Glans–Urethral Meatus–Shaft (GMS) Scoring System in Hypospadias: A Multicontinental Systematic Review and Meta analysis.

BACKGROUND: Traditional hypospadias classification systems based solely on meatal position inadequately predict surgical complexity and outcomes. The Glans-Urethral Meatus-Shaft (GMS) scoring system was developed to provide multidimensional phenotypic assessment, incorporating glans morphology, meatal location, and penile curvature. OBJECTIVE: To systematically evaluate the clinical utility of GMS scoring in hypospadias assessment, prognostic counseling, and surgical outcome prediction through a comprehensive analysis of published evidence. MATERIALS AND METHODS: A systematic review and meta-analysis were conducted following Preferred Reporting Items for Systematic Reviews and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. PubMed, Embase, Scopus, Ovid, and Google Scholar were systematically queried for studies reporting GMS scoring in unoperated hypospadias cases. Data extraction and quality assessment were performed independently by two reviewers. Statistical analysis employed random-effects models with 95% confidence intervals. RESULTS: Twenty-seven studies encompassing 2300 unoperated hypospadias cases from 10 countries across the globe were included. Seventy-five percent of studies were published within the past 5 years. Studies demonstrated the following primary applications: Complication prediction (n = 19), surgical decision-making (n = 16), cosmetic outcome assessment (n = 10), validation studies (n = 10), artificial intelligence integration (n = 5), comparative scoring analysis (n = 12), and developmental research (n = 2). Statistical analysis revealed a significant association between increasing GMS severity and urethra-cutaneous fistula incidence (Z = 4.2871, P < 0.001). CONCLUSIONS: GMS scoring provides a validated, reproducible hypospadias severity assessment with demonstrated clinical utility in risk stratification, surgical planning, and outcome prediction. While showing strong correlation with surgical complications, weaker associations with cosmetic outcomes indicate the need for complementary assessment tools. Integration with emerging technologies and standardization of scoring methodology represent key priorities for optimizing clinical implementation.