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Photographic Digital Measurements in Hypospadias: Validation of a Reliable Substitute for Intraoperative Measurements
Ardavan Akhavan, MD1, Paul Merguerian, MD1, Richard Grady, MD1, Michael DiSandro, MD2, Margarett Shnorhavorian, MD1.
1Seattle Children's Hospital, Seattle, WA, USA, 2University of California San Francisco, San Francisco, CA, USA.

BACKGROUND: Surgical decisions regarding hypospadias are based on glans, penile and urethral plate dimensions. Intraoperative measurements are often subjective, time-consuming and tedious. In an effort to minimize operative time, document penile anatomy and aid in surgical planning, we propose a standardized protocol for photographing the hypospadias penis and validate the use of digital image software for measuring penile dimensions preoperatively.
METHODS: Photographs were taken of hypospadias penises in 4 different views after placement of a traction stitch and retraction of the prepucial hood in the operating room. Views included: 1) ventral stretched penis; 2) ventral view with the urethral plate spread wide; 3) above the tip of the glans; 4) side of the stretched penis. The following measurements were obtained with a caliper intraoperatively: glans width, glans height, glans depth, urethral plate width, urethral plate length, penile length. Using ImageJ software (Bethesda, MD), digital measurements were taken of the same parameters.
All intraoperative and digital measurements were obtained in triplicate by multiple individuals. Averages of the digital and intraoperative measurements were tested for equivalency by determining the correlation coefficient for each parameter. Inter-observer correlation was also calculated for each parameter.
RESULTS:A total of 180 intraoperative and 180 digital measurements were taken from 60 dimensions on 10 hypospadias penises. Meatus location was distal shaft in 6, glanular in 2, and penoscrotal in 2. Strong correlation existed between digital and intraoperative measurements of the glans width, glans depth, urethral plate width, urethral plate length, and penile length (R=0.95, 0.68, 0.97, 0.96, 0.93, respectively). Glans height measurements were not as strongly associated with intraoperative measurements (R= 0.57). The average inter-observer correlation ranged from 0.90 - 1.00 for each of the intraoperative measurements ranged, and 0.90 - 1.00 for each of the digital measurements.
CONCLUSIONS: We propose a standardized method for photographing and digitally measuring the hypospadias penis. Digital photography allows for highly reliable and accurate penile measurements, which have the potential to aid in surgical planning, improve documentation, and minimize operating room time.br>


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