Pediatric Penile Perception Score

Pediatric Penile Perception Score‌


University Children’s Hospital Zurich, Switzerland

The Pediatric Penile Perception Score (PPPS) is designed to assess both the penile self-perception of children and adolescents with hypospadias and the surgical outcome of hypospadias repair. The PPPS allows a direct comparison between children’s and pediatric urologists’ appraisal of penile appearance.


The PPPS was developed and evaluated in a cross-sectional study on the psychosexual development and health- related quality of life of children and adolescents with hypospadias (Schönbucher, Landolt, Gobet, & Weber, 2008a, 2008b; Weber, Schönbucher, Landolt, & Gobet, 2008) because no instrument was available to objectively assess the surgical outcome and self-perception after hypospadias repair. Psychological interviews were conducted with 65 children and adolescents between the ages of 6 and 17 years who underwent surgery for hypospadias at the University Children’s Hospital Zurich (Switzerland). They were asked to express their satisfaction with the following aspects of surgical outcome and penile appearance on a 4-point Likert-type scale that ranges from Very Dissatisfied to Very Satisfied: position and shape of meatus, shape of the glans, shape of penile skin, and general penile appearance. In addition, patients with hypospadias were offered a physical examination by a pediatric urologist, during which standardized photo- graphs of the penis in four standardized views were taken, namely oblique, lateral, anteroposterior with the penis held against the abdominal wall, and anteroposterior with the penis held up straight (see Weber et al., 2008). Examinations were consented to by 56 boys.

The photographs were sent to six pediatric urologists for blind analysis, four of whom were not affiliated with the University Children’s Hospital Zurich. They were asked to evaluate the standardized photographs according to the same criteria and scale as the children. To assess the stability of the instrument, in the set of 56 charts, 10 were included twice. Reliability was high (interclass correlation coefficient (ICC): .75–.88). Thus, the scores of the six pediatric urologists could be averaged to obtain an objective assessment of the quality of surgical outcome. For a more detailed description of the development of the instrument, see Weber et al. (2008).

Response Mode and Timing

Younger children’s penile perception should be assessed in an interview. Alternatively, adolescents can fill in a questionnaire. (See the Exhibit for interview and questionnaire instructions.) Urologists can objectively rate the surgical outcome either from photographs or in vivo. Appraisal of the results with photographs allows evaluation by non- involved urologists and avoids the bias that occurs when judging one’s own results. The use of the questionnaire by urologists is easy and self-explanatory.

The application of the PPPS takes between 5 and 10 minutes for children and 2 minutes for urologists.


Each item of the PPPS is scored as follows: Very Satisfied = 3, Satisfied = 2, Dissatisfied = 1, Very Dissatisfied = 0. The four items are then added to a total score, ranging from 0 to 12.


The PPPS showed an excellent internal consistency for the children’s penile self-perception (α = .81), as well as for the pediatric urologists’ assessment of the surgical outcome (α = .84). Interrater reliability (ICC: .75–.88) and stability of the pediatric urologists’ assessment (rs between the 1st and 2nd assessment: .59–.83) were high both for the four single items and for the PPPS total score.


Validity was not examined.

Other Information

We recommend that the surgical outcome be assessed by an independent pediatric urologist who was not involved in the surgical treatment of the child, because it is assumed that pediatric urologists’ assessment of their own surgical results may be distorted in the direction of a more positive judgment (Weber et al., 2008). We further suppose that the PPPS might also be a reliable measurement for the social perception of a boy’s penis after hypospadias repair, such as by the boy’s parents. Assessment and possible modification of the penile perception score for the adult population as well as the social perception of the adult penis after hypospadias repair are currently being reviewed.

This research was supported by a grant of the Foundation Mercator. Verena Schönbucher is also affiliated with the Child and Woman Abuse Studies Unit, Department of Applied Social Sciences, London Metropolitan University.

Pediatric Penile Perception Score



Interview version. We will talk about several aspects of your penis. Please tell me how satisfied you are with these. There are four possible answers: very satisfied, satisfied, dissatisfied, very dissatisfied. Please tell me which one is the most appropriate for you.

Questionnaire. The chart below shows various aspects of your penis. There are four possible answers: very satisfied, satisfied, dissatisfied, very dissatisfied. Please mark with a cross the box that is most appropriate for you.

Pediatric Urologists

The use of the PPPS for urologists is self-explanatory.

Very Satisfied



Very Dissatisfied

Meatal position and shape

Shape of the glans

Shape of penile skin

General cosmetic appearance

Address correspondence to Verena Schönbucher, Child and Woman Abuse Studies Unit, Department of Applied Social Sciences, London Metropolitan University, Ladbroke House, 62–66 Highbury Grove, London N5 2AD, United Kingdom; e-mail:[email protected] or v.schonbucher@


Schönbucher, V. B., Landolt, M. A., Gobet, R., & Weber, M. A. (2008a). Health-related quality of life and psychological adjustment of chil- dren and adolescents with hypospadias. Journal of Pediatrics, 152, 865–872.

Schönbucher, V. B., Landolt, M. A., Gobet, R., & Weber, M. A. (2008b). Psychosexual development of children and adolescents with hypospa- dias. Journal of Sexual Medicine, 5, 1365–1373.

Weber, D. M., Schönbucher, V. B., Landolt, M. A., & Gobet, R. (2008). The Pediatric Penile Perception Score: An instrument for patient self- assessment and surgeon evaluation after hypospadias repair. Journal of Urology, 180, 1080–1084.