A Novel and Objective Method of Documenting Hypospadias Anatomy- Three-Dimensional Scanning
Albert S T Lee, DO, PharmD, Christina P. Ho, MD, Austin Hester, MD, Emmanuele Delot, PhD, Daniel Casella, MD.
Children's National Hospital, Washington, DC, USA.
BACKGROUND: The absence of a hypospadias classification system or standardized anatomic measurements is hindering hypospadias research. Three-dimension (3D) scanning offers a non-invasive and efficient method of documenting a patient’s anatomy with sub-millimeter resolution. We developed a standardized approach for obtaining 3D scans in patients undergoing hypospadias repair and evaluated the inter-rater reliability of measurements made from the three-dimensional computer models.
METHODS: An Artec3D Space Spider scanner was used to obtain 3D scans in 29 patients undergoing hypospadias repair. To standardize the image capture, a glans suture was placed and retracted upwards with a force of 500 grams. Measurements of the urethral plate width, urethral plate length, glans width, penile shaft length, and penile shaft width were made by 2 pediatric urology attendings and 1 pediatric urology fellow. Measurements were compared and Inter-rater reliability was calculated.
RESULTS: A total of 435 measurements were made on 29 successfully generated 3D scans, ranging from distal to proximal hypospadias. The inter-rater reliability of measurements from the generated 3D models shown good inter-rater reliability of urethral plate width (ICC 0.87 [95% CI:0.76, 0.93]), penile shaft length (ICC 0.87 [95% CI:0.70, 0.94]) and glans width (ICC 0.83 [95% CI: 0.68, 0.92]), excellent inter-rater reliability of urethral plate length (ICC 0.96) and moderate interrater reliability of penile shaft width (ICC 0.69 [95% CI: 0.44, 0.84]). A strong inter-rater correlation was found ranging from (r= 0.76, P <0.001) to (r= 0.98; P < 0.001) between any two raters (Rater 1 vs. Rater 2, Rater 1 vs. Rater 3, and Rater 2 vs. Rater 3) for all the parameters.
CONCLUSIONS: 3D scanning offers a rapid, reproducible, and non-invasive method of documenting the individual anatomy of patients with hypospadias. In addition to standardizing measurements among surgeons, the application of 3D shape analysis algorithms may allow for the identification of novel anatomic features. 
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