Rises in Hematocrit Are Associated With an Increased Risk of Major Adverse Cardiovascular Events in Men Starting Testosterone Therapy: A Retrospective Cohort Claims Database Analysis.

PURPOSE: Elevated hematocrit (Hct) can result in increased risk of major adverse cardiovascular events (MACE) in men receiving testosterone therapy (TTh). However, the impact of the magnitude of the change in Hct from baseline after starting TTh has never been assessed. MATERIALS AND METHODS: To assess whether an increase in Hct after initiating TTh is associated with an increased risk of MACE within 3 and 24 months of initiating TTh, we queried the TriNetX Research network database for men over the age of 18 with Hct values obtained within 6 months before starting TTh, and who had follow-up Hct measurements within 3 and 24 months after beginning TTh from 2010 to 2021. Men with and without a subsequent increase in Hct after initiating TTh were propensity matched. MACE was defined as myocardial infarction, stroke, or death. RESULTS: After matching, 10,511 men who experienced an any increase in Hct after initiating TTh and an equal number of controls who did have an increase in Hct were included. Compared to controls who did not have an increase in Hct after starting TTh, the men who had an increase in subsequent Hct had a significantly increased risk of MACE compared to men with no change in Hct. CONCLUSIONS: We demonstrate that increases in Hct from baseline are associated with increased risk of MACE, compared to men whose Hct remains stable while receiving TTh.

Characteristics of systemic testosterone therapy for female hypoactive sexual desire disorder-a claims database analysis.

BACKGROUND: Testosterone therapy (TTh) is recommended for postmenopausal women with hypoactive sexual desire disorder (HSDD); however, there remain insufficient data to support use of TTh in premenopausal women with sexual dysfunction. AIM: In this study, we used a large national database to evaluate prescribing trends of TTh for women with HSDD. METHODS: We conducted a cohort analysis of information from electronic health records acquired from the data network TriNetX Diamond. The study cohort consisted of women 18-70 years of age with a diagnosis of HSDD. We analyzed trends of testosterone prescriptions, routes of testosterone administration, and coadministration of testosterone with estrogen. OUTCOMES: Despite an increase in rates of testosterone prescriptions for HSDD, there remains a high degree of variability in the duration of treatment, route of administration, and coadministration of estrogen with significant underprescription of testosterone. RESULTS: Our query of the TriNetX database led to the identification of 33 418 women diagnosed with HSDD at a mean age of 44.2 ± 10.8 years, among whom 850 (2.54%) women received a testosterone prescription. The testosterone prescriptions were highly variable with regard to duration and route of administration and coadministration with estrogen. For all patients until 2015, the prevalence of testosterone prescriptions for HSDD showed a positive quadratic relation was observed. Since 2015 a linear increase in prevalence was observed, with the highest rate of increase for patients aged 41-55 years. CLINICAL IMPLICATIONS: The findings of this study reveal a significant need for further research investigating the optimal use of TTh to enhance the sexual health of women with HSDD, and further studies on the long-term effects of testosterone use must be undertaken to ensure that patients have access to safe and effective treatment. STRENGTHS AND LIMITATIONS: Limitations to this study include patient de-identification and lack of availability of testosterone dosage data. However, this study also has many strengths, including being the first, to our knowledge, to characterize the prescribing trends of testosterone for women with HSDD. CONCLUSION: Testosterone therapy should be considered as a potential therapy for premenopausal female patients with HSDD. Further studies on the long-term effects of testosterone use must be undertaken to address disparities in the management of HSDD and to ensure patients can access treatment.

Testosterone therapy in females is not associated with increased cardiovascular or breast cancer risk: a claims database analysis.

BACKGROUND: Testosterone therapy (TTh) has been shown to improve libido in women with sexual dysfunction, but its utilization has been limited due to concern for cardiovascular events and past studies reporting highly variable results. AIM: To assess the association of TTh in women with major adverse cardiac events (MACEs), including heart attack, stroke, or death, using a large database. METHODS: The TriNetX Diamond Network was queried from 2009 to 2022. Our study cohort included adult females with ≥3 systemic testosterone prescriptions within a year. Our control cohort excluded females with any testosterone prescriptions, polycystic ovary syndrome, or androgen excess. Both cohorts excluded females with prior heart failure, unstable angina, intersex surgery (female to male), personal history of sex reassignment, or gender identity disorders. Propensity matching between the cohorts was performed. A subanalysis by age was conducted (18-55 and >55 years). OUTCOMES: We evaluated the association of TTh to the following: MACE, upper or lower emboli or deep vein thrombosis (DVT), pulmonary embolism (PE), breast neoplasm, and hirsutism within 3 years of TTh. RESULTS: When compared with propensity-matched controls, adult females with TTh had a lower risk of MACE (risk ratio [RR], 0.64; 95% CI, 0.51-0.81), DVT (RR, 0.61; 95% CI, 0.42-0.90), PE (RR, 0.48; 95% CI, 0.28-0.82), and malignant breast neoplasm (RR, 0.48; 95% CI, 0.37-0.62). Similarly, females aged 18 to 55 years with TTh had a lower risk of MACE (RR, 0.49; 95% CI, 0.28-0.85) and DVT (RR, 0.48; 95% CI, 0.25-0.93) and a similar risk of malignant breast neoplasm (RR, 0.62; 95% CI, 0.34-1.12). Females aged ≥56 years with TTh had a similar risk of MACE (RR, 0.84; 95% CI, 0.64-1.10), DVT (RR, 0.82; 95% CI, 0.50-1.36), and PE (RR, 0.52; 95% CI, 0.26-1.05) and a significantly lower risk of malignant breast neoplasm (RR, 0.51; 95% CI, 0.38-0.68). Risk of hirsutism was consistently higher in those with TTh as compared with propensity-matched controls. CLINICAL IMPLICATIONS: Our results contribute to safety data on TTh, a therapy for sexual dysfunction in women. STRENGTHS AND LIMITATIONS: The TriNetX Diamond Network allows for significant generalizability but has insufficient information for some factors. CONCLUSIONS: We found a decreased risk of MACE among women with TTh as compared with matched controls and a similar risk of MACE in postmenopausal women while demonstrating a similar or significantly lower risk of breast cancer on age-based subanalysis.

Generality of Evaporative Crystal Liftoff on Heated Hydrophobic Substrates.

Scaling or mineral fouling occurs due to the presence of dissolved minerals in water. Scaling is problematic in numerous industrial and household plumbing applications where water is used. The current methods of scale removal often utilize harsh chemicals that are not environmentally friendly. The evaporation of a saline droplet provides a platform to study the role of the substrate in the dynamics of crystallization during scaling. In the present work, we show out-of-plane growth of crystal deposits during the evaporation of saline droplets of aqueous potassium chloride on a heated smooth and microtextured hydrophobic substrate. These out-of-plane deposits, termed as "crystal legs", are in minimal contact with the substrate and can be easily removed from the substrate. The out-of-plane evaporative crystallization of saline droplets of different initial volumes and concentrations is observed irrespective of the chemistry of the hydrophobic coating and the crystal habits investigated. We attribute this general behavior of crystal legs to the growth and stacking of smaller crystals (size ∼10 µm) between the primary crystals toward the end of evaporation. We show that the rate at which the crystal legs grow increases with an increase in the substrate temperature. A mass conservation model is applied to predict the leg growth rate, which agrees well with the experiments.

Vaginal Candida albicans: High Frequency of in Vitro Fluconazole Resistance in a Select Population-A Brief Note.

Among clinician-ordered vaginal cultures positive for Candida albicans , 30% exhibited fluconazole resistance. Resistance did not reliably predict future susceptibility. Prospective studies to verify associations with demographic and clinical factors as well as to correlate in vitro resistance with treatment response and longitudinal resistance patterns are needed.

Gunshot Injury to Distal Tibial Physis and Talus: A Case Report.

Introduction: Gunshot injuries, while relatively uncommon in pediatric patients, can have lasting consequences, both physically and psychologically. Physeal injuries to the distal tibia are very common just second distal radius physis. Disruption of physis often leads to growth disturbances and deformities if not managed appropriately. This case report discusses the experience of a 9-year-old girl who sustained a gunshot injury to her left ankle injuring her distal tibial epiphysis. The report highlights the importance of long-term follow-up and rehabilitation in pediatric gunshot injury cases. Case Report: The patient is a 9-year-old girl who suffered a gunshot wound to her left ankle. The bullet's trajectory traversed her tibia and talus, miraculously avoiding any significant neurovascular injury. Immediate medical attention was sought, and she underwent surgical intervention to address the damage caused by the gunshot wound. The surgical procedure aimed to stabilize the fractured bone, remove any foreign bodies, and repair soft tissue damage. Patient has been followed up for 2 years, with remarkable recovery considering the severity of her injury. The patient has returned to her daily routine activities with slight chronic pain and some degree of the limitation of movement owing to injury and subsequent surgery. This case underscores the importance of long-term rehabilitation and follow-up care in pediatric gunshot injuries, as the effects can be far-reaching and persistent. Conclusion: Injury to physis of weight bearing bones can be challenging to the patient as well as the surgeon. Long-term follow-up with continued medical and psychological support for the patients is necessary to ensure the better prognosis and quality of life after such traumatic events.

Tibial Tuberosity Avulsion Fracture with Epiphyseal Injury in a Soccer Player: Treatment Options and Challenges.

Introduction: Acute avulsion of the tibial tubercle is an uncommon fracture, with reported incidence rates of 0.4-2.7% of all epiphyseal injuries and <1% of all physeal injuries. Typically, these fractures present with marked displacement of the entire proximal apophysis, with or without intra-articular extension, and variable associated soft-tissue injury. The Ogden classification has historically directed both non-operative and operative treatment of this injury. The overarching objective of several fracture fixation techniques has been outlined as being to restore the joint surface and the extensor mechanism. Case Report: This case report describes the management of a 14-year-old male who sustained a rare avulsion fracture of the left tibial tuberosity with epiphyseal injury during a soccer game. The fracture was classified as Ogden Type III-B, indicating an intra-articular extension. The patient underwent open reduction and internal fixation with three cannulated screws and tension band wiring. Conclusion: The fracture united with no residual deformity and return of full range of motion. Tension band wiring provides stable reduction; hence, prompt diagnosis and appropriate surgical intervention in similar cases is important to optimize outcomes.

Management of Non-Union Distal Femur Fracture with Augmentation Nail-Plate Construct: A Case Report.

Introduction: Non-union fractures of the distal femur pose significant challenges in orthopedic surgery, often requiring revision procedures to achieve successful bone healing. In cases where the initial implant has failed, innovative solutions are necessary to promote bone union and functional recovery. Case Report: We present a case of a non-union distal femur fracture in a 22-year-old male patient, with a broken implant in situ. The patient had previously undergone internal fixation with a locking plate, which subsequently failed to promote bone healing. The patient was reoperated using a supracondylar nail and augmented with a distal femur locking plate to address the non-union. The combination of the supracondylar nail and distal femur locking plate successfully provided stability to the fracture site, promoting bone union and enabling functional recovery. Radiographic evidence and clinical assessment demonstrated excellent healing progress. Conclusion: This case report highlights the importance of individualized treatment for non-union distal femur fractures, especially when prior implant failure occurs. The combined approach of a supracondylar nail and distal femur locking plate can be a valuable option in addressing complex non-union fractures, achieving stable fixation, and facilitating successful bone healing.

From Trauma to Triumph: Navigating the Complexities of a Central Hip and Ipsilateral Knee Dislocation with Associated Fractures.

Introduction: Central hip dislocations are rare orthopedic injuries, and their concomitant occurrence with ipsilateral knee dislocations is an even rarer phenomenon. We present a unique case of central hip dislocation along with ipsilateral knee dislocation and additional fractures involving the lateral condyle of the left tibia and patella. This complex injury pattern resulted from a severe road traffic accident, necessitating operative management to address the multiple musculoskeletal injuries. Ultimately, femoral head avascular necrosis (AVN) developed, leading to the need for total hip replacement (THR). Case Report: A 28-year-old male was involved in a high-impact road traffic accident, leading to central hip dislocation, ipsilateral knee dislocation, and fractures of the lateral condyle of the left tibia and patella. The patient was promptly assessed, and operative intervention was initiated. Closed reduction and internal fixation with K-wires were performed for the fractures of the lateral condyle of the left tibia and patella. For the central hip dislocation, open reduction was achieved using a 9-hole RECON plate. Following the procedures, a long leg slab was applied for 6 weeks to facilitate optimal healing.Postoperatively, at the 6-week mark, K-wires were removed, and the patient commenced physiotherapy with partial weight-bearing permitted. However, during the rehabilitation phase, the patient reported instability in his left knee. Magnetic resonance imaging revealed an avulsion fracture of the posterior cruciate ligament (PCL) from its tibial attachment site and a complete anterior cruciate ligament (ACL) tear. It was observed that the femoral head had developed AVN. This complication necessitated further intervention, leading to the performance of a THR. Discussion: This case underscores the challenges and complexities associated with managing central hip dislocation and ipsilateral knee dislocation with multiple fractures. The post-operative instability of the knee, diagnosed as an avulsion fracture of the PCL and complete ACL tear, necessitated additional intervention. The patient subsequently underwent PCL reconstruction using a semitendinosus graft, highlighting the importance of a comprehensive approach to address the diverse musculoskeletal injuries resulting from high-impact trauma. Conclusion: The successful management of central hip dislocation and ipsilateral knee dislocation with associated fractures requires a multidisciplinary approach, incorporating timely surgical intervention, rigorous rehabilitation, and vigilant post-operative monitoring to address potential complications. This case emphasizes the need for ongoing clinical assessment and imaging studies to identify and manage secondary injuries that may manifest during the recovery phase. In addition, it highlights the development of femoral head AVN, ultimately leading to the necessity for THR.

Survival outcomes and molecular drivers of testicular cancer in hispanic men.

OBJECTIVE: To examine survival outcomes and molecular drivers in testis cancer among Hispanic men using a large national sample and molecular database. METHODS: We reviewed the SEER registry for testicular cancer from 2000 to 2020. Cox proportional hazards models were used to examine the relationship between race/ethnicity and cancer-specific survival (CSS) by tumor type (seminoma vs. nonseminomatous germ cell tumors [NSGCT]). All models were adjusted for demographic, socioeconomic, and treatment variables. We accessed somatic mutations for testicular cancers through AACR Project GENIE v13.1 and compared mutational frequencies by ethnicity. RESULTS: Our cohort consisted of 43,709 patients (23.3% Hispanic) with median follow-up 106 months (interquartile range: 45-172). Compared to Non-Hispanic Whites (NWH), Hispanics presented at a younger age but with more advanced disease. Hispanics experienced worse CSS for NSGCT (HR 1.7, 95% CI: 1.5-2.0, P < 0.01) but not seminoma. Somatic mutation data was available for 699 patients. KIT and KRAS mutations occurred in 24.2% and 16.9% of seminoma patients (n = 178), respectively. TP53 and KRAS mutations occurred in 12.1% and 7.9% of NSGCT patients (n = 521), respectively. No differences in mutational frequencies were observed between ethnic groups. There was significant heterogeneity in primary ancestral group for Hispanic patients with available data (n = 53); 14 (26.4%) patients had primary Native American ancestry and 30 (56.6%) had primary European ancestry. CONCLUSIONS: Cancer-specific survival is worse for Hispanic men with non-seminoma of the testicle. Somatic mutation analysis suggests no differences by ethnicity, though genetic ancestry is heterogeneous among patients identifying as Hispanic.

Management of Erythrocytosis in Men Receiving Testosterone Therapy: Clinical Consultation Guide.

The most common side effect of testosterone therapy (TT) is erythrocytosis. Patient-specific factors therefore should be considered when choosing an appropriate TT dosage and modality. Providers should decrease or discontinue therapy if the patient's hematocrit exceeds 54% until the hematocrit normalizes.

Sleep Disorders Are Associated with Female Sexual Desire and Genital Response - A U.S. Claims Database Analysis.

OBJECTIVE: To assess the association of common sleep disorders with female sexual dysfunction. MATERIALS AND METHODS: We conducted a cross-sectional analysis using the TriNetX Diamond Network. Adult women diagnosed with insomnia, obstructive sleep apnea, or circadian rhythm sleep disorder were assessed to determine the association with female sexual dysfunction, hypoactive sexual desire disorder, female orgasmic disorder, and female sexual arousal disorder. A propensity-score matched control cohort for age, race, ethnicity, tobacco use, outpatient service utilization, obesity, hyperlipidemia, diabetes mellitus, hypertensive disease, ischemic heart disease, and surgical procedures on the female genital system was generated, excluding those with any sleep disorders, sleep deprivation, or morbid obesity with alveolar hypoventilation. All cohorts excluded those with any antidepressant or antipsychotic prescriptions. RESULTS: Our query yielded 1,317,491 women diagnosed with sleep apnea, 1,538,567 with insomnia, and 58,902 with circadian rhythm sleep disorder. Women with sleep apnea and insomnia had higher odds of hypoactive sexual desire disorder, female sexual arousal disorder, and female orgasmic disorder compared to matched controls. Women with sleep apnea, insomnia, or circadian rhythm sleep disorder all had a significantly higher odds of female sexual dysfunction compared to matched controls. CONCLUSION: In this large cross-sectional analysis, sleep disorders were strongly associated with female sexual dysfunction. It is thus crucial for providers to screen for poor sleep when conducting a thorough evaluation for sexual dysfunction in women to diagnose highly prevalent sleep disorders and improve overall health.

Safety of Vaginal Estrogen Therapy for Genitourinary Syndrome of Menopause in Women With a History of Breast Cancer.

OBJECTIVE: To assess the risk of recurrence of breast cancer associated with vaginal estrogen therapy in women diagnosed with genitourinary syndrome of menopause with a history of breast cancer using a large U.S. claims database. METHODS: A U.S. health research network (TriNetX Diamond Network) was queried from January 2009 to June 2022. Our cohort consisted of women diagnosed with breast cancer within 5 years before the initial genitourinary syndrome of menopause diagnosis. Patients with active disease , defined as those undergoing mastectomy, radiation treatment, or chemotherapy within 3 months before diagnosis of genitourinary syndrome of menopause, were excluded. Recurrence was defined as mastectomy, radiation, chemotherapy, or secondary malignancy within 3 months to 5 years after the initiation of vaginal estrogen therapy for genitourinary syndrome of menopause. The study cohort included those with three or more vaginal estrogen prescriptions. The control cohort included women with breast cancer without any vaginal estrogen prescriptions after genitourinary syndrome of menopause diagnosis. Propensity matching was performed. A subanalysis by positive estrogen receptor status, when available, was performed. RESULTS: We identified 42,113 women with a diagnosis of genitourinary syndrome of menopause after breast cancer diagnosis with any estrogen receptor status, 5.0% of whom received vaginal estrogen. Of the initial cohort, 10,584 patients had a history of positive estrogen receptor breast cancer, and 3.9% of this group received vaginal estrogen. Risk of breast cancer recurrence was comparable between those who received vaginal estrogen and those who did not in both the any estrogen receptor (risk ratio 1.03, 95% CI 0.91-1.18) and positive estrogen receptor (risk ratio 0.94, 95% CI 0.77-1.15) status analyses. CONCLUSION: In a large, claims-based analysis, we did not find an increased risk of breast cancer recurrence within 5 years in women with a personal history of breast cancer who were using vaginal estrogen for genitourinary syndrome of menopause.

Perioperative Pain Management With Opioid Analgesics in Colpopexy Increases Risk of New Persistent Opioid Usage.

IMPORTANCE: Although the use of perioperative pain medications is highly investigated, limited studies have examined the usage of pain medication for post hysterectomy prolapse repair and the few that have have been restricted to smaller sample sizes. OBJECTIVE: Our objective was to assess the association of perioperative opioid usage after posthysterectomy prolapse repairs with development of new persistent opioid usage. STUDY DESIGN: The TriNetX Diamond Research Network was queried to create our cohorts of opioid-naive adult women with vaginal repair or laparoscopic sacrocolpopexy. The primary study outcomes were (1) the rate of perioperative opioid usage and (2) development of new persistent opioid usage. All cohorts were matched on age, race, ethnicity, chronic kidney disease, hypertensive diseases, ischemic heart disease, diseases of the liver, obstructive sleep apnea, affective mood disorders, pelvic and perineal pain, obesity, tobacco use, and utilization of office/outpatient, inpatient, or emergency department services. RESULTS: We identified 10,414 opioid-naive women who underwent laparoscopic sacrocolpopexy and 13,305 opioid-naive women who underwent vaginal reconstruction. Rates of perioperative opioid usage were higher after laparoscopic sacrocolpopexy. Rates of developing new opioid usage were higher in both surgical-approach populations that received perioperative opioids compared with those that did not. Rates of new and persistent opioid usage did not differ by surgical approach when stratified by perioperative opioid usage. CONCLUSIONS: We identified that opioid dependence may occur after surgery if patients are given opioids within 7 days of either approach, associating opioid dependence with perioperative opioid usage rather than the approach taken.

Postoperative Opioid Prescribing in Adolescents and Young Adults After Urologic Procedures Is Associated With New Persistent Opioid Use Disorder: A Large Claims Database Analysis.

OBJECTIVE: To assess the risk of persistent opioid use following various urologic procedures in adolescents and young adults. MATERIALS AND METHODS: The TriNetX LLC Diamond Network was queried for patients aged 13-21years who underwent pyeloplasty, hypospadias repair, inguinal hernia repair, inguinal orchiopexy, hydrocelectomy, or circumcision. Cohorts of patients prescribed and not prescribed postoperative opioids were created and propensity-matched for age, race/ethnicity, psychiatric diagnoses, and preoperative pain diagnoses. The primary outcome was new persistent opioid use, defined as new opioid use 3-9months after index procedure without another surgery requiring anesthesia during the postoperative timeframe. RESULTS: Of 32,789 patients identified, 66.0% received a postoperative opioid prescription. After propensity score matching for each procedure, 18,416 patients were included: 197 for pyeloplasty, 469 for hypospadias repair, 1818 for inguinal hernia repair, 2664 for inguinal orchiopexy, 534 for hydrocelectomy, and 3526 for circumcision. Overall, 0.41% of patients who did not receive postoperative opioids developed new persistent opioid use, whereas 1.69% of patients who received postoperative opioids developed new persistent opioid use (P < .05). Patients prescribed postoperative opioids had statistically higher odds of developing new persistent opioid use for hypospadias repair (RR: 17.0; 95% CI: 2.27-127.2), inguinal orchiopexy (RR: 3.46; 95% CI: 1.87-6.4), inguinal hernia repair (RR: 2.18; 95% CI: 1.07-4.44), and circumcision (RR: 4.83; 95% CI: 2.60-8.98). CONCLUSION: The use of postoperative opioids after urological procedures in adolescents and young adults is associated with a significant risk of developing new persistent opioid use.

Association of Sodium and Sugar-Sweetened Beverage Intake With Cardiovascular Disease Risk Factors in Adolescents and Young Adults With Obesity.

Cardiovascular disease (CVD) risk factors in children have increased in prevalence. Dietary intake may modify risk. Data collected during a randomized trial testing the effect of a behavioral intervention on adiposity, blood pressure (BP), and left ventricular mass index (LVMI) were analyzed using multivariable regression to determine independent associations of sodium, sugar-sweetened beverage (SSB), and artificially sweetened beverage (ASB) intake with outcomes. High sodium intake (≥3.5 g) was associated with hypertensive BP (odds ratio 12.8; P = .027) in minimally adjusted models. High SSB intake (≥4 oz) was independently associated with body mass index z-score (ß = .34; P = .035) and waist circumference z-score (ß = .49; P = .022) in fully adjusted models. Any ASB intake was associated with LVMI in fully adjusted model (% change 38.22; P = .004). There was no effect modification between sodium and SSB on outcomes. Dietary factors explored in this study independently impacted CVD risk. Further effect measure modification should be explored in larger cohorts.

Involvement of vulva in lichen sclerosus increases the risk of antidepressant and benzodiazepine prescriptions for psychiatric disorder diagnoses.

While vulvar lichen sclerosus (VLS) causes intense pruritus, associated risks of mood disorders and prescription patterns and impact of concurrent sexual dysfunction are unknown. We queried TriNetX Diamond Network between 2009 and 2022, conducting three comparisons after propensity-score matching for demographics and relevant comorbidities: (1) women with lichen sclerosus (LS) sparing the vulva vs. women with VLS; (2) VLS patients who received treatment within 6 months of diagnosis vs. patients who did not and (3) VLS patients with vs. without sexual dysfunction. Outcomes included new depressive episodes, anxiety disorder, major depressive disorder (MDD), and prescriptions of antidepressants or benzodiazepines. After matching, VLS was associated with increased depressive episode [risk ratio (RR) 1.39], anxiety disorder (RR 1.93), and MDD (RR 2.00) diagnoses compared to LS sparing the vulva. Next, VLS treatment was associated with decreased risk of depressive episode (RR 0.60) and anxiety disorder (RR 0.72). Finally, concurrent sexual dysfunction was associated with increased benzodiazepine (RR 3.50), vaginal estrogen (RR 6.20), antipruritic agents (RR 3.90), and topical anti-inflammatory (RR 2.61) prescriptions. In conclusion, vulvar involvement is associated with increased risk of antidepressant and benzodiazepine prescriptions, and diagnosis of depressive episode, anxiety disorder, or MDD.

Prevalence of opioid and benzodiazepine use in adult patients with the exstrophy-epispadias complex.

INTRODUCTION: Bladder exstrophy (BE), cloacal exstrophy (CE), and epispadias (E) are variants of the exstrophy-epispadias complex (EEC). These children require opioids and benzodiazepines to achieve pain management and immobilization for a lifetime of surgeries. It is hypothesized that these children would be sensitized to opiates and benzodiazepines as adults. The objective was to identify incidence of opiate and benzodiazepine use in adult EEC patients. METHODS: A US Health network, TriNetX Diamond was queried from 2009 to 2022. Incidence of prescriptions for benzodiazepines and opioids were calculated for adults aged 18-60 years with a diagnosis of BE, CE, or E. RESULTS: A total of 2627 patients were identified: 337 with CE, 1854 patients with BE, and 436 with E. Of these, 55.5% of CE, 56.4% of BE, and 41.1% of E had received any opioid prescription. Non-EEC controls had lower rates of opioids at 0.3%. E had a lower likelihood than BE or CE of receiving opioids (p < 0.0001, p < 0.0001). Benzodiazepines were prescribed in 30.3% of CE, 24.4% of BE, 18.3% of E, and 0.1% of controls. CE had a higher likelihood of benzodiazepines than both BE and E (p = 0.022, p < 0.001, respectively). E group had the lowest likelihood of benzodiazepine prescription (p = 0.007 when compared to BE) and all groups were significantly higher than controls (p < 0.0001 for all comparisons). For BE, females were more likely to be prescribed opioids (p = 0.039) and benzodiazepines (p = 0.027) than males. Sub-analyses revealed BE females had higher rates of surgical procedures (general, cardiac, gastrointestinal, and maternity) and chronic diagnoses (generalized anxiety disorder, major depressive disorder, chronic pain) compared to males with BE. Older age was associated with higher likelihood of opioid or benzodiazepine prescriptions in BE (p < 0.001), CE (p = 0.004), and E (p = 0.002). DISCUSSION: Across the EEC, adult patients with the most severe anomalies of CE were more likely to have received opioids and benzodiazepines. Females with BE were prescribed more opioid and benzodiazepines than males with BE. Mirroring the US population, female sex and increasing age were associated with higher rates of prescriptions, chronic diagnoses, and surgical procedures. Limitations include the lack of granular data and ability to correlate results with childhood surgeries. CONCLUSION: Adult EEC patients have higher rates of opioid and benzodiazepine prescriptions, with a high percentage of co-prescribing when compared to healthy controls. Across the spectrum, those with more severe anomalies, female sex, and increasing age were more likely to have received prescriptions.

Do Articles Shared by Academic Medicine Social Media Influencers Drive Future Citation Rates?

OBJECTIVE: To assess the role of influential figures within social media (SoMe) in driving future citations. METHODS: All original articles published in the Journal of Urology and European Urology in 2018 were identified. For each article, number of mentions on any SoMe platform, article's Twitter reach, and total citations were collected. Article characteristics such as type of study, article topic, and open access status were identified. Total academic research output was obtained for first and last authors of included articles. Influential SoMe figures were defined as users that tweeted about included articles and had over 2000 followers. For these accounts, we collected total followers, total tweets, engagement statistics, verification status, and academic characteristics such as total citations and total prior publications. The impact of SoMe, article, and academic characteristics on future citations was assessed using panel data regression analysis. RESULTS: We identified 394 articles with 8895 total citations and 460 SoMe influencers. On panel data regression modeling, tweets about a specific article were associated with future citations (0.17 citations per tweet about an article, P < .001). SoMe influencer characteristics were not associated with increased citations (P > .05). The following non-SoMe-associated characteristics were predictive of future citations (P < .001): study type (prospective studies received 12.9 more citations than cross-sectional studies), open access status (4.3 citations more if open access, P < .001), and previously well-published first and last authors. CONCLUSION: While SoMe posts are associated with increased visibility and higher future citation rates, SoMe influencers do not appear to drive these outcomes. Instead, high quality and accessibility were more predictive of future citability.