Peritoneal Puns

Hello!

I'm roughly two months post-op, and I can't seem to get a good response to this question. My instructions state that I should be douching once a day with 'warm, soapy water'. However, I've not received a good answer on what sort of soap would be best acceptable, and as I'm prone to dry skin, regular old liquid soap seems to be drying me out down below. (No clear directions for how much to use, either.)

I know instructions vary from surgeon to surgeon, so I was hoping for some guidance from others that had a peritoneal pull-through vaginoplasty. Some have recommended a tablespoon of vinegar in warm water douche. Others have specifically mentioned Castile soap (lavender seems appealing). Others still have noted just warm water...

It gets sort of frustrating, so I'm just asking for thoughts and advice! Thanks. :)

Side note: I'm using Slippery Stuff lube. It's super nice, but it's thick! I can imagine that stuff potentially sticking up in the canal over time, which is part of why I guess I could see the need to douch regularly.

Hey all,

I am 38yo mail who started PD around a month and a half ago. I urinate frequently so am not on fluid restrictions and my amount of PD is rather low. I use 1 yellow 6000 bag, 1600ml fills, 3 cycles a night.

For the most part everything has been fine, but last night this issue happened again for the second time and I am curious if anyone can explain it or has experienced it. During fill I have a slight twinge of pain around my lower right abdominal cavity. I fell asleep as the fill finished. About an hour into the dwell cycle I had apparently rolled to my right and I was awoken with a sharp pain in that area of lower abdomen. I quickly rolled back over to more or less on my back sitting upright, slightly leaning to the right to try to counter it.

All of a sudden I felt the urge like I was going to have terrible bathroom trouble so I made my way to the bathroom and sat down. The pain started to consume my entire abdomen and everything got foggy, my vision, my hearing, and my face became really hot feeling, then I broke out into a cold sweat. I called for my wife and think I blacked out for a few seconds (but didn't fall). I told her that pain thing was starting again and she started the emergency drain in which case the pain subsided rather quickly.

The only other correlation I have is that when this happens there are large chunks of fibrin that seems to drain out. I still don't know why the pain happens in the middle of a dwell as opposed to a fill or drain. I took my blood pressure just after I got back into bed and it was really low (for me - 107/82) and slowly came back up. It could have been even lower during the incident.

Any ideas what in the heck this could be? 99% of the time I have no pain.... not even drain pain. I have an extremely high pain tolerance as well and have never felt something so excruciating. My abdomen becomes like a rock. Could it be a hernia, reaction to bad fluid, pressure on my heart from the fluid?

Would be great to know before I have a consult with him, so I can get to work on it now if it's extensive. Thanks in advance :)

What surgeons in the US do peritoneal vaginoplasty?

There is some advantage over the full peritoneal technique over the partial technique, and What are the advantages and disadvantages of each technique?

I'd really prefer to get this rather than the older techniques but I can't afford it out-of-pocket at US prices, I'm not hopeful for getting NHS funding for it, and I can't find anywhere outside of the US that offers it (except one place in Mumbai, maybe?). Are there any surgeons within Europe, ideally within the UK, that can do it? And I guess failing that, any good ways to convince the NHS to pay for overseas treatment?

This webinar is on robotic peritoneal flap vaginoplasty as performed at NYU Langone Health. This procedure is sometimes called "peritoneal pull through," we call it robotic peritoneal flap. Please see further information at the zoom registration link below.

Briefly, we will cover a general overview of our process, surgical techniques, as well as surgical outcomes published in existing and forthcoming peer-reviewed research. We hope to offer more focused webinar sessions in the future. Photos of genitals will be displayed.
Here is a direct link to register for the webinar, as well as a chance to submit your questions:
https://nyulangone.zoom.us/webinar/register/WN_vEvMvNEqRNKWZ622jXOO5A

Here is a flyer with shortened URL link:

Flyer Promoting Webinar

I’m 22 years old MTF

Hey y'all, was just hoping to get some clarification and hopefully hear about experiences of people who have had either of these procedures. Thanks in advance :) here are my Qs:

1. For those who have had robot-assisted peritoneal vaginoplasty, where did you have to get electrolysis prior to the procedure? Also, about how long did it take to get the areas cleared?

2. For the vaginoplasty commonly performed by many practitioners in Thailand, I've read before that they "shave off" your hair follicles which means you don't need to get much if any electrolysis beforehand; for those who've had this version, did you get electrolysis beforehand, and if not then how has your experience been?

3. How are either of these procedures impacted by previously having an orchiectomy? I had a simple orchi (incision in the scrotum) about five years ago, and one thing I've read before is that some of the best surgeons in Thailand don't work on patients who've had an orchi; my question is, does this mean I'm realistically not a good candidate for bottom surgery in Thailand, or is there surgeons there who are well-rated and work with patients like me? Also, does my orchi impact my elibility for the robot-assisted method in any significant way?

I’m curious about your comfort level when taking care of a PD patient.

Does your hospital use Baxter or Fresenius?

Which modality is used- CAPD or CCPD?

I’m curious because prior to becoming a dialysis nurse, I had never been assigned a PD patient.

Does your hospital provide education/have a policy with instructions to follow?

Hi everyone What’s the difference between full peritoneal pull through and the hybrid PPV? What do you consider to be better? I understood that only Dr. Wittenberg does full PPT, in the USA, and in Thailand they only do the PPV method. I’m researching doctors both in the USA and Thailand, where would you recommend to go to? Which doctor do you think is the best? It’s really important for me to get the best result possible, with good functionality, great depth and great aesthetics.

We are in holidays and traveling with holiday supplies plus extra 14 days supplies in case of emergency or if we get stuck. Before we leave we would like to donate the extra supplies to someone local so we don’t have to take them back. We will have cassettes, minicaps, drain bags, and some solution. Please message if you have use for the supplies. Must be able to pick up from Waikiki, we have no transportation.

Hello smart and kind people!

Page 651 of First Aid 2021 says that bladder "dome rupture (weakest part) -> intraperitoneal urine accumulation." If the bladder is extra-peritoneal, how can dome rupture result in intraperitoneal urine accumulation?
Thanks!

I have a lot of FlexiCap Disconnect Caps, from when a relative was doing home dialysis. Do these things actually expire? I was planning to ship them to someone who needs them, but I see that there's an expiration date on the package, despite the caps being vacuum-sealed and Baxter using the 'expiration date' as the date when the order more supplies in bulk.

My mother got a CT scan last Monday because she was feeling abdominal pain. They found a mass on each of her ovaries and was told to see a gynecological oncologist. We went to one two days later and they immediately scheduled her for a hysterectomy for next week. Obviously this all very concerning but on her CT scan it says “likely peritoneal carcinomatosis.” When I googled this term it said that this happens in stage 4 ovarian cancer. I’m wondering if anyone has experience with this and if this is the case?

I've been reading about it, and to me it seems like it's something that I'd prefer over the regular PI method. I was wondering... what people who's had it got to say about it? Did you end up satisfied with your results? Is there any sort of bad odour? etc

💜

Cancer pt being treated with chemo yet pt is on peritoneal dialysis. The monograph of the the chemo drugs show no data under dosing guidelines for peritoneal dialysis. How does one dose a chemo drug in this case?

Im lost here any help or thought process would be helpful.

Was recommended this due to my orchiectomy limiting available tissue by Dr. Avanessian recently. I do have the option not to. She does a peritoneal graft, not the "pull through".

Pros:

• more depth bc more material
• has properties many find desirable at least in theory

Cons:

• requires additional surgeon, more time on table = risk
• according to her the abdomen discomfort after is arguably worse than the genital pain from healing
• minimal info online from folks who've had it

I was hoping you could help me with that last con! how'd your surgery go if your surgeon used this tissue? are the "desirable properties" (lubrication, pH, flora, etc) true in your experience? would you do it again?

Apologies if this is an obvious question, I just can’t find clear answers online. My insurance covers the inversion, but I’m pretty sure docs who do the PPV aren’t in-network (unless you know any that are with Kaiser).

I thought you were might be interested to see what these projections look like. The first image is a sort of before and after projection of what my face might sort of look like. The difference here is going to be that this production cannot accommodate for forehead advancement, blepharoplasty, or cartilage changes like in an open rhinoplasty.

The CT Scan images you see there show how much material is to be removed and where to help feminize the shape of my skull. You can also see how much of my mandible is to be removed and where.

The uncolored section in the center of the brow ridge is actually going to be surgically removed and ground down at another table while other work is being done. Then it will be affixed back into my skull with screws.

There are no projections for my labia revision. I wanna stress about the revision that I have been *very* happy with the work, and Dr. Del Corral seemed very keen to make sure everything was up to *his* standards. I can't complain. The peritoneal pull through has been a WILD healing experience, but I love the results so far even though I'm not fully healed. I have been able to achieve orgasm and have *light* and *gentle* forms of penetrative sexual intercourse with partners.

(please don't mind my skull as I have a fairly unique form of cleft palate that has really messed with my facial structure so the result is that a lot of stuff is twisted and changed in ways it won't be in your skulls. )

https://preview.redd.it/1fe559b9njo71.png?width=1370&format=png&auto=webp&s=d7ac3e5a845f1936ff8105fd6ea965adaf8eedc4

https://preview.redd.it/0zabk6t9njo71.png?width=542&format=png&auto=webp&s=e88069a094d8404c4e8ef2a39d45ac33cf89c9df

https://preview.redd.it/qimcl494njo71.png?width=960&format=png&auto=webp&s=c54e22b947a333f3f177f99c771ddb4d787d3d4d

Sharing my post lap report and photos in case it helps someone! In some of those photos it looks like basically nothing (to me at least), makes sense how it could get missed. The biopsy confirmed Stage 1 or peritoneal endo.

https://imgur.com/a/3LXbLUN

For reference, the 1st page is the before pics and the 2nd page is after excision/suspensions. The uterine suspension was done to reposition my retroverted uterus which she was thinking might be the cause of painful sex.

Hello all! What’s your go to technique for PD catheter insertion? Often times, I have observed that the surgeons prefer local anesthesia with sedation. However, at times, it gets really difficult especially in patients with previous history of multiple abdominal surgeries that during mid-way, I had to convert to GA. Would love to know the best way from experience

Someone here has undergone this technique, if so, could you tell me what made you choose this technique, how are its results at the level of aesthetics of the vulva, sensitivity, functionality and vaginal depth, please it would be very helpful.

On 9/1 during my 1 month follow-up visit, I asked my bottom surgeon (Dr. Joshua Roth in Indianapolis) about taking my progesterone vaginally instead of rectally and he approved a trial of it to see how it would affect my levels.

On 11/11/2020, the last time I had progesterone measured after 3 months of 100mg daily rectal progesterone, my levels were 0.6 ng/mL.

On 9/10/2021, after 10 days of vaginally applied progesterone, following 20 days of rectal progesterone and 10 days of halting progesterone by the order of Dr. Roth to prevent upset of the rectum following surgery, my levels were 1.2 ng/mL. The dose was not changed for these results.

This is obviously very exciting, doubling progesterone levels through vaginal application rather than rectal application. We are going to continue taking labs periodically and will keep you all posted.

I'm currently trying to pick a surgeon for SRS, and I think I want to go with peritoneal vaginoplasty. I'm from the New York area, so two of the prominent surgeons (Ting and Bluebond-Langner) both perform some type of it, but to my understanding their techniques are different. Wittenberg in San Francisco is also well known for peritoneal vaginoplasty. Any suggestions on what might be a good way to decide between these three?

Someone here has undergone this technique, if so, could you tell me what made you choose this technique, how are its results at the level of aesthetics of the vulva, sensitivity, functionality and vaginal depth, please it would be very helpful.