I began the process of doing bottom surgery at the beginning of 2022. This making appointments after researching some of the top surgeons, getting my letters together, and going on consults.
Hysterectomy/partial vaginectomy had been completed by Dr. Weinstein at Mass General Hospital is Boston, MA, which was June 2022. I did keep my right ovary, all the rest was removed and the canal was closed up to the first couple of cm of the opening so I could still urinate. Meta/UL/Scrotoplasty was done December 2022 with Dr. Santucci of the Crane Center. Both of these surgeons were the best in regards to making you feel heard and comfortable. Fortunately, their skills are just as desirable.
Metoidioplasty/UL/Scrotoplasty with complications starting one week post op. Everything looked great at the one week post op appointment. The first time emptying the catheter bag with a flip flow valve (using my own bladder to hold urine), urine came out both the catheter tube and the neourethra causing the UL to blow out the entire length of my phallus. There was a lot more swelling and fistulas developed under my scrotum and the side of my phallus too. Plans were made to do the repair surgery in 6 months from the third post op appointment. In the meantime it was expected that I would just void through the wide opening between my phallus and scrotum.
Two weeks later it closed and I went to the ER. Unfortunately I had a very bad experience with a non trans friendly urologist and ended up with another SPT and a number of incisions across my abdomen so he could find my bladder with his eyes instead of instruments (like a scope laparoscopically or ultrasound). I went to Mass General to see Dr. Wintner who is part of a transgender team in Boston. He was not confident to dilate my urethra and suggested to wait 6 months until my body is fully healed.
My next plan of action is to go back to Santucci, who I really like and trust (so far) at about 3 months post op to get a dilation and maybe urethroplasty (if I'm lucky). Then in July repair the rest of my phallus, lift the phallus and scrotum, and attempt a fat graft instead of testicle implants.
My main goal is to STP without any prosthetics, so if this ends up failing, I will seek phalloplasty. Over the course of this past year, I have consulted with the following surgeons, Miro, Cetrulo, Santucci, Kent, Freet, Chen. I originally wanted abdominal phalloplasty, but most the surgeons I spoke to did not want to do it.
The cost of $5400 was my out of pocket max which was reached before I actually had meta by going on consults and the hysterectomy. I did keep a spreadsheet of everything I spent money on for this, which included hotels, gas, out of pocket max, medical supplies etc. I spent about $10k total. I will probably be spending about the same for 2023 year from getting the revisions and care for complications.
Despite the complications, I have no regrets about attempting bottom surgery. There are some things in hindsight I would have done differently had I known. I wouldn't have let my bladder get so full the first time I was exercising it after a week of a catheter. I would have established a follow up apt and gone to a trans friendly urologist in my area after surgery instead of waiting to go to an ER where it's a crap shoot if you get someone who know the anatomy of a trans guy.
I absolutely love having a smooth perineum, and I love my scrotum more than I expected. Looking forward to getting through the rest of this process. I know it's going to be a long road.
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