Metoidioplasty patient journey

Pre-surgery steps for metoidioplasty

• Waiting for intake

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  Once GSPBC has received your referral package, your GP will be notified, and our clerks will email you a welcome package. 

  The wait time from accepted referral to intake appointment can be 12-16 months. Please note this wait time can vary. During this wait time you can begin to prepare yourself for surgery as much as possible. This can include working on stopping smoking, improving your overall health and wellness, putting money aside, working to find a GP, and many more important pieces of readiness.  

• Intake and first surgical consultation

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  Your first appointment with GSPBC will be an intake appointment over the phone with one of the GSPBC Nurses. The purpose of this session is to confirm your medical history and get a full sense of how best we can support you.  

  At a later date, you will then meet with a surgeon. This appointment typically happens via zoom. They help provide more information about your surgery, answer questions, and help determine steps to move towards surgical readiness.  

• Second surgical consultation

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  This consultation is a check-in on your surgical readiness and helps to determine if any additional steps are needed. If all steps are completed, you are deemed surgically ready and added to a wait list for surgery.  

  Please note the second surgical consult is typically completed in person and may require a physical examination that includes one of the surgeons looking at your current genitals to help plan for your surgery.  

  If you are traveling from out of town for this appointment and have concerns regarding this trip – you can look into options for reducing cost. We are happy to provide a TAP form if you are taking a ferry. Hope Air is a charity that can assist with transportation depending on eligibility. You may also request a phone call with the GSP Social Worker if you are experiencing barriers to coming to our clinic.  

• Preparing for surgery

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  While waiting for your surgery date, there are things you can work on to be as prepared as possible.  

  You will have allied-health appointments virtually to help identify these areas. You will meet with the GSPBC Social Worker for an assessment, and to help prepare multiple kinds of supports, travel, accommodation, and a post-surgery support plan. 

  For all types of metoidioplasty, we ask that patients arrive to Vancouver 1-2 days prior to surgery. Patients having metoidioplasty without urethral lengthening or vaginectomy can typically return home immediately post hospital discharge as their procedure is less invasive. 

  Patients who are having urethral lengthening are asked to stay in the Lower Mainland area for 1-2 weeks following hospital discharge. This local stay will allow you to be closely monitored by the GSPBC team and be nearby in the event of a post-surgical emergency. 

  The social worker will help to determine if you can apply for resources to off-set the cost of this local stay. To help prepare, you may begin reaching out to family members or friends that you could potentially stay with or beginning to put aside money. 

  You will also check-in with the GSPBC Pelvic Floor Physiotherapist for an assessment if your procedure involves urethral lengthening. If you are not having urethral lengthening, but has concerns with your bowel, bladder, or pelvic function, you may also have pre-operative pelvic floor appointment. This appointment is typically completed via zoom. During this appointment, they will teach you about your pelvic floor muscles and how you can prepare this area for the impact of surgery.  

  When a surgical date is offered to you, you will receive further education on your surgery. An Enhanced Recovery After Surgery (ERAS) booklet will be reviewed with the clinic nurse. 

  To learn more about how you can prepare for your upcoming surgery, read our guide to preparing for gender-affirming surgery. 

  Surgery Wait Times 

  Once you are added to the surgical waitlist, a GSP nurse will connect with you to discuss wait times. Please note that the wait time for surgery fluctuates constantly. This is mainly due to the amount of operating room (OR) time our program receives. GSPBC receives OR time in roughly 3-month intervals and the amount of OR time we are given each month often changes – making it very difficult to predict wait times. We estimate the average wait from consent to surgery to be 10-12 months, but this is highly variable. 

• Surgery

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  Your surgery may be at Vancouver General Hospital (VGH) or UBC Hospital (UBCH) – depending on availability. 

  You can expect to be in the hospital 1-5 days following metoidioplasty surgery, depending on the complexity of your procedure. During your hospital stay you can have visitors between 9:00am – 9:00pm. 

  During your stay you will have a foley urinary catheter. If you are having urethral lengthening, you will also have a suprapubic catheter.

  You likely will leave the hospital with your catheter(s) in place. 

• Post-surgery

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  You can expect to have 1 appointment per week for the first 6 weeks. The first 1-2 appointments will be in person for all patients. If you do not live in Vancouver, we switch to phone appointments once you return home. If you do live in Vancouver, we will continue to see you in person.  

  Things to know: 

  • Expect swelling and bruising, some minor bleeding is normal
  • Expect fatigue, walking will be slow initially, limited sitting
  • Lots of time without underwear and/or pants during the initial recovery 

  Metoidioplasty without urethral lengthening 

  • Foley catheter in place for 2 weeks after surgery 

  Metoidioplasty with urethral lengthening 

  • Try peeing without catheter around 3 weeks post-op
  • If goes well, catheters removed week 3-4
  • Gradual return to activity/work around 6 weeks (depending on work and healing) 

  You will have a check in post-op with the GSP social worker and pelvic floor physio. They will continue to meet with you as needed during your recovery. 

  After the first 6 weeks, your follow-up will be tailored to your specific healing. You can expect to come back to the clinic at 6 months and 1 year for in-person check-ins with the surgeon. You may have additional appointments between these as needed. 

  Typically, at the 1-year mark patients are discharged into the care of their family doctor or community.