title: Introducing the HOPE (Hypospadias Objective Penile Evaluation)-score: a validation study of an objective scoring system for evaluating cosmetic appearance in hypospadias patients.
abstract: OBJECTIVE
  To determine the reliability and internal validity of the Hypospadias Objective Penile Evaluation (HOPE)-score, a newly developed scoring system assessing the cosmetic outcome in hypospadias.
  
  
  METHODS
  The HOPE scoring system incorporates all surgically-correctable items: position of meatus, shape of meatus, shape of glans, shape of penile skin and penile axis. Objectivity was established with standardized photographs, anonymously coded patients, independent assessment by a panel, standards for a "normal" penile appearance, reference pictures and assessment of the degree of abnormality. A panel of 13 pediatric urologists completed 2 questionnaires, each consisting of 45 series of photographs, at an interval of at least 1 week. The inter-observer reliability, intra-observer reliability and internal validity were analyzed.
  
  
  RESULTS
  The correlation coefficients for the HOPE-score were as follows: intra-observer reliability 0.817, inter-observer reliability 0.790, "non-parametric" internal validity 0.849 and "parametric" internal validity 0.842. These values reflect good reproducibility, sufficient agreement among observers and a valid measurement of differences and similarities in cosmetic appearance.
  
  
  CONCLUSIONS
  The HOPE-score is the first scoring system that fulfills the criteria of a valid measurement tool: objectivity, reliability and validity. These favorable properties support its use as an objective outcome measure of the cosmetic result after hypospadias surgery.
authors.affiliation: Division Pediatric Urology, Sophia Children's Hospital, Erasmus Medical Center, P.O. Box 2060, 3000 CB Rotterdam, The Netherlands. Electronic address: f.vandertoorn.1@erasmusmc.nl.
authors.forename: Fred
authors.initials: F
authors.lastname: van der Toorn
authors.forename: Tom P V M
authors.initials: TP
authors.lastname: de Jong
authors.forename: Robert P E
authors.initials: RP
authors.lastname: de Gier
authors.forename: Piet R H
authors.initials: PR
authors.lastname: Callewaert
authors.forename: Eric H J R
authors.initials: EH
authors.lastname: van der Horst
authors.forename: Martijn G
authors.initials: MG
authors.lastname: Steffens
authors.forename: Piet
authors.initials: P
authors.lastname: Hoebeke
authors.forename: Rien J M
authors.initials: RJ
authors.lastname: Nijman
authors.forename: Nicol C
authors.initials: NC
authors.lastname: Bush
authors.forename: Katja P
authors.initials: KP
authors.lastname: Wolffenbuttel
authors.forename: Marleen M C
authors.initials: MM
authors.lastname: van den Heijkant
authors.forename: Jan-Willem
authors.initials: JW
authors.lastname: van Capelle
authors.forename: Mark
authors.initials: M
authors.lastname: Wildhagen
authors.forename: Reinier
authors.initials: R
authors.lastname: Timman
authors.forename: Jan J V
authors.initials: JJ
authors.lastname: van Busschbach
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005500:Follow-Up Studies; D006801:Humans; D007021:Hypospadias / Q000601:surgery*; D007223:Infant; D008297:Male; D015588:Observer Variation; D010413:Penis / Q000601:surgery; D015203:Reproducibility of Results; D013518:Surgery, Plastic / Q000379:methods* / Q000592:standards / Q000706:statistics & numerical data; D011795:Surveys and Questionnaires / Q000592:standards*; D016896:Treatment Outcome; D014521:Urethra / Q000601:surgery; D013521:Urologic Surgical Procedures, Male / Q000379:methods* / Q000592:standards / Q000706:statistics & numerical data
keywords: Hypospadias; Outcome assessment; Scoring system; Surgery