Tags

Type your tag names separated by a space and hit enter

Formulation and validation of meatal stenosis grading system.

Abstract

INTRODUCTION

Meatal stenosis (MS) is a common finding in circumcised children. Indication for surgical correction is based on urinary symptoms such as strength and direction of urine stream as well as physical examination, including direction and caliber of the urinary stream. There is no objective grading of MS severity, and therefore indications for surgery and management protocols are vague.

OBJECTIVE

We aimed to formulate a standardized, validated, and reliable grading system for MS severity based on the physical examination finding.

STUDY DESIGN

Photographs of the urethral meatus were taken in patients scheduled for meatotomy due to MS, whereas patients without this condition served as control. The photographs were rated by three experienced fellowship trained pediatric urologists. The study was conducted in two phases: 1) development of a grading system by the expert panel and 2) testing of the proposed grading system for inter- and intra-rater reliability. To estimate the correlation between different rates, the intra-class correlation coefficient (ICC) was calculated.

RESULTS

Three grades were generated: Grade 0 (wide open meatus, visible mucosa), Grade 1 (minimal mucosa/fibrotic tissue visible), and Grade 2 (pinpoint meatus/no mucosa visible/large fibrotic layer). A panel of 51 raters (pediatric urologist, community urologist, pediatricians) participated in the survey evaluating the representative photos from 86 patients. Inter-rater reliability was high ICC = 0.99 (95% confidence interval [CI] of 0.983-0.996, P < 0.0001) Cronbach's alpha = 0.992. In total, 18 raters participated in the same survey two weeks later for intra-rater reliability. An identical grading was obtained in 83.3% of photographs (kappa = 0.455 [P < 0.05]).

CONCLUSION

We propose a grading system that is a valid, reliable, and reproducible method to classify the severity of MS on physical exam. This grading system could improve the healthcare provider's and parent's communication and can be a building block for further research in this field. A further research should assess the correlation with clinical signs and symptoms.

Authors+Show Affiliations

Pediatric Urology Unit, Hadassah Hebrew University Medical Center, Jerusalem, Israel. Electronic address: mci10matan@gmail.com.Pediatric Urology Unit, Hadassah Hebrew University Medical Center, Jerusalem, Israel.Tel Aviv Sourasky Medical Center, Paediatric UroIogy Unit, Department of Urology, Tel Aviv, Israel.Pediatric Urology Unit, Hadassah Hebrew University Medical Center, Jerusalem, Israel.CHOC Children's Hospital of Orange County, Orange, CA, USA; Department of Urology, University of California, Irvine, CA, USA.Department of Urology, Hadassah Hebrew University Medical Center, Jerusalem, Israel.Department of Urology, Hadassah Hebrew University Medical Center, Jerusalem, Israel.Pediatric Urology Unit, Hadassah Hebrew University Medical Center, Jerusalem, Israel.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31964617

Citation

Mekayten, Matan, et al. "Formulation and Validation of Meatal Stenosis Grading System." Journal of Pediatric Urology, 2019.
Mekayten M, Meir E, Jacob BC, et al. Formulation and validation of meatal stenosis grading system. J Pediatr Urol. 2019.
Mekayten, M., Meir, E., Jacob, B. C., Landau, E. H., Khoury, A. E., Gofrit, O. N., ... Hidas, G. (2019). Formulation and validation of meatal stenosis grading system. Journal of Pediatric Urology, doi:10.1016/j.jpurol.2019.11.012.
Mekayten M, et al. Formulation and Validation of Meatal Stenosis Grading System. J Pediatr Urol. 2019 Dec 2; PubMed PMID: 31964617.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Formulation and validation of meatal stenosis grading system. AU - Mekayten,Matan, AU - Meir,Eyal, AU - Jacob,Ben-Chaim, AU - Landau,Ezekiel H, AU - Khoury,Antoine E, AU - Gofrit,Ofer N, AU - Duvdevani,Mordechai, AU - Hidas,Guy, Y1 - 2019/12/02/ PY - 2019/07/27/received PY - 2019/11/23/accepted PY - 2020/1/23/entrez KW - Grading system KW - Meatal stenosis KW - Pediatric urology KW - Stream deviation KW - Stricture JF - Journal of pediatric urology JO - J Pediatr Urol N2 - INTRODUCTION: Meatal stenosis (MS) is a common finding in circumcised children. Indication for surgical correction is based on urinary symptoms such as strength and direction of urine stream as well as physical examination, including direction and caliber of the urinary stream. There is no objective grading of MS severity, and therefore indications for surgery and management protocols are vague. OBJECTIVE: We aimed to formulate a standardized, validated, and reliable grading system for MS severity based on the physical examination finding. STUDY DESIGN: Photographs of the urethral meatus were taken in patients scheduled for meatotomy due to MS, whereas patients without this condition served as control. The photographs were rated by three experienced fellowship trained pediatric urologists. The study was conducted in two phases: 1) development of a grading system by the expert panel and 2) testing of the proposed grading system for inter- and intra-rater reliability. To estimate the correlation between different rates, the intra-class correlation coefficient (ICC) was calculated. RESULTS: Three grades were generated: Grade 0 (wide open meatus, visible mucosa), Grade 1 (minimal mucosa/fibrotic tissue visible), and Grade 2 (pinpoint meatus/no mucosa visible/large fibrotic layer). A panel of 51 raters (pediatric urologist, community urologist, pediatricians) participated in the survey evaluating the representative photos from 86 patients. Inter-rater reliability was high ICC = 0.99 (95% confidence interval [CI] of 0.983-0.996, P < 0.0001) Cronbach's alpha = 0.992. In total, 18 raters participated in the same survey two weeks later for intra-rater reliability. An identical grading was obtained in 83.3% of photographs (kappa = 0.455 [P < 0.05]). CONCLUSION: We propose a grading system that is a valid, reliable, and reproducible method to classify the severity of MS on physical exam. This grading system could improve the healthcare provider's and parent's communication and can be a building block for further research in this field. A further research should assess the correlation with clinical signs and symptoms. SN - 1873-4898 UR - https://www.unboundmedicine.com/medline/citation/31964617/Formulation_and_validation_of_meatal_stenosis_grading_system L2 - https://linkinghub.elsevier.com/retrieve/pii/S1477-5131(19)30412-7 DB - PRIME DP - Unbound Medicine ER -