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Objective To summarize the diagnosis and treatment of epispadias with complete prepuce.Methods Between January 2007 and April 2017,clinical records were reviewed for 5 patients diagnosed as epispadias with complete prepuce.The patients were 34 to 66 months old (mean age 44.3 months),who presented with short beaked penis and nonretractile prepuce.A dorsal midline gap between corpora cavernosa could be felt on palpation.There was dorsal chordee with broad spade like glans.The preputial opening was stenosed and dorsally placed urethral opening after retraction of the prepuce.Two patients were incontinent before surgery.Epispadias were coronal type in 2 cases and penile type in 3 cases.All 5 cases were repaired by Thiersch-Duplay procedure.Results The mean follow-up time was 44.5 months (ranged 3 to 98 months).The stricture occurred in 1 patient 1 month after operation,and after dilation and indwelling catheter for a month,the problem resolved.One needed a secondary preputial plasty due to redundant ventral foreskin 8 years after operation.In 3 of 5 cases,parental satisfaction was not achieved mainly due to short length.Only 1 case was incontinent after surgery and the other four achieved urinary continence.Voiding cystourethrogram (VCUG) and ultrasonography (USG) were done in 2 patients who were incontinent before surgery.One case presented right vesicoureteral reflux of Grade Ⅱ and the other was normal.The urodynamic results of 2 patients were normal.Conclusions Epispadias with complete prepuce is extremely rare and its preoperative diagnosis remains difficult.A definitive diagnosis is based upon history,physical examination and imaging tests.Fewer complications and better continence rates were achieved in the boys with epispadias and intact prepuce.Penile length is an important factor affecting surgical outcome.
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Objective To explore the risk factors of incontinent-associated dermatitis (IAD) in MICU. Methods A retrospective analysis of 141 cases of MICU incontinence in our hospital was done in IAD. The risk factors of IAD were analyzed by single factor and logistic regression analysis. Results The incidence of IAD in MICU fecal incontinence was 43.97%.The risk factors of IAD in MICU incontinence included the amount of defecate,age,body temperature (all P＜0.05). Conclusion The incidence of IAD in patients with MICU incontinence is higher.The risk factor for IAD in patients with ICU incontinence are the amount of defecate, age and body temperature.These high-risk factors should be well-considered and relative measures should be done.
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The effect of urine and feces on the skin is a contributing factor to the development of incontinent and diaper dermatitis. The objective of this research was to evaluate skin effects of a given urine or fecal sample on the donor child and/or an adult caregiver, both of whom would be exposed to the biological material in course of daily life. Methods: Urine was evaluated under a variety of experimental skin conditions: normal (N), compromised by tape stripping (C), hydrated by prolonged exposure to water via occlusive patch (H), and hydrated/compromised (H/C). After pre-treatment, sites were patched (3 times of 24-h each) with 0.5 ml infant urine, saline (negative control) or 0.3% sodium lauryl sulfate (SLS, positive control). Fecal material was evaluated using a 4-h patch followed by tape stripping of selected sites. Results: In the urine study, a single 24-h patch produced a significant elevation of pH compared to both the negative (saline) and positive (sodium lauryl sulfate) controls for all experimental skin conditions. Erythema produced by urine was intermediate between the negative and positive controls, and significantly different from the negative control on the N and C skin test sites. All three materials produced an increase in hydration of the skin. The single 4-h patch of fecal material produced significant erythema, a significant elevation of pH, and a significant increase in TEWL. Recovery to pre-treatment levels was observed by the next day on sites that received no further treatment. However, on sites patched with fecal material, then further compromised by tape stripping, recovery to pre-treatment levels for erythema and TEWL were delayed. Conclusion: These studies indicate that urine appears to have an inherent low level irritant property when in continuous contact with skin for 24 to 48 hours. With relatively short exposures of 4 hours fecal material causes visible erythema, increases in pH and TEWL, and decreases in stratum corneum resilience to the subsequent insult of tape stripping. Results re-inforce the utility of modern diapers and incontinent products, utilizing superabsorbent materials, to effectively absorb wetness, keeping skin dryer and minimizing adverse skin effects.
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This paper essentializes the pertinent discussion regarding the treating incontinent syndrome with dredging method in traditional Chinese medical literature. It illustrates 2 medical records of famous doctors as prove, and brings forward 6 gains from clinical experiences in the light of traditional Chinese medical articles and the author and precursors’ clinical experiences.