Patient and surgeon evaluation of outcome in hypospadias repair
Purpose Despite increased emphasis on cosmetic outcomes of hypospadias surgery, few reports objectively determine appearance. Furthermore, prior studies demonstrate patient and surgeon assessments may vary significantly. We used a standardized questionnaire to survey parent and surgeon perception after TIP repair. Material and methods A Likert scale questionnaire (responses from 1, very abnormal, to 5, normal) was developed concerning 6 items: overall penile appearance, cosmesis of meatus and skin, penile size, straightness, and voided stream. Parents and surgeon independently completed surveys 6 weeks after primary TIP repair; similar surveys after circumcision provided normal controls. Maximum score was 30. Results Hypospadias patients comprised 50 distal and 15 midshaft to scrotal TIP repairs. There were 22 circumcision controls. Mean score by parents for hypospadias repair was 28 +/- 3, compared to 27.7 +/- 3 after circumcision. Questions regarding straight erection and voided stream were not answered by the surgeon in all patients, so comparison between parents and surgeon were based on the other 4 parameters with a maximum score of 20. Parents of patients and controls scored 18.3 +/-2 and 17.6 +/- 3, respectively, versus surgeon scores of 18.9 +/- 2 and 18.6 +/-2. Pearson's test showed statistically significant agreement and the correlation coefficient between parents and surgeon was 0.6 and 0.5 for controls and hypospadias repairs, respectively. There were no differences in evaluations for distal versus proximal hypospadias surgery. Conclusions Parents and surgeon agree TIP results in penile appearance are indistinguishable from normal circumcised penis. Similar surveys should be performed after alternative repairs.