Introducing the HOPE (Hypospadias Objective Penile Evaluation)-score: A validation study of an objective scoring system for evaluating cosmetic appearance in hypospadias patients

Fred van der Toorn*, Tom P. V. M. de Jong, Robert P. E. de Gier, Piet R. H. Callewaert, Eric H. J. R. van der Horst, Martijn G. Steffens, Piet Hoebeke, Rien J. M. Nijman, Nicol C. Bush, Katja P. Wolffenbuttel, Marleen M. C. van den Heijkant, Jan-Willem van Capelle, Mark Wildhagen, Reinier Timman, Jan J. V. Busschbach

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review


Objective: To determine the reliability and internal validity of the Hypospadias Objective Penile Evaluation (HOPE)-score, a newly developed scoring system assessing the cosmetic outcome in hypospadias. Patients and methods: The HOPE scoring system incorporates all surgically-correctable items: position of meatus, shape of meatus, shape of glans, shape of penile skin and penile axis. Objectivity was established with standardized photographs, anonymously coded patients, independent assessment by a panel, standards for a "normal" penile appearance, reference pictures and assessment of the degree of abnormality. A panel of 13 pediatric urologists completed 2 questionnaires, each consisting of 45 series of photographs, at an interval of at least 1 week. The inter-observer reliability, intra-observer reliability and internal validity were analyzed. Results: The correlation coefficients for the HOPE-score were as follows: intra-observer reliability 0.817, inter-observer reliability 0.790, "non-parametric" internal validity 0.849 and "parametric" internal validity 0.842. These values reflect good reproducibility, sufficient agreement among observers and a valid measurement of differences and similarities in cosmetic appearance. Conclusions: The HOPE-score is the first scoring system that fulfills the criteria of a valid measurement tool: objectivity, reliability and validity. These favorable properties support its use as an objective outcome measure of the cosmetic result after hypospadias surgery.
Original languageEnglish
Pages (from-to)1006-1016
JournalJournal of Pediatric Urology
Issue number6
Publication statusPublished - Dec 2013


  • Hypospadias
  • Outcome assessment
  • Scoring system
  • Surgery

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