Is objective assessment of cosmetic results after distal hypospadias repair superior to subjective assessment?

Objective: To evaluate whether systematic scoring of pictures is really superior to subjective evaluation in the assessment of cosmetic results of distal hypospadias surgery, and whether any differences exist in subjective evaluation among the operating surgeon, the parents of the child, and a third party not previously involved in the care of the patient. Patients and methods: Twenty-seven patients undergoing distal hypospadias repair by either the Snodgrass or Mathieu technique were enrolled. Cosmetic results of surgery were scored from 0 to 10 by one of each child’s parents and by three surgeons. The latter assessed the results blindly on pictures taken during the outpatient visits; one used a systematic scoring system while the other two including the operating surgeon used subjective scoring. The four scores were compared using the Kendall W coefficient of concordance. Results: Overall, there was excellent concordance among the four observers (P < 0.0001). The Snodgrass repair allowed for significantly better cosmetic results overall. Conclusion: In distal hypospadias, subjective evaluation of overall penile appearance can be as reliable as an evaluation made using a systematic scoring system. There seems to be excellent concordance among the subjective evaluations of different observers. ª