I general information
The clinical data of 135 cases of daytime operation and 106 cases of inpatient operation for the treatment of children with a concealed penis who agreed to accept the satisfaction survey in the Second Hospital of Hebei Medical University from January 2020 to July 2022 were selected as the day group and the inpatient group, respectively. Both groups of children were diagnosed and admitted according to the diagnostic criteria in the expert consensus for the diagnosis and treatment of concealed penis in children: (1) the penis is short in appearance; (2) the penis body develops normally; (3) The doctor presses the prepubic fat towards the pubic symphysis at the root of the penis to reveal the normal penis body, and the penis will retract when the pressure is released. (4) ruled out other penis deformities, such as hypospadias or fissure, idiopathic small penis, etc. [6, 7]. Meanwhile, the satisfaction survey results of patients' families were collected.
Inclusion criteria: 1. All the children were preliminarily diagnosed in the Pediatric Urinary Surgery Clinic of the Second Hospital of Hebei Medical University during COVID-19. 2. All patients have no other medical history and are in good health. 3. In the day group, consent was obtained from the patient's families. Pre-operation education was given by the medical staff of the Day Surgical Center and the pediatric urologist in our hospital. The operation informed consent form was signed. 4. In the day group, preoperative examinations, including ECG, urine routine, chest X-ray, blood routine, coagulation routine, liver and kidney function, blood electrolytes, blood glucose, and preoperative were completed in the outpatient department of our hospital one to three days before surgery. The same routine inpatient and preoperative examinations for hospitalized children were perfected. 5. All children have no operation taboos. 6. All children had no other basic diseases, or infectious diseases, and no history of other surgical trauma or blood transfusion. 7. All children were not allergic to cephalosporins and drug resistance. All children fasted with water 8 hours before surgery. [8] Due to the characteristics of the surgery on the day of hospitalization on the day of day surgery, fasting water required the cooperation of the children's families to complete. Therefore, the time and importance of fasting were repeatedly explained to the children and their families. Families and patients expressed understanding and cooperation. Hospitalization procedures were normally handled in the inpatient group, while those in the daytime group were handled on the same day of surgery.
II. Surgical methods
The surgical methods used in the day group and the inpatient group were the same, and both were performed by the same physician or physicians with the same level of qualifications. All of them adopted the modified Devine exclusion. The postoperative appearance of this surgical approach is consistent with that of circumcision. The dressing change is the same as that of circumcision, which can be changed everywhere. This further reduced population movement and contributed to the prevention and control of the COVID-19 outbreak. [9]: Intravenous inhalation compound anesthesia. The patient took the supine position, and the foreskin was longitudinally cut in the middle of the dorsal side of the penis. The glans adhesion of the foreskin was separated. The scaling was removed. In a penile cephalic suture traction line, an inn plate of a foreskin is annularly cut at that position 0.5-2.0 cm away from a coronal groove according to the size and length of the penis. BUCK fascia is attached to free the skin of the penis to the root in a degloving mode, all thickened and inelastic meat membranes and fib bands that limit the penis to extend out are excised so that the penis can naturally extend out without tension, and vascular nerves are avoided at both sides of the root of the penile cavernous body, and white membranes in a 10-point direction and a 2-point direction at both sides of the root of the cavernous body are fixed on a pubic anterior fascia by a line 4. After the foreskin was trimmed, the wound edge of the penis skin was sutured with a 5 − 0 absorbable suture line. Indwelling urinary catheter wound dressing pressure dressing. (Fig. 1–7)
III. Discharge criteria
In the day group, the surgeons checked the patients' condition within 6 hours after the operation. The patients who met the following criteria could be discharged after a routine infusion of a group of antibiotics, antispasmodic, and analgesic drugs. 1. the patient's vital signs were stable and the patients were alert with no nausea, vomiting, a small amount of food, fever, chills, or other discomforts. 2. there were no short-term complications such as bleeding, infection, edema, and hematoma after the operation. If the patients' families strongly requested to extend the observation time, the hospital discharge could be postponed according to the requirements of the patients' families, but the total extension time was not more than 24 hours. In the day group, family members of the patients were given education upon discharge, including the cases where the patient needed to be treated at home, including progressive bleeding of the wound, bleeding and bleeding, bruise on the glans penis, necrosis of the flap, dysuria caused by the removal of the urinary catheter, and other unpredictable situations, as well as the cases where the family members of the patient could not handle themselves. Moreover, the family members were repeatedly informed of the dressing change time and reexamination time for the children to prevent incision infection or even more serious complications due to delayed dressing change and human factors. In the inpatient group, cephalosporins were routinely used to prevent infection after surgery. After the first dressing change, the wound was checked for recovery. The rest met the same criteria and were discharged.
IV. Postoperative treatment
The urinary catheter was retained in both groups after the operation. According to the children's body weight, tramadol hydrochloride for injection was used routinely for analgesia, phloroglucinol for plasmolysis, and cephalosporins for anti-infection after the operation. The patients who met the discharge criteria after infusion were discharged from the hospital with the urinary catheter and penis dressing retained during discharge. The parents were also asked to come to our hospital for penis dressing replacement in pediatric urology on the 3rd, 6th, and 9th day after the operation. The patients in the day group were orally administered with cephalosporins for 7 days after discharge, and those in the inpatient group were orally administered with cephalosporins for 4 days after discharge. The times of dressing change and time of indwelling urinary catheter were determined according to the postoperative recovery. The total times of dressing change were not less than 2 times and not more than 4 times, and the time of indwelling urinary catheter was not less than 6 days and not more than 14 days. After the dressing was removed, the penis wound was disinfected with iodine for external use, once or twice a day. The time standards for removing the dressing and the urinary catheter were consistent between the daytime and inpatient groups. In case of postoperative complications such as bleeding, infection, and wound dehiscence after discharge, the patient can be treated in the local hospital or returned to the hospital for emergency treatment. In addition, the urology department of our hospital is on duty 24 hours a day, which can solve the problem that the local hospital or the emergency department of our hospital cannot handle at any time.
V. Statistical methods
Statistical analysis was performed using SPSS 26.0 statistical software, and the statistical difference was considered to be significant if the P value was less than P༜0.05. The clinical data of patients were expressed as “mean standard deviation”. Patients’ age was expressed as “mean (quartile)”. The comparison between the two groups was performed by rank-sum test. Enumeration data were described as cases or percentages. The incidence of various complications between the two groups was compared by the Chi-square test. Patient satisfaction surveys were compared using the chi-square test and by satisfaction rate.