The GMS hypospadias score: Assessment of inter-observer reliability and correlation with post-operative complications

Further analysis of the Glans-Urethral Meatus-Shaft (GMS) hypospadias score: Correlation with postoperative complications

“…The GMS score, based on anatomic features, felt to most likely impact functional and cosmetic outcomes (i.e. glans size/ urethral plate quality, location of meatus, and degree of chordee), demonstrated high inter-observer reliability in a previous study [4]. Specific measurements using calipers, such as urethral plate or glans width, penile length, and chordee angle were not included in the present scoring system due to the potential for poor inter-observer reliability and uncertainty as to how these measurements were obtained.…”

“…The G score was based on glans size and urethral plate quality; in cases of discrepancy, the higher score was used. Mild (GMS 3e6), moderate (GMS 7e9) and severe (GMS 10e12) scores were used to further stratify the severity of hypospadias, as previously described [4]. The total GMS scores, as well as individual components, were tested in univariate and multivariate analyses.…”

“…The literature is lacking on both a clear definition of severe hypospadias and a generally accepted standardized classification scheme. The Glans-Urethral Meatus-Shaft (GMS) hypospadias classification was developed as a means of qualitatively scoring the severity of hypospadias, based on easily observable features, and has been shown to have high inter-observer reliability [4]. In the GMS classification, each of the three penile components is scored numerically on a scale of 1e4, with more unfavorable characteristics being assigned higher values.…”

Current challenges with proximal hypospadias: We have a long way to go

“…The Atlanta group introduced the concept of pre-operative GMS scoring of hypospadias to determine potential risk for post-operative complications. The penis is scored from 1 to 4 on three qualities: (G)lans size / urethral plate configuration; (M)eatal location; and degree of curvature in the penile (S)haft, for a total score ranging from 3 to 12 [35]. They subsequently demonstrated that the GMS score was correlated with post-operative risk of complications with increasing score associated with increasing rate of urethrocutaneous fistula.…”

Can We Correct Hypospadias with a Staged Operation? If not, are We Bold Enough to Report it?

“…There are a number to choose from that vary in complexity and reproducibility. 6,7 Even digital photography may not decrease the subjectivity of assessment of this art/science of hypospadiology, but if standardized, digital imaging will likely lead to better segregation of subjects and more precise reporting of outcomes. 8 Most of all, we need to structure our followup assessment to include the parent and, if appropriate, the patient.…”