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Background Erectile dysfunction (ED) is an adverse effect of many medications. Aim We used a national pharmacovigilance database to assess which medications had the highest reported frequency of ED. Methods The Food and Drug Administration Adverse Event Reporting System (FAERS) was queried to identify medications with the highest frequency of ED adverse event reports from 2010 to 2020. Phosphodiesterase-5 inhibitors and testosterone were excluded because these medications are often used as treatments for men with ED. The 20 medications with the highest frequency of ED were included in the disproportionality analysis. Outcomes Proportional Reporting Ratios (PRRs) and their 95% confidence intervals were calculated. Results The 20 medications accounted for 6,142 reports of ED. 5-α reductase inhibitors (5-ARIs) and neuropsychiatric medications accounted for 2,823 (46%) and 2,442 (40%) of these reports respectively. Seven medications showed significant levels of disproportionate reporting with finasteride and dutasteride having the highest PRRs: 110.03 (103.14–117.39) and 9.40 (7.83–11.05) respectively. The other medications are used in a wide variety of medical fields such as cardiology, dermatology, and immunology. Clinical Implications Physicians should be familiar with these medications and understand their respective mechanisms of action, so that they may counsel patients appropriately and improve their quality of life. Strengths and Limitations The strength of the study is its large sample size and that it captures pharmacologic trends on a national level. Quantitative and comparative “real-world” data is lacking for the most common medications associated with ED. The limitation is that the number of reported events does not establish causality and cannot be used to calculate ED incidence rates. Conclusion In a national pharmacovigilance database, 5-ARIs and neuropsychiatric medications had the highest reports of ED adverse effects. There were many other medications used in a variety of medical fields that were also associated with ED.

We report the rare case of a primary malignant melanoma of the urethra. An 89-year-old African American woman who was referred to our urology clinic for intermittent gross hematuria and a palpable vaginal mass of two months duration. Cystoscopy revealed a 3 cm mass in the distal urethra and urethral meatus that was surgically resected by wide local excision. The histopathologic diagnosis was primary malignant melanoma of the urethra. The patient was subsequently treated with adjuvant EBRT and immunotherapy with nivolumab and ipilimumab. Post-treatment PET-CT showed good response to treatment and patient remained in remission at eight month follow up.

T he recent article by Kim et al. highlighted the disproportionate impact of the coronavirus disease 19 (COVID-19) pandemic on lower income and racial minorities in the USA. 1 The authors discuss how greater comorbidities, less access to medical care, and financial challenges markedly worsened the incidence and severity of COVID-19 in certain disadvantaged groups. Detailed racial data released by public agencies in New York further demonstrates the stark disparities of the pandemic. The New York City (NYC) Department of Health and Mental Hygiene reported 19,540 confirmed or probable deaths from COVID-19 among NYC residents as of May 6, 2020. Ageadjusted (per 100,000) death rates among African Americans and Latinos were 243.6 and 237.7, respectively, in contrast to death rates among Whites and Asians that were 121.5 and 109.4, respectively. 2 Data from NYC reported by the New York State Department of Health demonstrated that Latinos comprised 34% of COVID-19 deaths but 29% of the population and African Americans comprised 28% of deaths while making up 22% of the population. 3 In contrast, Whites comprised 27% of deaths while representing 32% of the population. To date, there remains a relative paucity of racial mortality data from individual hospitals in NYC. Two of the largest hospital systems published early clinical outcomes, but both series contained over 37% White patients which may not accurately reflect the experience of lower income, minority communities. 4, 5 To our knowledge, the NYC Health and Hospitals Corporation which cares for the largest number of minorities has not publicly released race-specific mortality data. It is noteworthy that the best available data has come directly from governmental agencies in a timely fashion through both daily press briefings and well-organized websites. We commend the political leadership in New York for this effort and are keenly aware that not all states have been as transparent. The rapid dissemination of health information has been critical in allowing the public to grasp the sheer magnitude of the crisis and objectively highlight the hardest-hit zip codes and racial groups. As we consider ways to safely reopen, it is critical that the latest data continue to be openly disseminated to best understand the causes of racial disparities and direct recovery efforts towards communities that bear the greatest burden of disease. This will require government agencies to continue to publicize accurate pandemic statistics and individual hospitals to prioritize sharing their unique experiences.