title: Digital photographic measurement in hypospadias: validation and comparison to intraoperative measurement.
abstract: BACKGROUND
  We propose a standardized method of photographing the hypospadias penis to capture penile dimensions that may be relevant for surgery. We also validate the use of digital imaging software for calculating penile dimensions as a substitute for intraoperative caliper-based measurements.
  
  
  METHODS
  Photographs were taken of hypospadias penises in four different views after placement of a traction stitch and retraction of the preputial hood. Intraoperative measurements were obtained with a caliper. Digital measurements were taken of the same parameters postoperatively. All measurements were obtained in triplicate by multiple participants, and averages were tested for equivalency by determining the correlation coefficient for each parameter. Inter-observer correlation was also calculated for each parameter.
  
  
  RESULTS
  180 intraoperative and 180 digital measurements were taken from 60 dimensions on 10 hypospadiac penises. Strong correlation existed between most digital and intraoperative measurements. Average inter-observer correlations ranged from 0.91 to 0.99 for each of the intraoperative measurements, and 0.90 to 1.00 for each of the digital measurements.
  
  
  CONCLUSIONS
  Standardized imaging is effective in capturing penile dimensions and measurements during hypospadias surgery. When compared with intraoperative measurements, digital measurements are reliable and precise; digital photography has the potential to both aid in surgical planning and improve documentation.
authors.affiliation: Department of Pediatric Urology, Seattle Children's Hospital, 4800 Sand Point Way, Seattle, WA 98105, USA. Electronic address: Ardavan.akhavan@seattlechildrens.org.
authors.forename: Ardavan
authors.initials: A
authors.lastname: Akhavan
authors.affiliation: Department of Pediatric Urology, Seattle Children's Hospital, 4800 Sand Point Way, Seattle, WA 98105, USA.
authors.forename: Paul A
authors.initials: PA
authors.lastname: Merguerian
authors.affiliation: Department of Pediatric Urology, Seattle Children's Hospital, 4800 Sand Point Way, Seattle, WA 98105, USA.
authors.forename: Richard W
authors.initials: RW
authors.lastname: Grady
authors.affiliation: Department of Urology, University of California San Francisco, San Francisco, CA, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: DiSandro
authors.affiliation: Department of Pediatric Urology, Seattle Children's Hospital, 4800 Sand Point Way, Seattle, WA 98105, USA.
authors.forename: Margarett
authors.initials: M
authors.lastname: Shnorhavorian
mesh_terms: D002675:Child, Preschool; D015331:Cohort Studies; D005500:Follow-Up Studies; D006776:Hospitals, Pediatric; D006801:Humans; D007021:Hypospadias / Q000175:diagnosis* / Q000601:surgery*; D007091:Image Processing, Computer-Assisted / Q000379:methods; D007223:Infant; D007430:Intraoperative Care / Q000379:methods*; D008297:Male; D010781:Photography / Q000379:methods*; D011300:Preoperative Care / Q000379:methods; D012680:Sensitivity and Specificity; D016896:Treatment Outcome; D014521:Urethra / Q000601:surgery*; D013521:Urologic Surgical Procedures, Male / Q000379:methods; D014894:Weights and Measures
keywords: Digital measurements; Hypospadias; Photography; Standardization