title: The Penile Perception Score: an instrument enabling evaluation by surgeons and patient self-assessment after hypospadias repair.
abstract: OBJECTIVE
  Studies of the outcome of hypospadias repair must document quality, including assessment of complications and appraisal of appearance. To our knowledge the Pediatric Penile Perception Score is the first validated instrument for the outcome assessment of hypospadias repair in prepubertal males by surgeons and patients. We validated the instrument for adult genitalia.
  
  
  METHODS
  Standardized photographic documentation was prepared for 19 men after hypospadias repair and 3 with normal genitalia after circumcision. This was sent to 21 urologists, who rated the outcome with a questionnaire comprising items on the penile meatus, glans, shaft skin and general appearance. Each item was rated with a 4-point Likert scale. The Penile Perception Score is a sum score of all items. Patients were asked to provide a self-assessment with the same instrument.
  
  
  RESULTS
  When calculated with the ICC and the rank correlation using Kendall W, concordance among urologist scores was fair and good (0.46 and 0.64, respectively, p <0.001). Instrument stability was 0.78, indicating good reproducibility. Using the Spearman rank correlation coefficient general appearance correlated well with single items, including the meatus (r = 0.93, p = 0.000), glans (r = 0.92, p = 0.000) and shaft skin (r = 0.89, p = 0.000). No significant differences were found between patient and urologist Penile Perception Scores.
  
  
  CONCLUSIONS
  The Penile Perception Score is a reliable instrument for urologist assessment and self-assessment of postpubertal genitalia after hypospadias repair. The instrument can be recommended for all age groups because it was previously validated for the pediatric population.
authors.affiliation: Division of Pediatric Urology, Department of Pediatric Surgery, University Children's Hospital Zurich, Zurich, Switzerland. Daniel.Weber@kispi.uzh.ch
authors.forename: Daniel Max
authors.initials: DM
authors.lastname: Weber
authors.forename: Markus A
authors.initials: MA
authors.lastname: Landolt
authors.forename: Rita
authors.initials: R
authors.lastname: Gobet
authors.forename: Markus
authors.initials: M
authors.lastname: Kalisch
authors.forename: Norma K
authors.initials: NK
authors.lastname: Greeff
mesh_terms: D000328:Adult; D059026:Diagnostic Self Evaluation; D006801:Humans; D007021:Hypospadias / Q000601:surgery*; D008297:Male; D010413:Penis / Q000033:anatomy & histology; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D013521:Urologic Surgical Procedures, Male; D014572:Urology; D055815:Young Adult