Intradyadic analysis of child parent perceptions of penile appearance post-hypospadias repair using the Paediatric Penile Perception Score (PPPS) in a middle-income country setting.

Abstract

Purpose: Hypospadias affects roughly 1 in 125 live male births, yet subjective outcome assessment is infrequent. We compared child- and parent-reported cosmetic satisfaction after repair and quantified inter-rater agreement.

Methods: In this cross-sectional study, all boys aged 7-15 years who attended follow-up at Hospital Sultanah Bahiyah, Malaysia (repairs 2017-2019), were invited. Each child-parent dyad independently completed the Paediatric Penile Perception Score (PPPS; four domains, 1 = very dissatisfied to 4 = very satisfied). Paired Wilcoxon tests examined child-parent differences. Concordance was analysed with Spearman's ρ and quadratic-weighted Cohen's κ.

Results: Sixty-three dyads participated (median child age 10.6 years). Median satisfaction for every domain was 3 [IQR 2-3] in both cohorts. Children rated penile-skin appearance one Likert step lower than parents (median difference - 1; p = 0.033); no other paired differences reached significance. Correlations between raters were moderate (ρ = 0.49-0.61). Agreement was fair for penile skin (κ = 0.27) and moderate for meatus position (κ = 0.56, 95% CI 0.29-0.77), glans shape (κ = 0.43) and overall appearance (κ = 0.45).

Conclusion: High overall satisfaction was reported despite surgical delays. Only moderate concordance emerged, with children less pleased with penile skin than their parents. Pre-operative counselling and longitudinal follow-up should explicitly address child-centred aesthetic concerns to enhance psychosocial well-being.