size and did not show any signs of obstruction (like a stricture). However, it also showed that when I voided, some urine was flowing through a fistula in the posterior 1/3rd of my new urethra and was collecting posteriorly in a space. However, when I was done voiding, the urine was no longer there (so it flowed through the fistula, into a space, then possibly back through the fistula into the urethra, then out). They weren't exactly sure how the fluid eventually got out of my body - either by dripping from the end of my penis (which would explain the post-voiding dripping) or through the stitches between my balls (which would explain how sometimes those stitches were slightly wet) or both. What they did know for sure was that urine was flowing through a fistula in the posterior 1/3rd of my new urethra, into a space inside my body, then somehow ended up outside of my body. The urologist said he thought it was going to be OK to take the suprapubic catheter out, as he thought that was what was probably causing the pain in my bladder area. He said that even with the small fistula, taking the suprapubic catheter out wouldn't impede upon it healing. I may have to deal with some dripping from the tip of my penis and/or from the sutures between my balls for a little while, but it would eventually close up. I expressed to him that I was fine with that idea, except that I was worried that by taking out the suprapubic catheter, I would then be forced to void only through my penis - I wanted to be sure that I didn't have any fluid collection (fluid that wasn't draining after urinating) before taking it out. He agreed and ordered an ultrasound of the area to make sure there wasn't any fluid pooling in the area (ie. that all of the fluid flowing through the fistula eventually ends up outside of my body, instead of creating a pool somewhere inside and just sitting there). In the ultrasound, they first took images while I had a fairly full bladder. Then they had me void so they could take some images of the fluid that was left in the space in question. They said they could only see a very small line of fluid that was resting between my balls. We went back up to see the urologist, thinking that he would take out the suprapubic catheter and send me on my way. Upon talking to the urologist again, he said that he had taken another look at all of the images from the VCUG and had talked to the technicians that did the test. As it turns out, he said it looked as if the space in question was actually a "pocket" of vaginal space. In other words, he said there was some of the vagina remaining that should have been taken out during the vaginectomy. and this is acting as a collecting space for the urine that flows through the fistula. We decided to keep the suprapubic catheter in so I could void only through the catheter to give the fistula time to heal. Another VCUG will be performed after four weeks, and hopefully by then the fistula will have closed up and the "vaginal" space will have become smaller. He did say that based on the VCUG and ultrasound alone, he could not say for sure that it was vaginal tissue - but it looked as if it could be because it was so "regular" in appearance. If there is any suspicion it is vaginal tissue when I see him next (in four weeks), then I will have to have an MRI to determine the exact type of tissue that is present. Upon thinking more about what could be happening, I realized that perhaps I did not make myself clear when I described to my urologist what procedures I had in Belgrade. I had just said that I had a "vaginectomy," but it may be possible that my urologist had thought I meant that the vaginal mucosa and the vaginal muscles were removed. Actually, the vaginal muscles were not removed, and I knew that going into the surgery; however, all vaginal mucosa should have been removed. If all of the vaginal mucosa was indeed removed, it seems conceivable that there could still be a space between the remaining vaginal muscles, thus creating a space for the urine to collect. If/when an MRI is performed, the difference between vaginal mucosa and vaginal muscle should be apparent. If vaginal mucosa is still present, there is no doubt that I will have to have another surgery to remove it, as it could potentially cause problems down the road. However, I won't know if I will need another surgery until I have the MRI, or at the least my next VCUG, in four more weeks. My urologist told me I could stop the antibiotic (Augmentin), because whatever bacteria have colonized in my bladder are probably already there - by staying on the antibiotic, I may just be selecting for Augmentin-resistent bacteria. He also gave me Ditropan (oxybutynin), which should reduce the spasms in my bladder to decrease pain. Saturday, July 21, 2007 - 32 Days Post-op The redness and crusty scabbing around the insertion point of my suprapubic catheter had gotten so red and painful, I was almost positive I had an infection. The stitch that was previously holding the tube to my body had come undone, and the stitches were instead slipping in and out of the hole, causing so much pain I could barely bend over. I had expressed how painful it was to my local urologist, but he said that it had actually looked better than he had expected it to - probably because I had just cleaned it the night before. To cure the infection I was given Bactroban (mupirocin) topical ointment and told to follow these instructions twice per day until the infection was gone (5-7 days):   1. Clean around the catheter and the catheter site with dial soap, moving in an outward direction   2. Rinse around the catheter and the catheter site, moving in an outward direction   3. Apply a very thin layer of Bactroban around the catheter insertion site   4. Fold a 3x3 gauze into a square and cut a slit halfway through it on one side   5. Put the gauze around the catheter tube, against the skin   6. Cover the gauze with Tegaderm So until the infection was gone (5-7 days), I was supposed to repeat this procedure twice a day. After the infection was gone, I did the same procedure once per day, applying hydrogen peroxide instead of the prescription Bactroban. In case the skin infection had already gotten too deep, I was also given Keflex (cephalexin) to take orally at 250mg three times per day for five days. Wednesday, July 25, 2007 - 36 Days Post-op I noticed the stitches in my mouth were completely gone. Although I could no longer feel any stitches, the suture line in my cheek felt very bumpy and irregular. It was also still tight and slightly painful when I stretched it to the max, like when yawning or puckering. Sunday, July 29, 2007 - 40 Days Post-op I heard back from my local urologist, and he said that the removal of the vaginal mucosa only while leaving the vaginal muscles (despite them being sewn together) could indeed account for the cavity they saw on the VCUG. Since I haven't heard of anyone ever having a problem with the vaginectomy part, I am hopeful that it will close up over time, and it will cease to be a problem. He said if additional surgery is required that entails access around that area (ie. to close the fistula if it does not close on its own before my next appointment), then the presence of mucosa could be determined at that time. I had also asked him about the possibility of forming strictures - since there was no indication of a stricture on my VCUG, I wanted to know if it was possible /likely to form one before my next appointment. He said that delayed strictures can occur so it would be premature to conclude that I am out of the woods in that respect. Wednesday, August 8, 2007 - 50 Days Post-op The suture line in my mouth has smoothed out considerably. It has also stretched out quite a bit. The only place that feels tight is in the very back near my molars. I can yawn and pucker normally again. I noticed that virtually all of my stitches have dissolved around my penis and between my balls. The scabs on the suture lines where the implants were put in are also gone. I can tell my balls are dropping and the skin around the end of my penis (I think what will be the foreskin) is starting to reduce in swelling, too. I heard that this swelling isn't fully down until 3-6 months post-op so I'm not too surprised it is still swollen. I'm finally walking normally (ie. not like a cowboy who just got off his horse), and I'm sleeping on my side with only two small pillows between my knees (as opposed to the 3 or 4 I had been using to keep my legs apart while sleeping on my side). Only rarely do I feel the pinching feeling anymore while emptying my bladder though the suprapubic catheter. I've now developed another urinary inconvenience, specifically that I feel the urge to pee very frequently, and when I do have the urge to pee, it is an extremely intense feeling. A couple of times the urge to void has been so strong, I've had trouble holding it. I hadn't been taking the Ditropan (oxybutynin) everyday, because I wasn't having the pelvic pain that caused my urologist to prescribe it. However, since it is the same drug that is prescribed for overactive bladder, I have been taking it more regularly, which has been helping with the frequency and urgency problem. I'm hoping that it will work itself out once I am able to urinate normally. Wednesday, August 24, 2007 - 66 Days Post-op I had my second VCUG at 10:15 am and a urologist's appointment that followed at 11:30 am. The VCUG procedure was the same as the one at 29 days post-op. I laid on the table while they put the radiographic dye into my bladder via the suprapubic catheter. Then they raised the table so I was in a standing position and told me to urinate into a plastic urinal. While I urinated they took digital x-rays, at a rate of two per second, that would show them where the radiographic dye traveled. Unlike the first VCUG, I hadn't been using the new urethra for a couple days before the test (so this was the first time I had used the new urethra since the last VCUG at 29 days post-op). I was a little nervous, but I eventually started urinating. However, as I was urinating, the stream would sometimes stop, even though I felt like I was releasing my bladder sphincter and I was actively trying to pee. My stream was one stream (not a spray), but it would start and stop, even though I was just trying to release it all. Eventually they said they thought they had enough pictures, and I emptied the rest of my bladder through the suprapubic catheter. We went upstairs to the urologist's office and waited to see him. He said that there was clearly still a fistula in the same place, but there was significantly less fluid in the "vaginal cavity" they identified at the last VCUG. This could be a result of the fistula getting smaller and/or the ex-vaginal space collapsing upon itself and scarring together. Since the fistula was still there, some urine still leaked out of the new urethra and into a space just below the urethra; however, as with the VCUG I had 5 weeks ago, all of that urine eventually left that space (ie. the urine was not pooling inside my body). After urinating, I did not have nearly as much dripping, which is probably because there wasn't as much that had leaked out of the urethral fistula and into that "vaginal space." They had also noticed "mild narrowing" of the distal urethra, which could account for why I felt like it was a little more difficult to pee, resulting in the starting and stopping of the stream. I asked if they saw any indication of a stricture or other blockage, and they said they did not. I'm hoping that this "mild narrowing" doesn't turn into a stricture or further narrowing that could cause a problem in the future. I also told him that I was having frequency and urgency issues around urinating so he raised my dose of Ditropan from 5 mg/day to 10 mg/day. The following are photos of the VCUG tests, both the first one at 29 Days Post-op and the second one at 66 Days Post-op. I colored the bladder and urethra yellow and the part that is not supposed to be there in red since radiographs are difficult to read:   VCUG #1 - 29 Days Post-op   VCUG #2 - 66 Days Post-op It's easy to see the magnitude of healing that occurred during the past five weeks, using only the suprapubic catheter. Because of the vast improvement seen in the amount of fluid that had leaked out of the fistula, my urologist wanted to leave the suprapubic catheter in for another four weeks. He said that after another four weeks, I should have received the maximum benefit of the suprapubic catheter, and at that time it would need to come out anyway. If after an another four weeks there is no additional improvement, then I may just have to deal with it being a small diverticulum (unless it seems to cause problems, in which case we'll have to discuss treatment options at that time). So, while I'm not ecstatic about dealing with the suprapubic catheter for four more weeks (it will be a total of 13 weeks with the catheter when I eventually get it out), I think that since I had a lot of healing over the past five weeks, then it's probably the best idea to try to get the maximum benefit from it before taking it out. Wednesday, September 19, 2007 - 92 Days Post-op I wanted to be familiar with what it felt like to urinate through my new urethra before having my next VCUG so I started to void normally in preparation for the VCUG the next day. It burned quite a bit, but that didn't surprise me since it hadn't been exposed to acidic urine in 4 weeks. The first time I used it, it felt the same as it did 4 weeks ago (ie. I still had a small "full" feeling between my balls). The second time I voided normally, it literally felt like I was peeing in my pants. When I felt between my balls, it was quite wet. I wasn't sure if that was urine that that dripped from the tip of my penis down between my balls, or if it was leaking out somewhere else (which seemed improbable since the suture line between my balls looks very smooth - the only place that is different is where the vaginectomy was, but even there it looks sealed up, it just looks a little more bumpy than the rest). So later than night I took out a mirror and watched the vaginectomy area while urinating, and sure enough, a couple drops of urine dripped out from there. So that was incredibly disappointing, because that meant that both the fistula was still there and that I now had the additional complication of leaking from between my balls. I had prepared for the fistula to still be there and that I may have to deal with a small diverticulum; however, I had not prepared for this additional complication of leakage near my perineum. A huge let down, indeed. I'm certainly glad that I decided to start urinating a day early so that I was aware of this problem before my appointment! Thursday, September 20, 2007 - 3 Months Post-op I had my third VCUG at 9:00 am and a following urologist's appointment at 10:30 am. The VCUG procedure was exactly the same as at 29 days and 66 days post-op. Since I had been using the new urethra for a day already, I told them about seeing the urine drip from where the vaginectomy was. Apparently, they couldn't see the radiographic dye dripping from between my balls since the concentration is so low in small drops of fluid, but you could definitely tell it was leaking by the fact it was dripping down my leg. Also, the VCUG showed that the fistula was still there, and the space the urine was collecting in hadn't changed much, if at all. They said they still saw the "mild narrowing" of the urethra, but my stream had a good flow and I did not feel the pressure of an obstruction nor did they see any evidence of an obstruction. We then went upstairs to talk to the urologist. He said he looked at the VCUG films, and that (clearly) the fistula is still there, and he thought the suprapubic catheter should come out because it probably wasn't doing me any good anymore. When I told him about my leakage problem, he said it should be OK to continue urinating normally, even though it leaks from between my balls...and that leakage shouldn't cause any tissue damage and will only be an "inconvenience." He claimed that even with a small amount of urine flowing though the urethra and leaking out from where the vaginectomy was, it is still possible for the fistula to spontaneously heal on its own. He suggested I see him again in 3 months, at which point we could do a retrograde urethral study; if I'm still leaking from between my balls at that time, we could discuss pursuing a surgical repair of the fistula. However, he said that the "standard protocol" healing time after a urethroplasty/urethral repair is 6 months so to decide to surgically repair it at this time would be "premature."   VCUG #3 - 3 Months Post-op I have to admit that I don't see how it could be healthy or possible to heal with urine flowing through tissues that aren't normally and shouldn't be exposed to urine, but I trust that he's the expert and knows what he is talking about (he's literally one of the most esteemed pediatric urologists in the area - that's why I am going to him - so I'm just going to go with it). In addition, as long as things don't get worse, and of course I'll notify my doctor if they do, waiting another 3 months for healing and then pursuing a surgical repair will certainly be worth it if it means insurance may pay for it. So we decided to take out the suprapubic catheter and have me void normally, then return in 3 months. I expected the catheter removal to be easy and painless, but it was anything but that. The nurse first tried to empty the balloon part of the catheter, which is what keeps it from falling out of your bladder. The balloon is normally filled with water, but when she tried to suck the water out of the balloon, nothing came out! Even after cutting the entire end of the catheter off, still nothing came out! So she thought that maybe the balloon wasn't full so she told me to let her know if it became painful as she began pulling the catheter out. I began to feel a lot of pressure, and then pain, so she stopped pulling. She eventually got my urologist to come back in and take a look at it. My urologist tugged on it slightly, I told him it hurt, then while I wasn't paying as much attention - YANK! And out it came. Apparently, the balloon was indeed empty, but it had started to degrade inside my bladder so it was all wrinkly, instead of smooth, which was causing the resistance and pain when they were pulling on it. I guess all it needed was a good strong yank (NOTE: I would advise against doing this yourself! Have your doctor do it because you never know what could be the case!). She bandaged the wound up with some gauze and tegaderm, and we went on our way. I was also told that I could wean myself off of the Ditropan over the next seven days. When I got home, I tried holding some toilet paper against where the leak is, and putting some slight pressure on the area as I urinate. That definitely seems to reduce the amount of urine that leaks through. I also was instructed to massage the area after urinating to attempt to get all of the urine out of the ex-vaginal space where it collects due to the fistula. The combination of putting pressure on the vaginectomy area while urinating and the slight massaging after urinating seems to be working, resulting in only a couple drops (if that) dripping out in the end. Thursday, December 20, 2007 - 6 Months Post-op I had stopped putting slight pressure on the fistula area while urinating, mostly out of convenience, about a month after my last VCUG. The amount of urine leaking through the external fistula had gone from just a few drops to a small, steady stream, and I had to continue to sit to urinate. I had my next diagnostic imaging study, this time a Retrograde Urethrogram (RUG) as I no longer had the suprapubic catheter. They lubed up a small catheter with an anesthetic jelly, then inserted it into the tip of my penis. One nurse had to pinch the tip of my penis to help prevent the contrast dye from just leaking out while they injected the contrast dye into my urethra. The hope was that the contrast dye would flow retrograde towards my bladder, enter the fistula, highlight the "pocket" of space that was previously seen, then flow out the external fistula behind my balls. The contrast dye did indeed do this and showed the "pocket" very well, but because the external fistula leading to the outside world was so small, they had trouble visualizing it coming out of this area.   RUG #4 - 6 Months Post-op They next attempted a Fistulogram, where they directly catheterize the fistula itself, then inject contrast dye to see where the fistula goes. They tried multiple times, each time with a progressively smaller catheter, but to no avail. They even tried injecting some saline into the tip of my penis to visualize the saline flowing out of the fistula to help locate the tiny hole, but they finally gave up because the hole is just too small. After all of the poking and prodding, they weren't able to get any great radiographic images from the Fistulogram so that is why there are no images from that study included here. At my following appointment with my urologist, he told me that he would like to surgically remove the "pocket" of unknown tissue type, and at that time he would repair both the internal fistula (between the new urethra and the "pocket") and the external fistula (between the "pocket" and the outside world, opening just behind my scrotum). He also drew me a picture to describe my situation. The following picture was drawn by my surgeon, but I added the colors and the description: The purple line represents the current pathway that urine flows - when I urinate, it flows from both the tip of my penis (through the new urethra) as well as through the internal fistula, into the "pocket," then out through a hole behind my scrotum. The red circle represents what will be removed during the revision surgery. Since he will be removing an entire pocket of tissue, my doctor said that it can be hard to fill that area with surrounding scar tissue. Therefore, they will take a graft from my gracillis muscle (the most superficial muscle on the inside of the thigh). Since they will be using a graft, a plastic surgeon will have to be involved with my surgery, which works out well since I was already planning on getting a plastic surgeon to do a chest revision for me during the same surgery to minimize the number of times I have to undergo general anesthesia. Wednesday, December 26, 2007 - 6 Months, 1 Week Post-op I noticed that my urinating frequency had significantly increased, to the point of feeling like I had to go every hour. My local doctor figured I had a bladder infection and treated me with Ciprofloxacin, a common broad-spectrum antibiotic, for 7 days. Thursday, January 17, 2008 - 7 Months Post-op I had a culture and sensitivity done on my urine to re-check my bladder infection. Friday, January 18, 2008 - 7 Months Post-op I scheduled my revision surgery for mid-March. It looks like I will most likely be able to have simultaneous pubic liposuction to help make the penis more prominent as well as the chest revision I was previously perusing. I also heard back from my urine test, and they said "something was definitely going on" with it. The sensitivity test hadn't yet come back so they started me on Nitrofurantoin. If it comes back as being resistant to that drug, then they will put me on something else. Monday, January 21, 2008 - 7 Months Post-op The culture and sensitivity test came back, and apparently the drug they put me on (Nitrofurantoin) is effective against my bladder infection, but not as effective as another drug (Bactrim). So I started on Bactrim instead. Please see Revision Surgery 1 for the continuation of my written experience.