Papers by Matthew Truesdale
Journal of Clinical Oncology, May 20, 2011
e15167 Background: Widespread use of PSA screening has resulted in earlier detection of prostate ... more e15167 Background: Widespread use of PSA screening has resulted in earlier detection of prostate cancer, often in younger patients with small-volume, unilateral disease. Partial-gland cryoablation, sparing healthy tissue and the ipsilateral neurovascular bundle, is an attractive option for patients with unilateral cancer who wish to preserve erectile function and continence. We report our early cancer outcome data for focal prostate cryoablation. METHODS We performed a retrospective review from a single-institution IRB-approved cryotherapy database of over 900 patients. INCLUSION CRITERIA unilateral prostate cancer treated with primary focal cryoablation. EXCLUSION CRITERIA prior or concurrent hormonal therapy. Disease-free survival at 3 and 5 years was calculated using the Kaplan-Meier method, and multivariate Cox regression models were performed to determine predictors of cancer outcome. RESULTS From 2002-2010, 102 men underwent primary focal cryoablation for prostate cancer. Mean age was 69.3 years (standard deviation [SD] 6.7 years); mean follow-up time 30.0 months (SD 24.2 months); mean pre-operative PSA 7.0 ng/mL (SD 5.5 ng/mL); and median Gleason score sum 6 (range 5-9). Overall mean post-treatment PSA nadir was 1.2 ng/mL (SD 1.3 ng/mL). Following treatment, 22 patients underwent transrectal ultrasound-guided (TRUS) biopsy for clinical suspicion of recurrent disease, and 10/22 (45%) had confirmed recurrent prostate cancer. No patients developed metastatic disease at any point during follow-up. On multivariate analysis, preoperative PSA level, preoperative Gleason score, number of positive biopsy cores, and total tumor length were all associated with disease recurrence. CONCLUSIONS Early data show encouraging disease-free survival rates using follow-up TRUS biopsy results. Focal prostate cryoablation is a promising option for carefully selected patients, although further follow-up and long-term disease control will determine its role in prostate cancer treatment.
The Journal of Urology, 2015
INTRODUCTION AND OBJECTIVES: Percutaneous nephrolithotomy (PNL) remains an effective treatment fo... more INTRODUCTION AND OBJECTIVES: Percutaneous nephrolithotomy (PNL) remains an effective treatment for patients with a large stone burden. When a nephrostomy tube (NT) is left in place postoperatively, antegrade flow of urine is often confirmed with antegrade nephrostography (ANG) as edema from a chronically obstructing stone can resolve in variable amounts of time. Alternatively, antegrade flow can be estimated by injecting methylene blue dye into the NT or performing a NT capping trial. We compared the methylene blue dye test and capping trial against ANG to assess antegrade urine flow. METHODS: Consecutive patients undergoing PNL at 2 hospitals were prospectively enrolled between July and October, 2014. A cap was placed on the NT on the morning of postoperative day 1 (POD1). Capping trial failure was defined as need to uncap NT for any reason including increased pain or fever. 2 hours after capping, 7cc of methylene blue was injected into the NT and the tube recapped. Positive test was defined as the presence of blue per urethral Foley. Later that afternoon, ANG was performed to radiographically document antegrade urine flow. Sensitivity, specificity, positive (PPV) and negative predictive values (NPV) were calculated comparing capping and methylene blue tests against ANG. RESULTS: 34 subjects underwent PNL. 55.9% were left sided and 73.5% were lower pole punctures (mean age 54.9 13.9 years; mean BMI 31.7 12.7kg/m2; mean stone size 2.86 1.42cm). Capping trial was successful in 86.7% of patients. Compared to ANG, it had a sensitivity of 94.4% (CI 83.9-100%), specificity 25.0% (CI 0.5-49.5%), PPV 65.4% (47.1-83.7%), and NPV 75.0% (CI 32.6-100%) to predict antegrade urine flow. The methylene blue test was positive in 41.4% of patients. Compared to ANG, it had a sensitivity of 52.9% (CI 29.2-76.7%), specificity 75.0% (CI 50.5-99.5%), PPV 75.0% (CI 50.5-99.5%), and NPV 52.9% (CI 29.2-76.7%) to predict antegrade urine flow. CONCLUSIONS: Compared to ANG, a capping trial and methylene blue test are 94% and 53% sensitive and 25% and 75% specific respectively for confirming antegrade urine flow following PNL. In clinical practice, these tests may potentially be used in combination to obviate the need for ANG, which can be redundant and timeconsuming.
European Urology Supplements, 2011
clinical stage T3 or T4, or T2 with serum levels of prostate specific antigen (PSA) between 50 to... more clinical stage T3 or T4, or T2 with serum levels of prostate specific antigen (PSA) between 50 to 99 ng/mL, without signs of metastases and managed with noncurative intent. The patients were followed up in the Cause of Death Register for up to 11 years (median, 3.5 years). Cumulative incidence of prostate cancer-specific death and competing causes were calculated according to age, tumor grade (Gleason score), and prostate-specific antigen (PSA) levels at diagnosis. results: The prostate cancer-specific mortality at 8 years of follow up was 28% (95% CI, 25-32%) for Gleason score (GS) 2-6, 41% (95% CI, 38 to 44%) for GS 7, 52% (95% CI, 47 to 57%) for GS 8, and 64% (95% CI, 59 to 69%) for GS 9-10. Even for men aged more than 85 years at diagnosis with Gleason scores 8-10, prostate cancer was a major cause of death, 42% (95% CI, 37 to 47%). Conclusions: The prostate cancer-specific mortality within eight years of diagnosis is high in locally advanced prostate cancer, suggesting under-treatment not least of men in older age groups. Our results underscore the need for more studies of treatment with curative intent for locally advanced tumors.
NeuroImage, 2009
Electroconvulsive therapy (ECT) is an effective treatment for severe depression; however, the ind... more Electroconvulsive therapy (ECT) is an effective treatment for severe depression; however, the induced therapeutic seizure acts on the autonomic nervous system and results in significant cardiac effects. This is an important consideration particularly in the elderly. Magnetic seizure therapy (MST) is in development as a less invasive alternative, but its effects on cardiac function have not been studied. We sought to model those effects in nonhuman primates to inform the development of safer neurostimulation interventions. Twenty four rhesus monkeys were randomly assigned to receive 6 weeks of daily treatment with electroconvulsive stimulation (ECS), magnetic seizure therapy (MST) or anesthesia-alone sham. Digitally acquired ECG and an automated R-wave and inter-R interval (IRI) sampling were used to measure intervention effects on heart rate (HR). Significant differences between experimental conditions were found in the HR as evidenced by changes in the immediate post-stimulus, ictal and postictal epochs. Immediate post-stimulus bradycardia was seen with ECS but not with MST. ECS induced significantly more tachycardia than MST or sham in both the ictal and postictal periods. MST resulted in a small, but statistically significant increase in HR during the postictal period relative to baseline. HR was found to increase by 25% and 8% in the ECS and MST conditions, respectively. MST resulted in significantly less marked sympathetic and parasympathetic response than did ECS. This differential physiological response is consistent with MST having a more superficial cortical site of action with less impact on deeper brain structures implicated in cardiac control relative to ECT. The clinical relevance of the topographical seizure spread of MST and its associated effects on the autonomic nervous system remain to be determined in human clinical trials.
Journal of Endourology, 2010
Background and Purpose: Studies of radical prostatectomy (RP) suggest that higher lymph node yiel... more Background and Purpose: Studies of radical prostatectomy (RP) suggest that higher lymph node yield (LNY) improves tumor staging. Robot-assisted radical prostatectomy (RARP) is becoming increasingly popular, yet LNY data are not well reported. We compare LNY from contemporary open RP (ORP) with RARP at an academic center. Patients and Methods: A retrospective study was conducted of an Urologic Oncology Database. Between January 2005 and November 2009, 217 men underwent ORP with pelvic lymph node dissection (PLND); 99 underwent RARP with PLND by a single surgeon during the same period. Men were stratified according to the D'Amico risk criteria. For intermediate and high-risk disease, an extended PLND was performed. Patient demographic, operative, and pathologic variables were measured, and LNY was compared across groups. Results: No significant differences were seen between groups for race, body mass index, preoperative prostatespecific antigen level or biopsy Gleason score. Patients were younger for RARP vs ORP (P ¼ 0.003) and had higher clinical tumor stage (P ¼ 0.02). Operative time was longer (P ¼ 0.03) and estimated blood loss was greater (P < 0.001) in the ORP group. Overall, only a borderline significant difference was seen in LNY between ORP and RARP (7.49 vs 6.35 nodes, respectively, P ¼ 0.06). No difference was seen for intermediate and high-risk patients, with 7.7 vs 6.8 nodes for ORP and RARP, respectively (P ¼ 0.27). The lymph node metastasis rate was 6.3%, with more positive nodes detected during ORP vs RARP: 19=217 (8.8%) vs 1=99 (1.0%), P ¼ 0.009. Conclusions: No significant differences were seen in LNY during RARP and ORP for intermediate and high-risk men. For experienced surgeons, RARP can achieve equivalent LNY as ORP. A future study with a larger sample size is necessary to make a definitive statement of equivalence. a Student's t test. b Chi-square test. ORP ¼ open radical prostatectomy; RARP ¼ robot-assisted radical prostatectomy; PSA ¼ prostate-specific antigen.
Urology, 2011
To evaluate the application of a BioGlue adhesive shell to minimize iceball fracture. Iceball fra... more To evaluate the application of a BioGlue adhesive shell to minimize iceball fracture. Iceball fracture and hemorrhage is common with laparoscopic cryoablation (LCA) of larger (&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;4 cm) renal tumors. Twenty large iceballs were created in porcine kidneys using 3 cryoablation probes in a nonsurvival study. Each kidney underwent an upper and lower pole ablation. One pole in each kidney was covered with 5 mL of BioGlue and the opposite pole served as a control. A double freeze-thaw cycle was performed (10 minutes freeze and 5 minutes active thaw) in both renal poles simultaneously. The probes were removed and the sites were monitored for 20 minutes under direct vision. Fracture length (mm), severity of fracture depth, severity of bleeding (absent, mild, moderate, severe), and estimated blood loss (EBL) (mL) were recorded. In the control group, the mean fracture length was 1.9 mm (range, 0-3 mm). Blood loss was absent in 10%, mild in 60%, and moderate in 30% of ablations. The mean EBL was 20.5 mL (range, 0-50 mL). For the BioGlue ablations, there were no parenchymal fractures. Blood loss was mild in 30% and absent in 70% of sites with an average EBL of 5 mL (range, 0-20). Two bleeding sites occurred as a result of subcapsular hematomas caused by initial probe placement. BioGlue application minimized the frequency and magnitude of renal fracture. EBL was lower with BioGlue application and most sites demonstrated no postablation bleeding. Further clinical study of the BioGlue shell should be performed to confirm these results.
The Journal of Urology
In UTUC patients, comorbid diseases may cause delay both medical consultation and post-consultati... more In UTUC patients, comorbid diseases may cause delay both medical consultation and post-consultation treatment initiation. Coexistence of bladder cancer, which often has to be controlled prior to the treatment of RNU, may also delay RNU. URS may be needed for patients with negative urine cytology to have definitive evidence of tumor lesion. The present study has provided important information for social and clinical efforts to shorten time from disease onset to treatment initiation that potentially causes unfavorable pathological and oncological outcomes.
JAMA Dermatology
IMPORTANCE Pubic hair grooming is a common practice that can lead to injury and morbidity. OBJECT... more IMPORTANCE Pubic hair grooming is a common practice that can lead to injury and morbidity. OBJECTIVE To identify demographic and behavioral risk factors associated with pubic hair grooming-related injuries to characterize individuals with high risk of injury and develop recommendations for safe grooming practices. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study conducted a national survey of noninstitutionalized US adults (aged 18-65 years). The web-based survey was conducted through a probability-based web panel designed to be representative of the US population.
Sexually transmitted infections, May 1, 2017
STIs are the most common infections among adults. Concurrently, pubic hair grooming is prevalent.... more STIs are the most common infections among adults. Concurrently, pubic hair grooming is prevalent. Small-scale studies have demonstrated a relationship between pubic hair grooming and STIs. We aim to examine this relationship in a large sample of men and women. We conducted a probability survey of US residents aged 18-65 years. The survey ascertained self-reported pubic hair grooming practices, sexual behaviours and STI history. We defined extreme grooming as removal of all pubic hair more than 11 times per year and high-frequency grooming as daily/weekly trimming. Cutaneous STIs included herpes, human papillomavirus, syphilis and molluscum. Secretory STIs included gonorrhoea, chlamydia and HIV. We analysed lice separately. Of 7580 respondents who completed the survey, 74% reported grooming their pubic hair, 66% of men and 84% of women. After adjusting for age and lifetime sexual partners, ever having groomed was positively associated with a history of self-reported STIs (OR 1.8; 95%...
Lesbian, Gay, Bisexual, and Transgender Healthcare, 2016
In this chapter we will provide a brief primer on urologic care with a focus on the particular ne... more In this chapter we will provide a brief primer on urologic care with a focus on the particular needs of LGBT persons. It is our hope that this manuscript will be of use to primary care physicians who will see LGBT persons with urologic issues and to urologists who may not be familiar with issues germane to the LGBT community. We will address general urologic issues but will focus on urologic issues for which there is evidence of signifi cant differences between LGBT and non-LGBT patients.
The Journal of Urology, 2016
Perioperative anticoagulation during surgical shunting represents a logical next step in the mana... more Perioperative anticoagulation during surgical shunting represents a logical next step in the management of ischemic priapism. It resolves the issue of priapism recurrence in the early postoperative period, due to clotting of the shunt site. We suggest incorporating perioperative anticoagulation for priapism shunting procedures in future guidelines for the management of priapism.
Journal of endourology / Endourological Society, Jan 6, 2016
Percutaneous nephrolithotomy (PCNL) remains an effective treatment for large stones. When nephros... more Percutaneous nephrolithotomy (PCNL) remains an effective treatment for large stones. When nephrostomy tube (NT) is left postop, antegrade urine flow is often confirmed with antegrade nephrostography (ANG) prior to tube removal. We compare methylene blue (MB) test combined with NT capping trial against ANG to assess antegrade urine flow after PCNL. 101 consecutive patients undergoing PCNL were prospectively enrolled between 7/2014 and 4/2015. A NT cap was placed the morning of postoperative day 1 (POD1). Failure was defined as need to uncap NT for any reason. 2-hours after capping, 7cc MB was injected into NT. Positive MB test defined as presence of blue per bladder Foley. ANG was then performed to assess antegrade urine flow. NTs were removed prior to discharge home when antegrade flow was documented. Primary outcomes included presence of antegrade flow on ANG and NT removal prior to discharge home. ROC and areas (AUC) as well as Cohen's kappa coefficient (κ) were calculated com...
Journal of Endourology Endourological Society, Jul 1, 2010
Ten-year disease-specific survival for clinically localized prostate cancer after radiation is 93... more Ten-year disease-specific survival for clinically localized prostate cancer after radiation is 93%, 88%, and 80% for low-, medium-, and high-risk groups, respectively. The objective of this study was to report long-term cancer survival outcomes for patients who had undergone prostate cryotherapy at our institution more than 10 years ago. To date, this is the longest reported follow-up after cryotherapy. A retrospective patient chart review, conducted of an Institutional Review Board (IRB)- approved cryotherapy database, identified 76 men who had undergone prostate cryotherapy before January 1999. Pre-, intra-, and posttreatment data were collected. Primary study endpoints were overall mortality and prostate-cancer-specific death. Secondary endpoints were disease recurrence and clinical progression. Mean patient age was 69.2 (47.4-86.3) years; median preoperative prostate-specific antigen was 5.3 (0.2-208.0); mean Gleason score was 7. Forty of 76 (52.6%) were confirmed D&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;Amico high risk. Median follow-up was 10.1 (0.2-14.9) years; 25 patients underwent primary treatment; 51 postradiation. After 10 years of follow-up, 43 of 76 men (56.6%) were still alive; 33 men (43.4%) had died-10 (13.2%) from prostate cancer, 18 (22.4%) from noncancerous causes, and 5 (6.6%) unknown. The long-term results of prostate cryotherapy in our series indicate an 87% overall 10-year prostate-cancer-specific survival, despite early cryotherapy technology and the majority of patients being D&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;Amico high risk.
The Journal of Urology, 2015
The Journal of Urology, 2015
The journal of sexual medicine, 2015
Pubic hair grooming is a common practice in the United States and coincides with prevalence of gr... more Pubic hair grooming is a common practice in the United States and coincides with prevalence of grooming-related injuries. Men who have sex with men (MSM) groom more frequently than men who have sex with women (MSW). We aim to characterize the influence of sexual orientation and sexual role on grooming behavior, injuries, and infections in men in the United States. We conducted a nationally representative survey of noninstitutionalized adults aged 18-65 residing in the United States. We examined the prevalence and risk factors of injuries and infections that occur as a result of personal grooming. Of the 4,062 men who completed the survey, 3,176 (78.2%) report having sex with only women (MSW), 198 (4.9%) report sex with men (MSM), and 688 (16.9%) report not being sexually active. MSM are more likely to groom (42.5% vs. 29.0%, P < 0.001) and groom more around the anus, scrotum, and penile shaft compared with MSW. MSM receptive partners groom more often (50.9% vs. 26.9%, P = 0.005) ...
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Papers by Matthew Truesdale