The goal of hypospadias surgery is to reconstruct a penis that is both functional and cosmetically appealing. With the advancement of hypospadias techniques, functional outcome has been less concerning, thus highlighting the patient and parent’s concerns of cosmetic outcomes. There is currently limited research for preoperative counseling of children and their parents on the quality of life, specifically the cosmetic expectations post repair of hypospadias. Patients and parents’ perception may be more inhibited with regards to patient’s confidence and quality of life especially with their voiding experience.

A total of 23 participants who underwent hypospadias repair from January 2022 to June 2024 were scored using the GMS classification involving urethral plate quality, meatal location and degree of curvature. Postoperatively, Pediatric Penile Perception Score (PPPS) was used to assess satisfaction in surgical outcomes as determined by the patient/parents with respect to penile length, position and shape of meatus, shape of the glans, shape of penile skin and general appearance of the penis.

Of the 23 patients included, 17 had a moderate GMS score, while 6 were categorized as having severe GMS score. There were 18 prepubertal patients, 14 exhibited moderate and 3 had severe scores. In contrast, the 5 pubertal patients included 3 with moderate and 2 with severe GMS scores. For prepubertal individuals, the glans size and urethral plate quality were the primary factors influencing the GMS score. In pubertal patients, however, the primary determinant of a high GMS score was the location of the meatal opening, which in all cases was associated with proximal hypospadias. Across all age groups, severe GMS scores were predominantly influenced by the location of the meatus and the severity of chordee. GMS score is a significant predictor of an acceptable level of penile appearance with a p-value of <0.040, particularly the urethral plate quality and degree of curvature/

Irrespective of age, urethral location, and the stage of repair, the GMS score is a significant predictor of favorable acceptance regarding genital appearance in patients who have undergone hypospadias repair. Predictors of optimal penile appearance included urethral plate quality and degree of chordee. These factors must be discussed with the caregivers during decision-making to be able to gauge expectations about penile appearance.