title: Is objective assessment of cosmetic results after distal hypospadias repair superior to subjective assessment?
abstract: OBJECTIVE
  To evaluate whether systematic scoring of pictures is really superior to subjective evaluation in the assessment of cosmetic results of distal hypospadias surgery, and whether any differences exist in subjective evaluation among the operating surgeon, the parents of the child, and a third party not previously involved in the care of the patient.
  
  
  METHODS
  Twenty-seven patients undergoing distal hypospadias repair by either the Snodgrass or Mathieu technique were enrolled. Cosmetic results of surgery were scored from 0 to 10 by one of each child's parents and by three surgeons. The latter assessed the results blindly on pictures taken during the outpatient visits; one used a systematic scoring system while the other two including the operating surgeon used subjective scoring. The four scores were compared using the Kendall W coefficient of concordance.
  
  
  RESULTS
  Overall, there was excellent concordance among the four observers (P<0.0001). The Snodgrass repair allowed for significantly better cosmetic results overall.
  
  
  CONCLUSIONS
  In distal hypospadias, subjective evaluation of overall penile appearance can be as reliable as an evaluation made using a systematic scoring system. There seems to be excellent concordance among the subjective evaluations of different observers.
authors.affiliation: Paediatric Surgery Unit, S. Bortolo Hospital, Vicenza, Italy.
authors.forename: Mariagrazia
authors.initials: M
authors.lastname: Scarpa
authors.forename: Marco
authors.initials: M
authors.lastname: Castagnetti
authors.forename: Luciano
authors.initials: L
authors.lastname: Musi
authors.forename: Waifro
authors.initials: W
authors.lastname: Rigamonti
mesh_terms: D003357:Cosmetic Techniques / Q000592:standards* / Q000706:statistics & numerical data; D006801:Humans; D007021:Hypospadias / Q000601:surgery*; D008297:Male; D015588:Observer Variation; D010290:Parents; D010413:Penis / Q000601:surgery*; D015203:Reproducibility of Results; D016896:Treatment Outcome; D013521:Urologic Surgical Procedures, Male / Q000379:methods / Q000592:standards* / Q000706:statistics & numerical data