Anxiety and Depressive Symptoms Pre-Trauma as a Predictor of Dissociative Symptoms Post-Trauma – An AURORA Study

Introduction: Increased states of anxiety or depression may lead to increased occurrences of dissociative behavior, justifying the need to validate pre-traumatic cognitive states as a predictor of dissociation post-trauma. Early prediction can lead to medical intervention for high-risk patients and prevent potential adverse sequalae. The AURORA Study evaluates biomarkers and neuropsychological sequelae in patients immediately following traumatic events. We predict patients who suffered from depressive symptoms and anxiety prior to the traumatic event will experience increased dissociative symptoms post-trauma. Methods: This study includes survey data collected at ED’s from survivors (n = 666) of traumatic motorized vehicle collisions (MVC) at time points 30 days pre-collision, and 2- and 8-weeks post-collision. Inclusion criteria included those enrolled until the closure of the week 8 survey window and completed at least 90% of follow up surveys at weeks 2 and 8. Our primary outcomes were dissociative symptoms at 2- and 8- weeks post-MVC. We adjusted for sex at birth, age, race/ethnicity, and overall mental health prior to the MVA. Simple and multiple linear regression models were utilized for analysis, along with ANOVA. Results: Anxiety was not a significant predictor for dissociative symptoms at 2- (0.042, 95% CI -0.11-0.096, P=0.12) and 8- weeks (0.030, 95% CI -0.11-0.096, P=0.275). Depressive symptoms were a significant predictor at 2- (0.032, 95% CI 0.006-0.058, P=0.016) and 8- weeks (0.042, 95% CI 0.016-0.069, P=0.002). Additionally, overall mental health was a significant predictor at 2 weeks (-0.027, 95% CI -0.047- -0.008, P=0.006), and white ethnicity was significant at 8 weeks (-0.418, 95% CI -0/757- -79, P=0.016). Discussion: Symptoms of anxiety prior to traumatic events are reliable predictors of post-traumatic stress, while depressive symptoms are not. Additional long-term data points are needed, but preliminary analysis justifies the potential use of pre-traumatic anxiety for early medical intervention before deterioration of neurocognitive functioning

Perspectives and Experiences of Transgender and Non-binary Individuals on Seeking Urological Care.

OBJECTIVE: To describe perspectives and experiences related to urology care-seeking of transgender and non-binary (TGNB) individuals assigned male at birth. MATERIALS AND METHODS: This HIPAA-compliant study was IRB approved and followed Consolidated Criteria for Reporting Qualitative Studies (COREQ) guidelines. Through semistructured interviews, perspectives, and experiences of individuals related to urology care-seeking were explored. Open-ended questions were designed to elicit a range of responses rather than quantifiable data. Thematic codes were developed and explicitly defined. Codes pertaining to patient experiences were assessed and described. RESULTS: Twenty-five TGNB individuals assigned male at birth were interviewed. Participants reported an array of factors that informed and inhibited care-seeking, factors that framed individual urologic care experiences, and their overall impression of the healthcare system\u27s ability to effectively and respectfully serve the TGNB population. Specifically, participants reported that prior negative healthcare experiences dissuaded them from seeking care such as feeling discriminated against and having a lack of trust in providers. Additionally, participants reported feeling a need and responsibility to educate providers on both their medical needs and psychosocial experiences. Participants were also unclear how best to identify trans-friendly urologists who are culturally competent and have appropriate medical knowledge. CONCLUSION: TGNB individuals face significant barriers to care for unique healthcare needs. TGNB participants described care avoidance and reported experiences of healthcare discrimination. These data highlight the importance for urologists to understand the perspectives and historical experiences of these individuals who may seek urological care

Genitourinary and Sexual Symptoms and Treatments in Transfeminine Individuals: A Qualitative Exploration of Patients\u27 Needs

Introduction: Medical providers may not be familiar with the genitourinary and sexual symptoms of transgender and non-binary (TGNB) individuals. This lack of familiarity may hinder a provider\u27s ability to address these issues as patients may hesitate to report symptoms due to fear of stigma, misgendering, and being treated disrespectfully. Aim: To describe the array of genitourinary and sexual symptoms in transfeminine individuals. Methods: Upon institutional review board approval, researchers used semi-structured interviews with 25 transfeminine individuals assigned male at birth to explore urinary and sexual symptoms on a sample of convenience. Participants were recruited and interviews were conducted until saturation was achieved. Two research assistants independently coded all de-identified transcripts and resolved discrepancies. Outcomes: Thematic codes pertaining to genitourinary and sexual symptoms were defined and assessed in this study. Results: Some genitourinary symptoms unrelated to hormone therapy or genital gender-affirming surgery (GGAS) included frequency, urgency, nocturia, and incontinence, while those attributed to GGAS included slow stream, spraying, and retention. Sexual symptoms unrelated to hormone therapy or GGAS included sexually transmitted infections, erectile dysfunction, and low libido. Sexual symptoms related to GGAS included delayed ejaculation, penile pain, scar tissue pain, and pain with receptive vaginal penetration. Clinical implications: Increased provider awareness of and accountability for the treatment of genital and sexual symptoms of transfeminine individuals. Strengths and limitations: Open-ended questions were used to generate a range of responses and perspectives through conversation instead of quantifiable data. Findings are not applicable to all TGNB people since participants were limited to transfeminine adults assigned male at birth only. Recruitment was limited by the sensitive nature of the topic and hard-to-reach populations and relied on convenience through flyers and a chain-referral sampling approach. Conclusion: Transfeminine individuals experience a wide array of genitourinary and sexual symptoms both similar and different to their cis gender counterparts. Chung PH, Swaminathan V, Spigner S, et al. Genitourinary and Sexual Symptoms and Treatments in Transfeminine Individuals: A Qualitative Exploration of Patients\u27 Needs. Sex Med 2022;XX:XXXXXX

Outcomes of Venous Sinus Stenting in Patients With Papilledema From Idiopathic Intracranial Hypertension (IIH) Versus Non-IIH: A Comparative Study

While management of idiopathic intracranial hypertension (IIH) generally entails a multimodal approach, venous sinus stenting (VSS) has emerged as a promising interventional treatment in those who require surgery. Little is known on outcomes of VSS to manage increased intracranial pressures due to non-IIH etiologies