title: Patient Reported Outcomes in Preoperative and Postoperative Patients with Hypospadias.
abstract: OBJECTIVE
  Current outcome tools for hypospadias have limited focus on the caregiver or patient perspective of important patient centered outcomes. In this study we collaborated with patients, caregivers, and lay and medical experts to develop and pilot a patient reported outcome measure for hypospadias.
  
  
  METHODS
  We developed a patient reported outcome measure based on systematic review of the literature and focus group input. The patient reported outcome measure was piloted in caregivers for boys younger than 8 years and in patients older than 8 years who presented for urology consultation before meeting with the surgeon. Patients were classified with uncorrected hypospadias, successful repair or failed repair based on the presence or absence of complications (fistula, diverticulum, meatal stenosis/stricture, greater than 30-degree recurrent curvature, glans dehiscence and/or skin reoperation).
  
  
  RESULTS
  A patient reported outcome measure was developed and administered to 347 patients and/or caregivers-proxies, including 105 uncorrected cases, 162 successful repair cases and 80 failed cases. Satisfaction with appearance was highest in those with successful hypospadias repair compared to failed repair and uncorrected hypospadias (93% vs 77% and 67%, respectively). Voiding symptoms such as spraying or a deviated stream were highest in failed and uncorrected cases (39% and 37%, respectively). Overall dissatisfaction with voiding was highest for uncorrected hypospadias and failed repair compared to successful cases (54% and 47%, respectively, vs 15%).
  
  
  CONCLUSIONS
  The evaluation of patient and caregiver-proxy reported outcomes in preoperative and postoperative patients with hypospadias allows for the quantification of benefits derived from hypospadias repair and may ultimately represent the gold standard outcome measure for hypospadias. This pilot study identified preliminary patient centered themes and demonstrated the feasibility of administering hypospadias patient reported outcome measures in clinical practice.
authors.affiliation: Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario, Canada. Electronic address: Melise.keays@mac.com.
authors.forename: Melise A
authors.initials: MA
authors.lastname: Keays
authors.affiliation: University of Texas Southwestern Medical Center, Dallas, Texas.
authors.forename: Nathan
authors.initials: N
authors.lastname: Starke
authors.affiliation: University of Texas Southwestern Medical Center, Dallas, Texas.
authors.forename: Simon C
authors.initials: SC
authors.lastname: Lee
authors.affiliation: University of Texas Southwestern Medical Center, Dallas, Texas.
authors.forename: Ira
authors.initials: I
authors.lastname: Bernstein
authors.affiliation: PARC Urology, Frisco, Texas.
authors.forename: Warren T
authors.initials: WT
authors.lastname: Snodgrass
authors.affiliation: PARC Urology, Frisco, Texas.
authors.forename: Nicol C
authors.initials: NC
authors.lastname: Bush
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D006801:Humans; D007021:Hypospadias / Q000601:surgery*; D007223:Infant; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011184:Postoperative Period; D057234:Preoperative Period; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D055815:Young Adult
keywords: evaluation studies as topic; hypospadias; outcome assessment (health care); questionnaires; urethra