Latent profiles of emotion regulation among university students: links to repetitive negative thinking, internet addiction, and subjective wellbeing.

Recent years have seen a deterioration in the mental health of university students and notable surge in the need for psychological support. Due to its links to psychopathology and high-risk behaviors, difficulty in emotion regulation frequently serves as a transdiagnostic dimension. This cross-sectional study used a person-centered analytical approach (latent profile analysis; LPA) to identify groups of Portuguese university students with similar profiles of emotion regulation difficulties (N = 261; Mage = 22.5 ± 1.2 years; n = 213 female) and describe how these groups differ in their presentation of repetitive negative thinking, internet addiction, and subjective wellbeing. The analyses identified four latent profiles: 14.5% of students showed global dysregulation (the Low Emotion Regulation Profile), 23% were moderately dysregulated with elevated problems in goal-directed behavior (the Moderate Emotion Regulation Profile), 8% showed specific difficulties with low emotional awareness and clarity (the Low Insight Profile), and 54.4% showed adaptive emotion regulation (the High Emotion Regulation Profile). As anticipated, the Low Emotion Regulation Profile had the lowest subjective wellbeing and the highest prevalence of repetitive negative thinking and internet addiction. Students with a Low Insight Profile also showed low subjective wellbeing, but less repetitive negative thinking compared to the Low Emotion Regulation Profile. Our findings suggest that interventions aimed at improving health and wellbeing among university students should consider each student's unique set of emotion regulation difficulties, rather than focusing on particular strategies. Further research may help determine whether emotion regulation profiles can serve as predictive indicators of varying mental health trajectories and subjective wellbeing in university students.

Female Urethroplasty with a Buccal Mucosa Graft using a Supraurethral Approach.

INTRODUCTION AND HYPOTHESIS: In the setting of recurrent female urethral stricture, urethroplasty offer the best chance of cure. However, which approach (dorsal or ventral) and which tissue (buccal mucosa, vaginal graft, vaginal flap) remain areas of controversy. In this article and accompanying video, we describe female urethroplasty with a supraurethral approach using a buccal mucosa graft. METHODS: A stricture of 3 cm in length was observed in the mid urethra. A supraurethral semi-lunar incision was made and dissection was performed up to the stricture. A dorsal urethrotomy was performed and a 3 × 2 cm oral mucosal graft was harvested from the left cheek. The mucosal graft was anastomosed to both urethral edges with running sutures. The graft was fixed to the supraurethral tissue with quilting sutures. A urethral catheter and a suprapubic catheter were left in place for 3 weeks. RESULTS: Following removal of the catheters, the patient was able to void satisfactorily with no incontinence. No complications were observed in the urethral area or at the graft harvest site. CONCLUSIONS: Buccal mucosa graft urethroplasty with a supraurethral approach is a reliable method in the treatment of female urethral stricture.

Three joint temperament-character configurations account for learning, personality and well-being: normative demographic findings in a representative national population.

Introduction: A common practice in research and clinical practice is to use data considered representative of a target population to compare and understand the personality characteristics of specific groups or specific individuals. To this end, numerous studies have presented normative data for the temperament and character traits outlined in Cloninger's psychobiological model of personality. However, recent genomic evidence demonstrates that human personality is organized as a complex hierarchy that ascends beyond the individual traits to multi-trait profiles that regulate emotional reactivity (temperament profiles) or goals and values (character profiles), and then to three phenotypic networks, which integrate temperament profiles and character profiles, that regulate learning. Given this recent understanding, our aim was to provide a novel and more comprehensive description of personality features at a societal level (using a stratified sample representative of the Portuguese population) by considering personality at its higher levels of complexity. Methods: Toward this goal, a stratified sample of 2,443 Portuguese adults responded to the Revised Temperament and Character Inventory (TCI-R). Results: We summarize the prevalence of (a) temperament profiles, (b) character profiles, and (c) integrated temperament-character networks within the whole sample, as well as for men vs. women and different age groups separately. Independent of age and education, women were more likely to be capable of resourceful productivity and helpful cooperation combined with being more intuitive, meditative and creative than men. Independent of age and gender, individuals with a degree were also more likely to present these biopsychosocial features. We also found that the organized character profile was most typical of adults in their 40s. Finally, the distribution of personality profiles across age differed as a function of gender: for men the oldest individuals had the most coherent personalities while high personality integration was most prevalent for women in their 30s. Discussion: These results have strong implications for research and intervention. In particular, these results are relevant for understanding the epidemiology of interactions between personality, mental health and well-being, including their expressions in a national population as a function of demographic characteristics.

Subjective well-being and school engagement before versus during the COVID-19 pandemic: What good are positive emotions?

The present study overcomes the limited empirical evidence on the association between well-being and school engagement in times of adversity by exploiting available data from two large and comparable samples of eighth graders; one obtained prior to the COVID-19 pandemic and the second obtained during the pandemic. Results suggest that adolescents were less engaged with their learning context during the pandemic, as well as lower in positive and negative affect, but slightly more satisfied with life. Through SEM we found a stronger positive association between positive affect and school engagement in the COVID-19 group compared with the pre-COVID-19 group. This finding highlights the important role of positive affect in supporting better academic functioning in the aftermath of a global crisis.

Disentangling the personality pathways to well-being.

Recent genomic, psychological, and developmental research shows that human personality is organized as a complex hierarchy that ascends from individual traits in many specific situations to multi-trait profiles in two domains that regulate emotional reactivity (temperament) or goals and values (character), and finally to three integrated temperament-character networks that regulate learning to maintain well-being in changing conditions. We carried out person-centered analyses of the components of subjective well-being (positive affect, negative affect, and life satisfaction) to personality in both adolescents (N = 1739) and adults (N = 897). Personality was considered at each level of its organization (trait, temperament or character profiles, and joint temperament-character networks). We show for the first time that negative affect and life satisfaction are dependent on the personality network for intentional self-control, whereas positive affect is dependent on the personality network for self-awareness that underlies the human capacities for healthy longevity, creativity, and prosocial values.

Contemporary Outcomes of Surgery for Primary and Recurrent Genitourinary Fistulae in a Well-resourced Country.

BACKGROUND: Urinary fistula (UF) is a global health problem but less common in well-resourced countries. Over the past decade there has been a trend toward managing UF in dedicated centres. Most of the evidence for surgical treatment is from individual case series, with few publications that involve high numbers. We describe the repair of recurrent and complex UF cases and outcomes in a tertiary referral setting. OBJECTIVE: To describe UF aetiology, repair techniques, and outcomes. DESIGN SETTING AND PARTICIPANTS: This is a retrospective study of a series of patients undergoing UF repair at a specialist unit. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: We describe the aetiology, cure rate, complications, and postoperative urinary incontinence rates for the series of UF cases. RESULTS AND LIMITATIONS: A consecutive series of 98 patients was identified, all of whom were tertiary referrals. Of these, 31 (31.6%) had at least one prior attempt at repair at another centre. The median age was 48 yr (interquartile range [IQR] 40-60.25). The median time from occurrence to repair was 12 mo (IQR 6-12). UF occurred most commonly following hysterectomy (48.0%), Caesarean section (9.2%), other gynaecological surgery (7.1%), and anti-incontinence surgery (7.1%). Complex fistulae (eg, repeat cases, radiation, ureteric involvement) comprised 41 of the cases (41.8%). Most patients with vesicovaginal fistula underwent repair via a transabdominal approach (70.4%). Tissue interposition was used in 96 cases (98%). There were no Clavien-Dindo grade >3 complications. Two patients (2%) had a persistent UF postoperatively. Two patients (2%) developed recurrence more than 2 yr after their initial repair, and both were successfully repaired at our centre. Twelve patients (12.3%) developed de novo overactive bladder, 22 (22.5%) developed stress urinary incontinence (13 had subsequent incontinence surgery), and two (2%) developed bladder pain (both had a subsequent cystectomy). CONCLUSIONS: Despite a high rate of recurrent and complex UF, successful lasting closure was achieved in 96% of our cases. A minority of patients developed other problems such as de novo overactive bladder and stress urinary incontinence that may require further treatment. PATIENT SUMMARY: Urinary fistula is an abnormal opening or connection in the urinary tract and is less common in well-resourced countries. As a consequence, management of this condition is more frequently undertaken at specialist units. Even patients with a complex fistula and those who have had multiple attempts at repair can experience a cure. Urinary leakage is a common complication after the operation but can be successfully managed with surgery.

The Effectiveness of Post-exercise Stretching in Short-Term and Delayed Recovery of Strength, Range of Motion and Delayed Onset Muscle Soreness: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

Background: Post-exercise (i.e., cool-down) stretching is commonly prescribed for improving recovery of strength and range of motion (ROM) and diminishing delayed onset muscular soreness (DOMS) after physical exertion. However, the question remains if post-exercise stretching is better for recovery than other post-exercise modalities. Objective: To provide a systematic review and meta-analysis of supervised randomized-controlled trials (RCTs) on the effects of post-exercise stretching on short-term (≤1 h after exercise) and delayed (e.g., ≥24 h) recovery makers (i.e., DOMS, strength, ROM) in comparison with passive recovery or alternative recovery methods (e.g., low-intensity cycling). Methods: This systematic review followed PRISMA guidelines (PROSPERO CRD42020222091). RCTs published in any language or date were eligible, according to P.I.C.O.S. criteria. Searches were performed in eight databases. Risk of bias was assessed using Cochrane RoB 2. Meta-analyses used the inverse variance random-effects model. GRADE was used to assess the methodological quality of the studies. Results: From 17,050 records retrieved, 11 RCTs were included for qualitative analyses and 10 for meta-analysis (n = 229 participants; 17-38 years, mostly males). The exercise protocols varied between studies (e.g., cycling, strength training). Post-exercise stretching included static stretching, passive stretching, and proprioceptive neuromuscular facilitation. Passive recovery (i.e., rest) was used as comparator in eight studies, with additional recovery protocols including low intensity cycling or running, massage, and cold-water immersion. Risk of bias was high in ~70% of the studies. Between-group comparisons showed no effect of post-exercise stretching on strength recovery (ES = -0.08; 95% CI = -0.54-0.39; p = 0.750; I 2 = 0.0%; Egger's test p = 0.531) when compared to passive recovery. In addition, no effect of post-exercise stretching on 24, 48, or 72-h post-exercise DOMS was noted when compared to passive recovery (ES = -0.09 to -0.24; 95% CI = -0.70-0.28; p = 0.187-629; I 2 = 0.0%; Egger's test p = 0.165-0.880). Conclusion: There wasn't sufficient statistical evidence to reject the null hypothesis that stretching and passive recovery have equivalent influence on recovery. Data is scarce, heterogeneous, and confidence in cumulative evidence is very low. Future research should address the limitations highlighted in our review, to allow for more informed recommendations. For now, evidence-based recommendations on whether post-exercise stretching should be applied for the purposes of recovery should be avoided, as the (insufficient) data that is available does not support related claims. Systematic Review Registration: PROSPERO, identifier: CRD42020222091.

Student engagement with school and personality: a biopsychosocial and person-centred approach.

BACKGROUND: Engagement with school is a key predictor of students' academic outcomes, yet little is known about its association with personality. No research has considered this association using Cloninger's biopsychosocial model of personality. This model may be particularly informative because it posits the structure of human personality corresponds to three systems of human learning and memory that regulate associative conditioning, intentionality, and self-awareness, all of which are relevant for understanding engagement. AIMS: To test for defined personality phenotypes and describe how they relate to student engagement. SAMPLE: 469 adolescents (54.2% female) attending the eighth (Mage  = 13.2, SD = .57) or 11th (Mage  = 16.5, SD = .84) grades. METHODS: Students completed self-report measures of personality and engagement. We used mixture models to identify latent classes defined by common (1) temperament profiles, (2) character profiles, and (3) joint temperament-character networks, and then tested how these classes differed in engagement. RESULTS: Latent class analysis revealed three distinct joint temperament-character networks: Emotional-Unreliable (emotionally reactive, low self-control, and low creativity), Organized-Reliable (self-control but not creative), and Creative-Reliable (highly creative and prosocial). These networks differed significantly in engagement, with the emotional-unreliable network linked to lower engagement. However, the magnitudes of these differences across engagement dimensions did not appear to be uniform. CONCLUSIONS: Different integrated configurations of the biopsychosocial systems for associative conditioning, intentionality, and self-awareness (differences in personality) underlie student engagement. Our results offer a fine-grained understanding of engagement dimensions in terms of their underlying personality networks, with implications for educational policies and practices.

The Modified Prone Jack-knife Position for the Excision of Female Urethral Diverticula.

BACKGROUND: Female urethral diverticula (UD) are an uncommon and often overlooked aetiology in women presenting with lower urinary tract symptoms, urethral pain, and recurrent urinary tract infection. With increasing awareness, appropriate imaging is more commonly undertaken with consideration given to surgical management. OBJECTIVE: The video presented demonstrates the technique for excising large and/or complex UD using a modified prone jack-knife position-a position that offers excellent surgical access and allows the surgeon to operate in a more ergonomic position. DESIGN, SETTING, AND PARTICIPANTS: A retrospective review of the data on patients undergoing excision of UD at a tertiary referral unit was performed. SURGICAL PROCEDURE: Urethral and suprapubic catheters (±insertion of ureteric stents) were placed in supine position. UD excised in the modified prone jack-knife position (±placement of a Martius flap). MEASUREMENTS: Subjective cure rate, recurrence rate, rates of postoperative urinary incontinence, need for secondary incontinence procedure, and postoperative complications were measured. RESULTS AND LIMITATIONS: A total of 121 patients were operated on in the study period. The mean follow-up time was 10 mo (range 3-40). The most frequent presenting symptoms included a vaginal mass (n = 76, 63%), followed by dysuria (n = 72, 60%) and pelvic pain (n = 71, 59%). An identifiable aetiological factor was present in 45 patients, including traumatic vaginal delivery (18, 15%), prior periurethral surgery (17, 14%), and urethral dilatation (10, 8%). All patients underwent postvoiding magnetic resonance imaging (MRI) to confirm the diagnosis and plan surgery. UD ranged in maximum diameter from 8 to 48 mm, with a mean of 43 mm (standard deviation 9.24). The most common anatomical location was midurethral (55, 46%), followed by distal (36, 30%), proximal (25, 21%), and full length (5, 4%). Most UDs were single in configuration (74%), followed by multiloculated (15%), saddle shaped (7%), and circumferential (5%). On preoperative videourodynamics, 17 (14%) had stress urinary incontinence. UD excision was undertaken in the modified prone jack-knife position in all cases. A Martius flap was utilised in 36 (30%). The median postoperative postvoiding residual was 26 ml (interquartile range 0-40). In total, 88 (73%) patients were continent postoperatively and 16 (13%) experienced de novo stress urinary incontinence. Of the 37 with pre-existing stress incontinence symptoms, 20 (54%) were continent after operation. A total of 14 patients had subsequent autologous fascial sling at 6 mo. In total, five symptomatic recurrences occurred (4%); of these patients, three elected to undergo surgical excision, all of whom had symptom resolution and were continent after operation. A total of 11 patients (9%) experienced a Clavien-Dindo grade I-II complication within 90 d after operation. Five patients complained of dyspareunia, which resolved by 6 mo. CONCLUSIONS: The modified prone jack-knife position facilitates excellent access for excision of both simple and complex UDs. This positioning of the patient is not widely recognised amongst urologists. Using this approach, there were low rates of symptomatic recurrence and de novo stress incontinence at medium-term follow-up. Associated urinary incontinence resolves in over half of patients following UD excision; hence, we advocate deferring any incontinence procedure until after the results of surgery are established. PATIENT SUMMARY: Surgical removal of urethral outpouching (diverticula) in women is challenging due to its potential to damage the nearby sphincter muscle, which controls continence, or the urethra tube. Placement of patients on their front, rather than on their back, provides excellent access for the surgical removal of urethral diverticula. With this approach, we achieved excellent rates of cure and low rates of urinary incontinence at an average follow-up of 10 mo.

A Systematic Review of Surgical interventions for the Treatment of Bladder Pain Syndrome/Interstitial Cystitis.

CONTEXT: Bladder pain syndrome/interstitial cystitis (BPS/IC) is a poorly understood chronic debilitating condition. Surgery is reserved for severe refractory cases; however, there is no consensus on patient selection or optimal approach. OBJECTIVE: To evaluate the evidence relating to the safety and efficacy of surgical interventions for treating BPS/IC. EVIDENCE ACQUISITION: PubMed and Scopus databases were searched for original studies, using keywords "cystectomy", "interstitial cystitis", and "bladder pain syndrome". Articles were reviewed and screened by three independent reviewers. EVIDENCE SYNTHESIS: A total of 450 patients were identified from 20 eligible studies: mean age was 54.5 yr and 90.2% were female. The median duration of symptoms preoperatively was 60 mo (range 9-84), with a mean follow-up of 45.5 mo. A total of 448 patients underwent surgery: subtotal cystectomy with cystoplasty (48.6%), cystectomy and orthotopic neobladder (21.9%), cystectomy and ileal conduit (11.2%), and urinary diversion only (18.3%). Symptomatic improvement occurred in 77.2%, with higher rates in the total cystectomy and orthotopic neobladder group. Thirty-one patients (6.9%) required secondary total cystectomy and/or ileal conduit diversion; 48.4% subsequently improved. Seventeen studies reported 102 complications overall (26.5%). Overall mortality was 1.3%. CONCLUSIONS: Overall surgical intervention is associated with a 23% risk of failure to improve symptoms. Higher rates of improvement were reported in patients with total cystectomy. Interpretation should be guarded given the small patient number, multiple centres, and variable outcome measurements. There is a need for prospective randomised studies to answer questions regarding patient selection and optimal surgical approach. PATIENT SUMMARY: In this review, we looked at the outcomes of surgery for treatment-refractory bladder pain syndrome/interstitial cystitis. We found overall symptom improvement in 77.2% of patients with a complication rate of 26.5%. However, there remains a need for further studies of higher quality to identify patients who will have symptom improvement and the best surgical option.

Personality Networks and Emotional and Behavioral Problems: Integrating Temperament and Character Using Latent Profile and Latent Class Analyses.

Recent research indicates that adaptive functioning and well-being depends on the integration of three dissociable systems of learning and memory that regulate associative conditioning, intentionality and self-awareness. Our study objective was to describe how different integrated configurations of these systems (i.e. different expressions of personality) relate to the presence of internalizing, externalizing and total problems. In total, 699 adolescents completed the JTCI and Achenbach's YSR. Latent profile analyses revealed two temperament profiles and six character profiles. Adolescents with a steady temperament, and those with healthy characters, were significantly less likely to present clinical levels of problems. The integration of a steady temperament and healthy character profiles in a Mature-Steady joint temperament-character network was also associated with significantly less clinical problems. In sum, our person-centered study indicates that adaptive expressions of associative conditioning, intentionality, and self-awareness (i.e. integrated personalities) are critical for mental health.

Addressing a Need for Valid Measures of Trait Reactance in Adolescents: A Further Test of the Hong Psychological Reactance Scale.

Research is scant concerning the developmental aspects of trait reactance. If measures are not validated for use across different age groups, it is difficult for researchers to investigate the specificities of reactance across the life span. So far, the factor structure and psychometric properties of the Hong Psychological Reactance Scale (HPRS) have not been tested in adolescents. In Study 1, using data from 1,301 Portuguese adolescents (M = 14.8 years), we conducted a confirmatory factor analysis to test a series of competing factor models. Post hoc modifications resulted in a bifactor model with acceptable fit. Bifactor statistical indexes showed that HPRS scores are unidimensional. Path analysis via structural equation modeling indicated HPRS scores were strongly related to scores from another measure of trait reactance. Study 2, using an independent sample of 327 Portuguese adolescents (M = 14.2 years), supported modeling the HPRS with a bifactor model. Finally, our results indicated HPRS scores were negatively correlated with indicators of emotional and cognitive well-being, supporting a conceptualization of reactance as patterns of negative cognitions and negative affect. Overall, this study indicates the HPRS is an appropriate measure for assessing trait reactance in adolescents.

Another Therapeutic Role for Intravesical Botulinum Toxin: Patients with Long-stay Catheters and Refractory Bladder Pain and Catheter Bypass Leakage.

BACKGROUND: Botulinum neurotoxin (BotN) is used to treat detrusor overactivity (DO) refractory to medical treatment. Catheterised patients with symptoms of bladder spasm and catheter bypass leakage are challenging to manage and the efficacy of BotN is not established. OBJECTIVE: To review our experience using intravesical BotN to treat refractory bladder pain and catheter bypass leakage in patients with long-term indwelling catheters. DESIGN, SETTING, AND PARTICIPANTS: We carried out a review of data prospectively collected for patients with indwelling urethral or suprapubic catheters receiving BotN for the treatment of bladder spasms and catheter bypass leakage in a UK tertiary centre. An unvalidated structured questionnaire was used to ascertain quality of life (QoL) outcomes. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Qualitative data were collected for patient-reported symptoms and QoL. Paired Student t tests were applied for statistical analysis. RESULTS AND LIMITATIONS: Of the 54 catheterised patients who received BotN, 14 (26%) were male and 40 (74%) were female. The mean follow-up was 38mo. Of the patients, 34 (63%) had a neurological aetiology and 94% had experienced failure of medical therapy before BotN administration. The BotN starting dose was 100 or 200U and 17 patients (31%) required dose escalation. All 34 neurogenic and six non-neurogenic patients started on 200U. After treatment, 63% of patients managed their catheter with intermittent drainage and 37% managed on free drainage; 51 patients (94%) reported that their symptoms were controlled and 38% reported being treated for a urinary tract infection following BotN. Patients reported a mean improvement in QoL of 7.7/10 following BotN, while 83% reported a significant reduction in urine leakage (p=0.0001). CONCLUSIONS: Outpatient intravesical BotN is safe and efficacious for patients with long-term catheters suffering from bladder pain and catheter bypass leakage. PATIENT SUMMARY: Outpatient administration of intravesical botulinum toxin is a safe and effective treatment for patients with a long-term indwelling catheter with bothersome urine storage symptoms. Attention should be paid to urine microbiology results before treatment to ensure appropriate prophylactic antibiotic treatment to reduce the incidence of urinary tract infections.

The Resistance to Change Scale: Assessing Dimensionality and Associations with Personality and Wellbeing in Adolescents.

Resistance to change (RTC) is the tendency to have a negative attitude toward change. It is a relevant construct in adolescence because change can be perceived as a challenge to the formation of an integrated independent identity: the primary developmental task of this period. Currently, there are no validated measures of RTC for adolescents. To address this research gap, we tested the psychometric properties of the Resistance to Change Scale in a sample of adolescents from Portugal. Confirmatory factor analyses supported modeling the RTC scale via a bifactor model. Statistical indices indicated that RTC scale scores were largely unidimensional. When this model was applied, RTC was positively related with trait reactance, negatively related with wellbeing, and linked to high Harm Avoidance and low Self-Directedness personality dimensions. The bifactor model was equivalent across gender and early vs. late adolescent groups. Our findings suggest that the RTC scale is a psychometrically sound and potentially useful tool for researchers and educators who wish to measure RTC in adolescents.

Recent advances in surgical management of urinary incontinence.

There have been several recent developments in surgical treatments for male and female incontinence. This article reviews the current options for treatments of urge and stress incontinence in men and women. Treatments for urge incontinence discussed include intradetrusor onabotulinum toxin A, sacral neuromodulation and percutaneous tibial nerve stimulation. For stress incontinence, suburethral mesh, bulking agents, autologous slings, colposuspension, male slings and artificial urinary sphincters are assessed.

Spatially Consistent High-Resolution Land Surface Temperature Mosaics for Thermophysical Mapping of the Mojave Desert.

Daytime and nighttime thermal infrared observations acquired by the ASTER and MODIS instruments onboard the NASA Terra spacecraft have produced a dataset that can be used to map thermophysical properties across large regions, which have implications on surface processes, thermal environments and habitat suitability for desert species. ASTER scenes acquired between 2004 and 2012 are combined using new mosaicking and data-fusion techniques to produce a map of daytime and nighttime land surface temperature with coverage exclusive of the effects of clouds and weather. These data are combined with Landsat 7 visible imagery to generate a consistent map of apparent thermal inertia (ATI), which is related to the presence of exposed bedrock, rocks, fine-grained sediments and water on the surface. The resulting datasets are compared to known geomorphic units and surface types to generate an interpreted mechanical composition map of the entire Mojave Desert at 100 m per pixel that is most sensitive to large clast size distinctions in grain size distribution.

Therapeutic reactance in adolescents: the psychometrics of the Therapeutic Reactance Scale in adolescents.

BACKGROUND: The Therapeutic Reactance Scale (TRS) is a classic measure of psychological reactance, yet only two studies have evaluated its factorial structure. Both proposed different multidimensional structures based on exploratory analyses. Not only is the factorial structure of the TRS unclear, but the scale has yet to be validated in adolescents. OBJECTIVE: This study aimed to test the factorial structure of the TRS in adolescents. METHODS: The authors conducted exploratory and confirmatory factor analyses, and analyses of reliability and validity, with a sample of 1,344 adolescents. RESULTS: A four-factor model fits well to the data. Three of the four TRS dimensions (not susceptibility to influence, SI) were correlated with the Hong Psychological Reactance Scale (HPRS). These three dimensions were also correlated with novelty seeking, cooperativeness and persistence components of personality (Cloninger's psychobiological model of personality), while SI showed a different pattern. CONCLUSIONS: Overall, this study demonstrates that the TRS is a suitable and potentially useful tool for measuring reactance in adolescents, but the authors propose that practitioners may wish to consider excluding items pertaining to the SI dimension.

Penile Paraffinoma.

Penile paraffinoma is a rare cause of penile mass that can occur following injection of liquid paraffin, performed illicitly for penile augmentation. Over the past 2 yr, we have observed an increasing number of cases presenting with the complications of penile paraffinoma; three patients of central European origin have required inpatient treatment at our institution and posed a significant management dilemma. This mini-review aims to review the literature on the aetiopathogenesis, clinical features, diagnosis, and management of penile paraffinoma. A systematic search of PubMed and Scopus was performed with 10 case series and 26 case reports identified between 1956 and 2017. A total of 124 cases, with a mean age of 36.29 yr, were identified. The majority originated in Korea, and the most common injected material was liquid paraffin (80.6%). Patients presented with pain/swelling, ulceration/fistulae, and penile deformity. The majority required surgical excision of paraffinoma followed by reconstruction with a variety of procedures including split skin grafting, scrotal skin flap reconstruction, and prepuce grafting. Mean duration of follow-up was 15.8 mo. Penile paraffinoma remains a rare presentation; however, it can present management difficulties. We have had an increase in cases, with three patients presenting with complications following injection of paraffin in our unit in the past 2 yr. Definitive management includes surgical excision and reconstruction as required with early involvement of plastic surgeons. There may be a role for conservative management; however, long-term outcomes are unclear. There may be a need for targeted preventative measures through public health agencies in communities where the practice is more prevalent. PATIENT SUMMARY: Penile paraffinoma can occur following injection of liquid paraffin or similar substances, generally used by non-healthcare personnel for the purpose of penile augmentations, and can cause significant pain, ulceration, and penile deformity. Definitive management includes surgical excision with reconstruction as required. Prevention of its use through awareness and education may be required in communities where the practice is more common.

The treatment of complex female urethral pathology.

Lower urinary tract symptoms (LUTS) in women produce significant bother. Common conditions causing LUTS in women include urinary tract infections, overactive bladder, and stress incontinence. Urethral diverticulae and female urethral strictures are rare pathologies. They can cause symptoms, which can mimic commoner conditions, leading to delay in diagnosis and unnecessary delay in treatment. In this article, we discuss in detail the definition, symptoms, epidemiology, pathogenesis, diagnosis, and treatment option for these two conditions. Further understanding of these conditions will aid in the proper diagnosis and prevent delay in management.