Hypospadias surgery has been carried out for decades. Descriptive parameters for hypospadias severity are variable and difficult to reproduce. The severity of abnormalities lies along a continuous spectrum. The paediatric urological fraternity is attempting to develop more reliable comparators for article publications about hypospadias. This paper assesses the inter-observer reliability of the GMS hypospadias score (G = glans features, M = meatal deatures, S = shaft features) and correlates it with the risk of postoperative complications of 85 consecutive patients, scored by two surgeons. The features assess the glans size, urethral plate size and depth, meatal position and the presence or absence of chordee. The results of this scoring system suggest a good correlation with outcome and a good inter-observer reliability. As with most scoring systems, the description of the glans is subjective. It also does not take into account the variability of the corpus spongiosal defect which occurs in most hypospadias cases. There is also no analysis of associated peno-scrotal anomalies nor of correlation with age at operation, which may both make a significant difference on outcome. The paper highlights the need to standardise hypospadias descriptions more thoroughly to allow comparisons of outcomes to be made. 

The GMS hypospadias score: assessment of inter-observer reliability and correlation with post-operative complications.
Merriman L, Arlen A, Broecker B, et al.
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Henrik Steinbrecher

Southampton University Hospital NHS Trust

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