Descriptive RunningheadThe Pediatric Penile Perception Score: Assessment after hypospadias repair
Key WordsHypospadias, outcome assessment, child, surgery 2
Abstract
PurposeThe aim of this study is to develop and evaluate an instrument that allows to asses and compare the penile perception of patients, parents and surgeons.
Materials and MethodsSeventy-seven boys after hypospadias repair between the ages of 6-17 years were interviewed by a psychologist with a standardized questionnaire regarding their penile self-perception, including the following items: Meatus, glans, skin and general appearance. The Pediatric Penile Perception Score (PPPS) was calculated, consisting of the sum of these four items. The results were compared with a control group of age matched boys after inguinal hernia repair. A parent was asked with a questionnaire to report his son's penile appearance using the PPPS. Fifty-six patients accepted standardized photo documentation and their pictures were sent for evaluation with the PPPS to six blinded urologists.
ResultsThe PPPS allowed to assess perception of genitalia by patients, parents and urologists. Statistical analysis of the urologist's PPPS revealed a good interrater reliability (interclass correlation: 0.75-0.88) and stability (r=0.59-0.83). Intercorrelation of the items meatus, glans and skin with the general appearance was good in the boys, parents and urologists form. Hypospadias patients expressed a high satisfaction with their penile appearance that did not significantly differ from age matched controls. However, parents and urologists were less satisfied with the penile appearance than patients themselves.
ConclusionsThe PPPS is an evaluated, reliable instrument to assess penile self perception in children after hypospadias repair and to appraise the surgical result by parents and non involved urologists.3
Treating cartilage injuries and degenerations represents an open surgical challenge. The recent advances in cell therapies have raised the need for a potent off-the-shelf cell source. Intra-articular injections of TGF-β transduced polydactyly chondrocytes have been proposed as a chronic osteoarthritis treatment but despite promising results, the use of gene therapy still raises safety concerns. In this study, we characterized infant, polydactyly chondrocytes during in vitro expansion and chondrogenic re-differentiation. Polydactyly chondrocytes have a steady proliferative rate and re-differentiate in 3D pellet culture after up to five passages. Additionally, we demonstrated that polydactyly chondrocytes produce cartilage-like matrix in a hyaluronan-based hydrogel, namely transglutaminase cross-linked hyaluronic acid (HA-TG). We utilized the versatility of TG cross-linking to augment the hydrogels with heparin moieties. The heparin chains allowed us to load the scaffolds with TGF-β1, which induced cartilage-like matrix deposition both in vitro and in vivo in a subcutaneous mouse model. This strategy introduces the possibility to use infant, polydactyly chondrocytes for the clinical treatment of joint diseases.
The Penile Perception Score is a reliable instrument for urologist assessment and self-assessment of postpubertal genitalia after hypospadias repair. The instrument can be recommended for all age groups because it was previously validated for the pediatric population.
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