Background: Penile fractures are due to a traumatic rupture of the penile tunica albuginea of the corpus cavernosum and may result from numerous etiologies. The purpose of our review is to describe the etiology, management, and outcomes of penile fractures. Methods: A literature review was performed. Results: The diagnosis of penile fractures is usually made clinically but can also be made with the assistance of ultrasound or MRI (magnetic resonance imaging) imaging when unclear. Cystoscopy should be performed when urethral involvement is suspected. Surgical management should be initiated promptly after the diagnosis, and within 24 hours of presentation. Surgical management can include the subcoronal or penoscrotal approach, although the penoscrotal approach is preferred when imaging confirms the location of the injury to be ventral and proximal, due to the reduced morbidity of this technique. Complications following penile fractures include erectile dysfunction, penile curvature, and voiding symptoms, but the incidence of complications is reduced if surgical intervention is performed promptly after fracture presentation. A rare cause of penile fractures is collagenase clostridium histolyticum injection, and these cases should predominantly be managed conservatively. Conclusions: Penile fractures can present in various ways and must be managed surgically and promptly after the diagnosis is made.
Introduction The effect of the SARS-CoV-2 infection and vaccine on male fertility has been a cause of controversy. Studies have found that while active or recovering COVID-19 disease can be associated with decreased sperm counts and quality, the COVID vaccine is not. Despite evidence about the lack of association between the COVID-19 vaccine and male fertility, social media platforms continue to contribute to the spread of misleading information. TikTok is a popular application that has become critical in this regard. Objective To identify the role TikTok contributes to misinformation around the COVID-19 virus, vaccination, and male infertility. Methods 72 videos using the terms #covidvaccine and #malefertility were identified on Tiktok from January 1, 2020 to December 31, 2021. Videos not related to the topic were excluded, leaving 58 videos. Videos were reviewed by five independent researchers. Information collected included video publication date, length, views, likes, comments, presence of US certified medical professional, demographic details of main subject, scientific article cited or displayed, belief held on COVID-19 vaccine, infection and infertility, modified DISCERN score and Patient Materials Assessment Tool (PEMAT). U.S. medical professional certification was determined using certificationmatters.org. The PEMAT score evaluated 17 items regarding understandability and actionability. The modified DISCERN based reliability score ranked quality from 1 = poor, to 5 = excellent. Data was analyzed using SPSS statistics software v24. Results The average video was 51 seconds long, received 34,678 views, 3,301 likes, and 160 comments. The main subject of the videos were predominantly female (53.4%) and white (55.2%). A majority of videos featured a medical professional (67.2%) and were published by medical professionals (63.8%). Up to 46.4% of videos featured a scientific article that was either cited or displayed on the screen. Most videos were of the opinion that the COVID-19 infection causes infertility in men (48.3%) but not the vaccine (37.9%). Only a select few videos believed that the vaccine was responsible for male infertility (6.9%). The most popular video stating the COVID vaccine caused infertility in men had 2,708 views, 336 likes, and 18 comments. The average DISCERN score for the 58 videos was 2.93, PEMAT Understandability score was 76.1%, and PEMAT Actionability score was 25.7%. With the presence of a certified US Medical Professional in the TikTok video, the average DISCERN score (2.00 vs. 3.38, p= .001), PEMAT Understandability Score (67.68 vs. 80.26, p = .015), and PEMAT Actionability Score (13.16 vs. 31.82, p = .024) increased significantly. Videos with medical professionals present had a lower average number of views (31,996 vs. 40179, p = .691), fewer likes (1,902 vs. 6,173, p = .290), and fewer comments (150 vs. 182, p = .737), but none of these differences were statistically significant. Conclusions This study demonstrates that TikTok videos endorsing misinformation are popularly viewed. Among all the misinformation in social media, it is reassuring to see that there are medical professionals interested in promoting medically accurate information. Disclosure No
an average age of 14.7 AE 2.84 and 52% female and 48% male. Prescribing of antipsychotics and benzodiazepines were more frequent during the pandemic for adolescents (RR: 1.58, 95% CI 1.01-2.2). However, they were less likely to receive antidepressants (Risk Ratio (RR): 0.6, 95% Confidence Interval (CI) 0.57-0.63), anxiolytics (RR: 0.78, 95% CI 0.75-0.81), stimulants (RR: 0.26, 95% CI 0.25-0.27), as well as mood stabilizers (RR: 0.44, 95% CI 0.39-0.49). Erectile dysfunction requiring oral PDE5i in this cohort was more frequent during the pandemic for adolescents (RR: 1.53, 95% CI 1.05-2.01).CONCLUSIONS: The rates of antipsychotic and benzodiazepine prescriptions increased during the COVID-19 global pandemic compared to preceding years. This coincided with a statistically significant increase in the prescription of PDE5i for erectile dysfunction. Adolescents may face an increased risk of sexual dysfunction as both their illness and the medications they are prescribed both have a positive association with sexual dysfunction. Clinicians must be cognizant of the fact that adolescents may face an increased risk of medication related sexual dysfunction.
Introduction Low testosterone is a common finding in aging men. Symptoms of low testosterone include fatigue, loss of libido, depression, and erectile dysfunction, among others. American Urologic Association (AUA) guideline approved treatments for low testosterone include testosterone replacement therapy (TRT) either intranasally, intramuscularly, topically, or subdermally. Social media has become critical in the way patients obtain their medical information, including information surrounding treatment for low testosterone. TikTok and YouTube are two such popular social media video-sharing platforms. Objective To survey the different modalities to increase testosterone levels represented on YouTube and TikTok, and compare the content and quality of their videos. Methods “Testosterone treatment” was searched on YouTube and TikTok in June 2022 using private browser settings on Google Chrome. The top 60 YouTube and TikTok videos were selected. Exclusion criteria included YouTube videos longer than 10 minutes, due to evidence showing longer videos resulted in decreased viewer engagement, and videos that did not mention ways of increasing testosterone. This left 59 YouTube videos and 55 TikTok videos. Videos were reviewed by two independent researchers. Information collected included publication date, length, views, likes, comments, subscribers/followers, presence of US certified medical professional, scientific article cited or displayed, type of person posting video, methods of increasing testosterone, side effects of testosterone treatment, modified DISCERN score and Patient Materials Assessment Tool (PEMAT). U.S. medical professional certification was determined using certificationmatters.org. The PEMAT score evaluated 17 items regarding understandability and actionability. The modified DISCERN based reliability score ranked quality from 1 = poor, to 5 = excellent. Data was analyzed using SPSS statistics software v24. Results The average YouTube video was of 4.01 minutes in length and had 94,108 views, 137 comments, 1,172 likes, and 629,607 subscribers. The average TikTok video was 0.84 minutes long and had 144,707 views, 121 comments, 6,509 likes, and 163,344 followers. YouTube videos had a significantly higher DISCERN reliability score than TikTok videos (3.14 vs 1.35; p<0.001), although the PEMAT Understandability (81.0 vs 77.7; p=0.166) and Actionability Scores (49.9 vs 40.0; p=0.132) were not significantly different. Most video publishers on both YouTube and TikTok were laypersons. YouTube had a significantly higher number of certified medical professionals and inclusion of scientific articles than TikTok (p=0.009). Natural ways of increasing testosterone including changes in diet, exercise, and use of supplements such as ashwagandha, zinc, tongkat ali, and fadogia agrestis, were mentioned significantly more on TikTok compared to YouTube (31.5% vs 13.8%, p = 0.025). YouTube videos mentioned forms of hormonal TRT more often than TikTok videos. 52.7% of all videos described side effects related to increased testosterone, with TikToks describing side effects more than YouTube (p<0.001). Conclusions While YouTube videos contain more reliable information for patients with low testosterone than TikToks, both platforms will benefit from medical professionals playing an active role in creating comprehensive videos about treatment. Disclosure No
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