BACKGROUND: Primary small cell neuroendocrine carcinoma of the urinary tract is a very rare cancer, accounting for fewer than 0.5% of urinary tract tumors. These are aggressive neoplasms with high rates of metastases. Urethral diverticula can be found in up to 6% of women. CASE:A 31-year-old woman presented with a clear vaginal discharge and an anterior vaginal wall mass that was thought to be a recurrent cyst. After surgical dissection, she was noted to have a urethral diverticulum with a solid nodule at the base. Final pathology showed a high-grade small cell neuroendocrine carcinoma.CONCLUSION: Malignancy in a urethral diverticulum can occur in young patients. Clinicians should be aware of this possibility when choosing to manage urethral lesions expectantly.

Introduction: Overprescribing by providers is a leading contributor to the opioid crisis. Despite available information regarding the role that physician prescribing plays in the community availability of opioids, guidelines for the management of acute pain remain sparse. This project aims to evaluate opioid prescribing, opioid usage patterns, and postoperative pain control in patients undergoing isolated mid-urethral sling (MUS) placement. Methods: Patients who underwent isolated MUS placement from March 19, 2019 through March 19, 2020 were contacted by telephone in May 2020 and asked a series of questions examining opioid usage, postoperative pain, what they did with unused opioids, and whether they had received education on disposal techniques. A chart review was utilized to determine the amount of opioid prescribed, the presence of any operative complications, and medical and demographic characteristics of subjects. Results: A total of 53 subjects met inclusion criteria, of which 31 participated in a phone interview. Of the 53 subjects, 54.7% received a postoperative opioid prescription, and all but two of these subjects filled their prescription. Of the interviewed subjects, only 66.6% who filled a prescription reported using opioids Fifty percent (n=6) of patients that required oxycodone reported use of four tablets (30 morphine milligram equivalents (MMEs)) or less and used for 1-2 days postoperatively. No patient reported using opioids beyond five days. Only 22.2% reported receiving instruction on opioid disposal, and 16.7% returned unused opioids to a disposal center. 87.1% of subjects rated postoperative pain as “better” or “much better” than expected. Conclusion: Patients undergoing isolated MUS placement require limited amounts of postoperative opioids, if any are needed at all, to achieve satisfactory pain control. Excess prescribed opioids, along with inadequate patient education on proper disposal techniques, may contribute towards opioids that are at risk of diversion for nonmedical use.

BACKGROUND The Sun Protection Outreach Teaching by Students (SPOTS) program addresses an unmet need by training medical students to teach adolescents about skin cancer prevention and early detection. OBJECTIVE To measure (1) changes in adolescents' knowledge, attitudes, and behaviors regarding sun protection and (2) the impact on medical students' confidence in skin cancer preventive counseling. METHODS Pre-SPOTS and 1-month post-SPOTS program surveys were completed by adolescent participants and medical student instructors. RESULTS Amongst adolescent students, analysis of 1,142 pre-program surveys and 618 post-program surveys revealed statistically significant improvements in knowledge, attitudes, and behaviors. Among the favorable results, 26%, 41%, and 20% improvements over baseline were observed in SPF knowledge, preference for natural untanned skin, and intent to wear sunscreen, respectively (p < .001). One-third of adolescents reported having tried to increase sunscreen use. Amongst medical students, analysis of 78 pre-teaching and 74 post-teaching surveys revealed an increase in feeling “very confident” in counseling patients, from 23% pre-teaching to 82% post-teaching (p < .001). CONCLUSION SPOTS demonstrated a dual benefit to adolescents and medical students. The program is available for dermatologists to implement in their communities.

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This was a cross-sectional study of 217 public Instagram posts using hashtag "#endometriosis surgery" that met inclusion criteria. These posts were reviewed daily, and first 7 posts a day that met inclusion criteria collected in March 2020 (Endometriosis Awareness Month). Each post was evaluated to see what categories of content it contained. RESULTS: Posts were reviewed for the following content: "endo" in Instagram username (36%), outcomes of surgery (9.2%), surgical complications (6.9%), posed questions in their post (3.7%), medical history (5.5%), symptoms pre-operation (24%), posted a picture (16%), fertility (13.4%), medications (9.2%), comfort in pets (3.8%), alternative therapies (4.6%), and Corona Virus Disease (COVID-19) (12%). Content was categorized as emotional (52.5%) (discussing feelings) or educational (30.4%) (discussing facts) or both. Posts with educational content showed strong associations with "endo" in Instagram username, fertility, and COVID-19. When posts included COVID-19 (OR ¼ 0.23, P ¼ 0.05), or the Instagram users' name included "endo" (OR ¼ 0.51, P ¼ 0.05), they were less likely have educational content. However, educational posts were more likely to also include fertility content (OR ¼ 2.65, P ¼ 0.02). Posts that included complications from surgery (RR ¼ 1.22), medical history (RR ¼ 2.90), fertility (RR ¼ 2.30), symptoms pre-operation (RR ¼ 1.62), and educational content (RR ¼ 3.52) were associated with a higher number of followers than those that didn't. It was found that the higher number of categories covered in a post, the higher the number of followers. For example, as categories in a post increased from 6 to 9, the median number of followers increased 174% (P ¼ 0.0001). CONCLUSION: Posts on Instagram related to endometriosis surgery provide both educational and emotional content, as well as information on a variety of other topics related to endometriosis surgery. Instagram users who post educational content are much more likely to have more followers, compared to those who didn't. For that reason, Instagram may be recommended by physicians as means for patients who are planning surgery to seek more education and support, especially from users with a large number of followers.