Evaluation of Perceptions of Cosmetic Outcomes Post Hypospadias Surgery in Kenyatta National Hospital Using the Paediatric Penile Perception Score

Abstract

Background: Hypospadias is a condition whereby the urethral meatus opens onto the penis’ ventral surface. The goal of surgical repair of hypospadias is to achieve a functional and cosmetic normal penis. Cosmetic outcome is often overlooked. The Paediatric Penile Perception Score is a validated scoring system for assessing cosmetic outcomes by patients, parents and surgeons. Study Objective: The research evaluated perceptions of cosmetic outcomes by parents and surgeons post hypospadias surgery at the Kenyatta National Hospital using the Paediatric Penile Perception Score. Study Setting: The study was carried out at the Pediatric Surgical Outpatient Clinic at the Kenyatta National Hospital. Study Population: The study targeted 115 male children with hypospadias condition who had undergone urethroplasty procedure between January 2014 and December 2018 (5years) in KNH. Study Design: The study is a descriptive cross-sectional study. Methodology: The study targeted a total of 115 children. 51 parents agreed to participate in the study. The parents/guardians were asked to indicate their contentment according to a 4 point Likert scale of the Paediatric Penile Perception tool and a score calculated by summing up the scores of the items glans, meatus, general appearance, and shaft skin. Standard photographic charts were prepared and shown to 2 surgeons who were requested to grade the pictures using the same criteria and scale as the parents. Results: The patients ranged from 2 years to 18 years with a mean age of 8.2 years. Parents were

found to be more satisfied than the surgeons with a P.P.P score of 10.3(+/-2.6) vs 7.7 (3.6) for surgeon 1 and 7.6 (1.6) for surgeon 2. There was good correlation (>0.4) between the various items and general cosmetic appearance. Interrater reliability among the surgeons scores was moderate at 0.53 (0.18 – 0.73), p = 0.004. Interrater reliability between the parents and the surgeons on the general cosmetic outcome was moderate (0.65, p < 0.001). Conclusion: We found the Paediatric Penile Perception Score to be a reliable tool for assessing cosmetic outcome in both parents and surgeons after hypospadias surgery in our population.