HOSE: an objective scoring system for evaluating the results of hypospadias surgery


A.J.A. Holland, Department of Academic Surgery, Division of Surgery, The Children's Hospital at Westmead, Royal Alexandra Hospital for Children, The University of Sydney, Locked Bag 4001, Westmead NSW 2145, Australia.
e-mail: AndrewH3@chw.edu.au


Objective To determine the accuracy and utility of a scoring system designed to allow an objective appraisal of the outcome of hypospadias repair, based on evaluating meatal location, meatal shape, urinary stream, straightness of erection, and the presence and complexity of any complicating urethral fistula.

Patients and methods Twenty patients (median age 23 months) were randomly selected and reviewed at a median of 8.9 months after their hypospadias repair. Two paediatric surgeons, a nurse and one of the child's parents independently assessed each patient using the ‘hypospadias objective scoring evaluation’ (HOSE) system. The results were collated and the level of interobserver variation assessed using the weighted kappa test.

Results The mean weighted kappa was 0.66, indicating good agreement among observers. The level of agreement was highest between surgeon and nurse at 0.70, but remained good between surgeon and parent, at 0.65.

Conclusions Interobserver variation using the HOSE system was minimal, supporting its use as an objective outcome measure after hypospadias surgery, and facilitating an impartial evaluation of operations used in correcting hypospadias.