Third-Line Overactive Bladder Therapies on TikTok: What Does the Public Learn?

IMPORTANCE: Millions of people rely on social media platforms, including TikTok, for health-related information. TikTok has not yet been evaluated as an information source for overactive bladder (OAB) third-line therapies. OBJECTIVES: Our aim was to assess TikTok videos on third-line therapies for OAB for misinformation and quality. STUDY DESIGN: In this cross-sectional analysis, we abstracted the top 50 TikTok videos for keywords: "Axonics," "sacral neuromodulation," "Interstim," "PTNS," "posterior tibial nerve stimulation," and "bladder Botox." Videos were scored for quality by 3 independent reviewers using the Medical Quality Video Evaluation Tool (MQ-VET). Two reviewers determined if videos contained misinformation. RESULTS: Of 300 videos screened, 119 videos were included. Twenty-four (21%) were created by medical professionals (MPs). Medical professional videos were more frequently shared (5 vs 1, P < 0.01) but had similar views, likes, comments, and length. Although MP videos had significantly higher MQ-VET scores (43 vs 27, P < 0.01), there was no difference in the rate of misinformation between MP and non-MP videos (21% vs 18%). Twenty-two videos (18.4%) contained misinformation, which were 3 times longer (50.5 vs 15 seconds, P < 0.01) and had higher MQ-VET scores (34.5 vs 27, P = 0.03) than those without misinformation. Common themes of misinformation pertained to therapy indication, mechanism of action, and patient limitations after undergoing therapy. CONCLUSIONS: Many TikTok videos on OAB third-line therapies contain misinformation. Most of these videos were not of high quality and created by the public. Medical professionals should be aware of misinformation permeating TikTok, given its large audience, and aim to promote or offer educational material of better accuracy and quality.

Understanding Current Demographics, Practice Patterns, and Concerns of Women in Urology: Analysis From the 2022 Society of Women in Urology Census Task Force.

OBJECTIVE: To describe the current demographics, needs, and challenges of women in Urology throughout the United States, including active Urologists as well as urologic trainees. METHODS: An electronic survey was distributed via email and social media sites to all members of the Society of Women in Urology, including residents, fellows, and female urologists practicing in the US and its territories, between February 2022 and May 2022. The survey collected information on demographics, practice type, workplace, personal, family issues, barriers, and career plans from all respondents. RESULTS: Of the estimated 1375 women urologists and trainees based on AUA census data, 379 responses (27.6% response rate) were received. Almost all respondents (98%) are members of the AUA. The average age was 42.9years (SD 18.6). In terms of ethnicity, most self-reported as White 71.0%, followed by 16.4% Asian or Asian American, and 6.3% African American. The majority reported practicing in urban locations (63.5%) at an academic setting (55.7%), followed by similar distribution between private practice and hospital-employed settings (17.0% and 16.7%, respectively). The vast majority, 89.6%, reported working full-time, while only 10.4% worked part-time. The average hours of work per week were 56.7 (SD 14.5). In terms of personal demographics, 81.9% were married, 17.3% were single and 1% did not answer. 68.8% of responders had children, with the majority of these children being born during or after training. CONCLUSION: Based on the findings, although female urologists have increased in numbers, certain ethnicities are under-represented. Additional surveys and engagement of current trainees and practitioners are needed to identify further areas of intervention for specific needs.

National Utilization, Reimbursement, and Urban Versus Rural Trends of Extracorporeal Shockwave Lithotripsy and Ureteroscopic Laser Lithotripsy.

OBJECTIVE: To describe temporal utilization and reimbursement trends of extracorporeal shockwave lithotripsy (ESWL) and ureteroscopy (URS) with laser lithotripsy. METHODS: The Medicare Provider Utilization and Payment Database was queried for all ESWL and URS performed between 2013 and 2020 using Current Procedural Terminology codes: ESWL - 50590; URS - 52352, 52353, 52356. Cases that lacked rural or urban identification codes were excluded. A total of 347,174 ESWL and 401,899 URS cases were identified. Linear regression was performed with statistical significance set to 95% confidence intervals. RESULTS: There was a significant upward trend for URS utilization over the study period (R2 = 0.91, P <.001), but there was not a significant trend for ESWL utilization. In 2013, ESWL was used more frequently than URS, but by 2016, URS was used more frequently than ESWL. From 2013 to 2019, URS utilization increased by 241% and 168% by urban and rural urologists, respectively. URS was also associated with a slight increase in physician reimbursement over time (R2 = 0.87, P <.001), whereas there was no association between ESWL and physician reimbursement. For URS, rural and urban urologists were reimbursed an average of $312.07 (standard deviation [SD] $14.03) and $404.86 (SD $21.96), respectively. For ESWL, rural and urban urologists were reimbursed an average of $456.22 (SD $5.74) and $562.66 (SD $16.68), respectively. CONCLUSION: According to the Medicare database, URS has surpassed ESWL in utilization, especially by urban urologists. Physician reimbursement for ESWL remained higher than URS reimbursement, though URS reimbursement increased slightly in recent years.

Robotic distal ureterectomy and re-implant for obstructing metastatic melanoma - surgical considerations in the palliative setting.

Non-urothelial malignant ureteral obstruction (MUO) causes hydronephrosis, renal damage and infectious sequelae. The overall condition, symptoms, and plans for systemic therapy inform urologic intervention. In well-selected cases, there is a role for definitive reconstruction. We describe a robotic-assisted distal ureterectomy and reimplant for definitive repair of obstructive metastatic melanoma.

Contemporary Clinical Research in the Management of Pelvic Organ Prolapse in the United States: A Systematic Review.

IMPORTANCE: Pelvic organ prolapse (POP) can cause bothersome symptoms that negatively affect quality of life. Management strategies include observation, conservative management, and surgery. OBJECTIVE: The purpose of this study was to evaluate the current focus of research in POP. STUDY DESIGN: We queried clinicaltrials.gov, a registry of clinical research studies maintained by the U.S. National Library of Medicine, for active, recruiting, and enrolling studies involving POP. RESULTS: A total of 104 unique clinical trials were included for analysis. Investigators most commonly specialized in obstetrics and gynecology (obstetrician-gynecologists [ob-gyns]; n = 66, 57.9%); urologists numbered 5 (4.4%). The most common subspecialty was urogynecology (n = 46, 40.4%). Seventy-six percent of clinical research involved surgical intervention. The second most common field of research was diagnostic evaluation of POP (8.4%). Only 12.1% of clinical research focused on conservative measures, and 2.8% investigated medications. Objective outcome measures were used more often than subjective or mixed measures (42.3%, 22.3%, and 32.7%, respectively). The most common outcome measure was Pelvic Organ Prolapse Quantification (14.5%), followed by the mixed measure, "composite success" (8.7%). CONCLUSIONS: Urologists are less involved in POP research than ob-gyns. Urogynecologists from either background are most involved. Most clinical research involves surgical management of POP, despite the fact that less than 20% of women pursue surgical correction. Despite dubious concordance with quality of life, objective outcome measures are used more often than subjective or mixed measures to assess severity of POP. Clinical research in POP should be directed to better align with the needs and preferences of patients.

Medications Most Commonly Associated With Erectile Dysfunction: Evaluation of the Food and Drug Administration National Pharmacovigilance Database.

BACKGROUND: Erectile dysfunction (ED) is an adverse effect of many medications. AIM: We used a national pharmacovigilance database to assess which medications had the highest reported frequency of ED. METHODS: The Food and Drug Administration Adverse Event Reporting System (FAERS) was queried to identify medications with the highest frequency of ED adverse event reports from 2010 to 2020. Phosphodiesterase-5 inhibitors and testosterone were excluded because these medications are often used as treatments for men with ED. The 20 medications with the highest frequency of ED were included in the disproportionality analysis. OUTCOMES: Proportional Reporting Ratios (PRRs) and their 95% confidence intervals were calculated. RESULTS: The 20 medications accounted for 6,142 reports of ED. 5-α reductase inhibitors (5-ARIs) and neuropsychiatric medications accounted for 2,823 (46%) and 2,442 (40%) of these reports respectively. Seven medications showed significant levels of disproportionate reporting with finasteride and dutasteride having the highest PRRs: 110.03 (103.14-117.39) and 9.40 (7.83-11.05) respectively. The other medications are used in a wide variety of medical fields such as cardiology, dermatology, and immunology. CLINICAL IMPLICATIONS: Physicians should be familiar with these medications and understand their respective mechanisms of action, so that they may counsel patients appropriately and improve their quality of life. STRENGTHS AND LIMITATIONS: The strength of the study is its large sample size and that it captures pharmacologic trends on a national level. Quantitative and comparative "real-world" data is lacking for the most common medications associated with ED. The limitation is that the number of reported events does not establish causality and cannot be used to calculate ED incidence rates. CONCLUSION: In a national pharmacovigilance database, 5-ARIs and neuropsychiatric medications had the highest reports of ED adverse effects. There were many other medications used in a variety of medical fields that were also associated with ED. Kaplan-Marans E, Sandozi A, Martinez M, et al. Medications Most Commonly Associated With Erectile Dysfunction: Evaluation of the Food and Drug Administration National Pharmacovigilance Database. Sex Med 2022;10:100543.

Representation in Figures Depicting Penile Pathology in Urologic Textbooks.

OBJECTIVE: To investigate whether penile pathologies are presented diversely in urologic textbooks and identify areas where more diverse presentation is warranted. METHODS: Photographic depictions of penile pathologies in 9 urologic textbooks were assigned a Fitzpatrick skin phototype and constitutive skin color. Fitzpatrick skin phototypes ranged from I to VI, and constitutive skin colors were light, fair, medium, and dark. Fitzpatrick skin phototypes I-III were deemed nonskin of color, and IV-VI considered skin of color. Figures were classified based on pathology presented: infectious benign or sexually transmitted infection (STI), noninfectious benign, or malignant. Chi-square and odds ratios were used to compare skin color ranges across pathologic categories and determine where a figure depicting skin color would most likely be encountered. RESULTS: Within 116 figures meeting inclusion criteria, 15 (51.7%) infectious/STI pathologies displayed skin of color, while 10 (27.8%) noninfectious benign and 7 (13.7%) malignant pathologies displayed skin of color. Within 85 diagnostic images, 15 (51.7%) images of infections/STIs, 10 (28.6%) noninfectious benign, and 4 (19.0%) malignant pathologies presented skin of color (P < 0.01). Overall, images of patients with skin of color were more likely depictions of infections/STIs than any other pathology (P < .001, OR = 2.26). CONCLUSION: There is a lack of depictions of malignant and noninfectious benign penile pathology on the skin of color. This may contribute to continued disparities in the diagnosis and treatment of penile pathologies.

Availability of Lactation Accommodation Information for Urology Residency Programs.

OBJECTIVE: To assess whether urology residency programs publish information about lactation accommodations online. Although residencies are required to provide lactation accommodations, there is limited data on whether programs disclose this information. MATERIALS AND METHODS: Webpages of U.S. urology residency programs were assessed for presence of information about lactation accommodations. Program characteristics were noted, as were mentions of resident wellness and diversity. Associations between program characteristics and published lactation accommodations were determined by univariate analysis and development of a multivariate logistic regression model. RESULTS: Of 145 urology residency programs, 72.4% included information about lactation accommodations anywhere on the institution's website There was great variability in ease of accessing information and of quality of information available. Information was most commonly on graduate medical education websites (28.3%) followed by human resources (24.1%), press releases (7.6%), or other sections (11.0%), and least likely to be found on urology residency websites (1.4%). Programs with lactation accommodations anywhere on the institution website were more likely to be larger (P < 0.001), university-based (P < 0.01), and to publish information about resident wellness (P < 0.001), or diversity and inclusion (P < 0.01). On multivariate analysis, only university-based setting and presence of wellness information were predictors of availability of lactation accommodation information. CONCLUSION: Lactation accommodation information is usually not available on urology residency websites and most online information is found elsewhere. Predictors of publishing lactation accommodation information were university-based setting and information about resident wellness. Efforts to recruit and retain female urologists should include making this information more easily accessible.

Who is at the Podium? Women Urologist Speakers at Recent AUA Meetings.

OBJECTIVE: To quantify the representation of women urologists as invited speakers at the AUA Annual Meeting. METHODS: Programs for the AUA Annual Meeting were reviewed from 2017 to 2019. Topics of sessions and genders of moderators and panelists were collected. Percentages of women urologists as well as topics of sessions were compared between years. RESULTS: Women urologists comprised 60 of 467 moderators (12.8%) and 63 of 614 panelists (10.3%). Sessions about infection had the most women urologist moderators while oncology had the least. Sessions about FPMRS has the most women urologists as panelists. Male urologists were more likely to be full professors compared to women urologists. While the percentage of female panelists fluctuated, the percentage of female moderators decreased each year. CONCLUSION: Although the proportion of women to men in urology is increasing, the number and proportion of woman urologist panelists and moderators at the annual AUA meeting does not reflect this trend. It is important to recognize and correct this discrepancy, as well as to increase visibility of women and others underrepresented in the field.