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VALIDATION OF THE HOPE QUALITY ASSURANCE
SCORE ON POSTOPERATIVE RESULTS AFTER SUTURED
OR SUTURELESS CIRCUMCISION
Charlotte VANDERSTAPPEN
1
, Guy BOGAERT
1
, Hendrik-Jan FLORIN
1
and Marleen VAN DEN HEIJKANT
2
1) UZLeuven, Pediatric urology, Leuven, BELGIUM - 2) UZLeuven, Gasthuisberg Campus, Urology, Leuven, BELGIUM
PURPOSE
The cosmetic aspect of the penis is an important factor for parents, not only after hypospadias
repair, but also after circumcision. The HOPE score (hypospadias objective penile score) is an
excellent tool for quality assurance after hypospadias repair. To study the HOPE score on postop-
erative outcome after circumcision, we have used the scoring system in children who underwent
circumcision with sutures or sutureless with fibrin glue.
MATERIAL AND METHODS
Boys between 3 months and 10 years of age were randomized in this ethically approved study
between a sutured circumcision (Vicryl
®
5.0 rapide) (21 patients) or a sutureless circumcision
with fibrin glue (Dermabond
®
) (20 patients). Pictures were taken before surgery and 4 to 6 weeks
after surgery. Standardized pictures were evaluated independently by medical students, urology
residents, pediatric urologists using the HOPE score. The 2 groups were assessed using the two
sample t-test to compare both surgical techniques. The inter-observer reliability was assessed us-
ing the intraclass correlation coefficient.
RESULTS
There was no difference in the HOPE score on the postoperative cosmetic aspect of the penis
between the two techniques; the overall HOPE score of sutured circumcisions was 46,15 ±3,17 vs
sutureless circumcisions 46,75 ±2,37 (p > 0,05). The HOPE score items “Shape of the skin” and
“rotation” were items that were able to differentiate in an objective quality parameter. The inter-
observer reliability was strong (0,862).
CONCLUSIONS
In this study, sutured and sutureless circumcisions resulted in similar HOPE score results. As it will
be more and more important in the future to have quality assurance scores for surgical outcome,
it would be beneficial to have a singular objective scoring system for hypospadias and circumci-
sion. The HOPE score has also shown to be an excellent quality assurance tool for postoperative
circumcision scoring.