Faculty Bibliography

INTRODUCTION:YouTube is the most used social media website, and there is a growing body of literature examining the reliability of healthcare information on this platform. Patients seeking men's health information may be more likely to use YouTube owing to the sensitivity of these issues. OBJECTIVES:The objective of this study is to review the literature for studies related to the reliability of YouTube videos about men's health topics. METHODS:A literature review was conducted using PubMed and Google Scholar for publications related to the reliability of YouTube videos about men's health as of July 1, 2020. RESULTS:There were 17 studies related to YouTube and Men's Health. Most videos were found to be unreliable, and videos uploaded by physicians or healthcare organizations were usually more reliable. However, there were no studies in which more reliable videos had higher metrics of user engagement (views, likes, comments) than unreliable videos and there were several studies where unreliable videos had higher metrics of user engagement. In addition, the methods used to evaluate YouTube videos are not uniform across studies including the way that terms are searched (filtering by relevance vs view count) and the way in which reliability is assessed. For example, some studies create custom evaluation forms based on clinical guidelines, whereas others use validated questionnaires. The only validated questionnaire used across multiple studies was the DISCERN score criterion. CONCLUSIONS:Most information on YouTube about men's health is unreliable. Videos created by physicians and healthcare organizations are more reliable, and videos that are advertisements are less reliable. Physicians and healthcare systems should continue to upload educational YouTube videos but work to increase their views and user engagement. It may benefit patients if physician organizations could work with YouTube to create verified videos disseminating healthcare information that are favored in the search algorithm. Warren CJ, Sawhney R, Shah T, et al. YouTube and Men's Health: A Review of the Current Literature. Sex Med Rev 2021;9:280-288.

INTRODUCTION/BACKGROUND:YouTube is an unregulated platform that patients are using to learn about treatment options. AIM/OBJECTIVE:To assess the reliability of YouTube videos (YTVs) related to male hypogonadism and testosterone therapy. METHODS:Searching on YouTube by relevance and view count, we analyzed the top 10 videos (80 videos total) for the following search terms: low testosterone, testosterone replacement therapy, AndroGel, and hypogonadism. MAIN OUTCOME MEASURE/METHODS:We recorded the number of views for each video, evaluated videos using the DISCERN score (DS) criterion, and compared the DS for videos including board-certified physicians and videos without. A second comparison was made between videos with board-certified physicians in urology, endocrinology, other MD, and those without any physician. RESULTS:The YTVs analyzed received a total of 38,549,090 views, a median of 25,201 and 17.30 views/day. Videos that featured physicians had significantly fewer views/day than videos that did not (39.48 CI 9,72 vs 1,731 CI 330, 3,132; P = .019). Most YTVs studied were unreliable. The median DS across all videos was 2. However, most videos created by physicians were found to be reliable with a median DS of 4. In addition, YTVs that did not feature a physician were found to be significantly less reliable than videos that featured a physician (3.22 CI 3.06, 4.09 vs 1.87 CI 1.56, 2.18; P < .001). There was no significant difference in the reliability or viewership of YTVs stratified by physician type. CONCLUSION/CONCLUSIONS:Most YTVs related to male hypogonadism/testosterone therapy were unreliable, but there are reliable YTVs available. Reliable videos usually feature a physician and receive fewer views than unreliable YTVs. Physicians and academic societies should work to provide verified videos to provide patients with reliable information about male hypogonadism and testosterone therapy. CJ Warren, J Wisener, B Ward, et al. YouTube as a Patient Education Resource for Male Hypogonadism and Testosterone Therapy. Sex Med 2021;9:100324.

PURPOSE:We examined whether patients are appropriately screened for previous prolonged erections or priapism and counseled about trazodone complications, specifically prolonged erections and priapism, prior to trazodone treatment. MATERIALS AND METHODS:We identified patients under the age of 50 on trazodone as of February 27, 2019 at the VA New Jersey Health Care System. Patients were asked about information provided to them prior to medication initiation, occurrence of prolonged erections/priapism, and reporting rate of side effects. RESULTS:Two hundred and twenty nine out of five hundred and twenty four male patients agreed to participate in the study. Forty three out of two hundred and twenty nine of patients were informed about the side effects of prolonged erections and 37/229 of patients were informed of risk of priapism prior to treatment. Only 17/229 of patients were asked if they had had any episodes of prolonged erection or priapism in the past. Eighteen patients developed prolonged erection while taking trazodone. Only 5/18 patients who had developed prolonged erections informed their physicians. CONCLUSIONS:Only a fraction of patients were properly screened for previous prolonged erections or priapism and properly informed about the side effects of trazodone. Urologist should better educate trazodone prescribers, such as family medicine and psychiatric colleagues, regarding the side effects of trazodone. It is imperative that prescribing physicians appropriately screen and educate patients prior to trazodone initiation and instruct patients to report any treatment side effects to avoid potential long-term adverse outcomes.

BACKGROUND:Prior to the coronavirus disease 2019 (COVID-19) pandemic, urology was one of the specialties with the lowest rates of telemedicine and videoconferencing use. Common barriers to the implementation of telemedicine included a lack of technological literacy, concerns with reimbursement, and resistance to changes in the workplace. In response to the COVID-19 pandemic declared in March 2020, the delivery of urological services globally has quickly shifted to telemedicine to account for the mass clinical, procedural, and operative cancellations, inadequate personal protective equipment, and shortage of personnel. OBJECTIVE:To investigate current telemedicine usage by urologists, urologist perceptions on the necessity of in-person clinic appointments, the usability of telemedicine, and the current barriers to its implementation. METHODS:We performed a global, cross-sectional web-based survey to investigate the use of telemedicine before and after the COVID-19 pandemic. Urologists' perceived usability of telemedicine was assessed using a modified Delphi approach to create questions based on a modified version of the validated Telehealth Usability Questionnaire (TUQ). For the purposes of this study, telemedicine was defined as video calls only. RESULTS:A total of 620 urologists from 58 different countries and 6 continents participated in the survey. Prior to COVID-19, 15.8% of urologists surveyed were using telemedicine in their clinical practices; during the pandemic, that proportion increased to 46.1%. Of the urologists without telemedicine experience, interest in usage of telemedicine increased from 43.7 to 80.8% during COVID-19. Among urologists that used telemedicine during the pandemic, 80.9% were interested in continuing to use it in their practice. The three most commonly used platforms were Zoom, Doxy.me, and Epic and the top three barriers to implementing telemedicine were patient lack of technological comprehension, patient lack of access to required technology, and reimbursement concerns. CONCLUSIONS:This is the first study to quantify the use, usability, and pervading interest in telemedicine amongst urologists during the COVID-19 pandemic. In the face of this pandemic, urologists' usage of telemedicine nearly tripled, demonstrating their ability to adopt and adapt telemedicine into their practices, but barriers involving the technology itself are still preventing many from utilizing it despite increasing interest.

PURPOSE/OBJECTIVE:American Urological Association (AUA) antibiotic prophylaxis recommendations may be insufficient for covering organisms commonly found in penile prosthesis infections. In this study we assess the difference between AUA recommended antibiotic prophylaxis and nonstandard prophylaxis in preventing device infections in penile prosthesis surgery performed in diabetic patients. MATERIALS AND METHODS/METHODS:A multicenter, retrospective cohort study of diabetic patients undergoing primary penile prosthesis surgery was performed between April 2003 and August 2018. Eighteen institutions from the United States, Europe and Korea contributed. The association between antibiotic prophylaxis type and postoperative penile prosthesis infections, device explantations and revision surgeries was assessed. RESULTS:Standard AUA antibiotic prophylaxis was followed in 48.6% (391) of cases while nonstandard prophylaxis was used in 51.4% (413). Common nonstandard antibiotic prophylaxis included vancomycin-gentamycin-fluoroquinolone, clindamycin-fluoroquinolone, and vancomycin-fluoroquinolone among other combinations. Patients who received AUA prophylaxis had significantly more postoperative device infections (5.6% vs 1.9%, p <0.01) and explantations (8.3% vs 2.0%, p <0.001) compared to those who received nonstandard prophylaxis. Patients who received AUA prophylaxis had significantly higher odds of a postoperative device infection (OR 2.8, 95% CI 1.1-7.3) and explantation (OR 3.6, 95% CI 1.4-9.1) compared to those who received nonstandard prophylaxis. CONCLUSIONS:Diabetic men with erectile dysfunction who received standard AUA prophylaxis for penile prosthesis surgery had significantly greater odds of experiencing a postoperative device infection and device explantation compared to patients who received nonstandard prophylaxis. Our study provides a strong rationale for a prospective investigation to establish the most appropriate prophylaxis strategy in penile prosthesis surgery.

OBJECTIVE:To evaluate the number of PubMed-indexed research projects of medical students matching at top-ranked urology programs as compared to the average publications reported in the Electronic Residency Applicant Service (ERAS). METHODS:Doximity Residency Navigator was used to generate the top 50 residency programs when sorted by reputation. Residents were then found using program websites. PubMed was queried for peer-reviewed publications of incoming interns through post graduate year 3 residents as of February 2020. All PubMed-indexed research was recorded before September 15th of the residents' fourth year of medical school. We recorded the number of publications, first/last author publications, and urology-specific publications. RESULTS:The average number of publications across all 4 years was 2.38 ± 4.19. The average for urology-specific publications was 1.05 ± 3.19 and for first/last author publications was 0.80 ± 1.77. Most matched applicants had at least one PubMed-indexed publication (61.2%) and having over 3 placed them in the 75th percentile. It is uncommon for students to have urology specific or first/last author publications (34.0%, 36.5%). Top 10 programs matched applicants with significantly more research in each of the aforementioned categories and as program reputation declined, so did the publications of the applicants they matched. CONCLUSION:Most research that matched urology applicant's report in ERAS is not PubMed Indexed. Most had at least one PubMed-indexed publication by the time they submitted ERAS and those at top programs had more. It would be helpful to students and faculty advisors if ERAS published research metrics for matched and unmatched applicants separating PubMed-indexed work from posters and presentations.