title: Penile appearance after hypospadias correction from a parent's point of view: Comparison of the hypospadias objective penile evaluation score and parents penile perception score.
abstract: BACKGROUND
  As there is only scarce information on the parents' view of the cosmetic outcome after hypospadias surgery we aimed to evaluate whether the results of the hypospadias objective penile evaluation (HOPE) score are transferable to parents satisfaction as measured by the pediatric penile perception score (PPPS).
  
  
  METHODS
  42 patients after hypospadias correction were included (2 (6.9%) glandular, 20 (68.9%) coronal, 6 (20.6%) penile and 1 (3.4%) scrotal hypospadias, median age 15.0 months). Two surgeons independently assessed HOPE score; the PPPS score as well as 4 questions specifically designed by a psychologist were completed by fathers and mothers. 29 (69.9%) full datasets were available for evaluation.
  
  
  RESULTS
  Parents' assessment of the cosmetic results was worse than surgeons' assessment (81.13% [PPPS] vs. 92.81% [HOPE] of the respectively possible highest score, P < 0.0001). All 58 parents (100%) were convinced that surgery led to a better cosmetic aspect of their sons' genitalia although both, mothers and fathers, perceived the operation as a major encumbrance (fathers 3.62 vs. mothers 3.97 on a scale from 0-6, P = 0.22).
  
  
  CONCLUSIONS
  Parents can be encouraged preoperatively that a hypospadias operation, seen from their point of view will be a major amendment to the cosmetic appearance of their sons' genitalia even if the operation itself is perceived as a major psychological burden. In direct comparison of the highest possible score of either tool (HOPE or PPPS), the cosmetic results were judged significantly more optimistic by surgeons as compared to parents using validated tools. HOPE score results therefore may not be transferred uncritically to the parents view on the cosmetic results.
authors.affiliation: Department of Pediatric Urology, Hospital of the Sisters of Charity, Linz, Austria. Electronic address: bernhard.haid@bhs.at.
authors.forename: Bernhard
authors.initials: B
authors.lastname: Haid
authors.affiliation: Department of Pediatric Urology, Hospital of the Sisters of Charity, Linz, Austria.
authors.forename: Tanja
authors.initials: T
authors.lastname: Becker
authors.affiliation: Department of Pediatric Urology, Hospital of the Sisters of Charity, Linz, Austria.
authors.forename: Mark
authors.initials: M
authors.lastname: Koen
authors.affiliation: Department of Pediatric Urology, Hospital of the Sisters of Charity, Linz, Austria.
authors.forename: Christoph
authors.initials: C
authors.lastname: Berger
authors.affiliation: Department of Pediatric Urology, Hospital of the Sisters of Charity, Linz, Austria.
authors.forename: Christa
authors.initials: C
authors.lastname: Strasser
authors.affiliation: Department of Pediatric Urology, Hospital of the Sisters of Charity, Linz, Austria.
authors.forename: Judith
authors.initials: J
authors.lastname: Roesch
authors.affiliation: Department of Clinical Psychology, Hospital of the Sisters of Charity, Linz, Austria.
authors.forename: Christian
authors.initials: C
authors.lastname: Zniva
authors.affiliation: Department of Pediatric Urology, Hospital of the Sisters of Charity, Linz, Austria.
authors.forename: Josef
authors.initials: J
authors.lastname: Oswald
mesh_terms: D005260:Female; D006801:Humans; D007021:Hypospadias / Q000503:physiopathology / Q000523:psychology / Q000601:surgery*; D007223:Infant; D008297:Male; D010290:Parents / Q000523:psychology*; D010413:Penis / Q000033:anatomy & histology*; D010465:Perception; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D013521:Urologic Surgical Procedures, Male / Q000379:methods*
keywords: Cosmetic outcome; HOPE score; Hypospadias; PPPS; Parents