Tope Rude, MD

All Publications

• Interaction between race and prostate cancer treatment benefit in the Veterans Health Administration. Cancer Rude, T., Walter, D., Ciprut, S., Kelly, M. D., Wang, C., Fagerlin, A., Langford, A. T., Lepor, H., Becker, D. J., Li, H., Loeb, S., Ravenell, J., Leppert, J. T., Makarov, D. V. 2021

  Abstract

  BACKGROUND: Studies have demonstrated that Black men may undergo definitive prostate cancer (CaP) treatment less often than men of other races, but it is unclear whether they are avoiding overtreatment of low-risk disease or experiencing a reduction in appropriate care. The authors' aim was to assess the role of race as it relates to treatment benefit in access to CaP treatment in a single-payer population.METHODS: The authors used the Veterans Health Administration (VHA) Corporate Data Warehouse to perform a retrospective cohort study of veterans diagnosed with low- or intermediate-risk CaP between 2011 and 2017.RESULTS: The authors identified 35,427 men with incident low- or intermediate-risk CaP. When they controlled for covariates, Black men had 1.05 times the odds of receiving treatment in comparison with non-Black men (P < .001), and high-treatment-benefit men had 1.4 times the odds of receiving treatment in comparison with those in the low-treatment-benefit group (P < .001). The interaction of race and treatment benefit was significant, with Black men in the high-treatment-benefit category less likely to receive treatment than non-Black men in the same treatment category (odds ratio, 0.89; P < .001).CONCLUSIONS: Although race does appear to influence the receipt of definitive treatment in the VHA, this relationship varies in the context of the patient's treatment benefit, with Black men receiving less definitive treatment in high-benefit situations. The influence of patient race at high treatment benefit levels invites further investigation into the driving forces behind this persistent disparity in this consequential group.

  View details for DOI 10.1002/cncr.33643

  View details for PubMedID 34184271

• The Association of Veterans' PSA Screening Rates With Changes in USPSTF Recommendations. Journal of the National Cancer Institute Becker, D. J., Rude, T., Walter, D., Wang, C., Loeb, S., Li, H., Ciprut, S., Kelly, M., Zeliadt, S. B., Fagerlin, A., Lepor, H., Sherman, S., Ravenell, J. E., Makarov, D. V. 2021; 113 (5): 626-631

  Abstract

  In 2012, the United States Preventative Services Task Force (USPSTF) formally recommended against all prostate-specific antigen (PSA) screening for prostate cancer. Our goal was to characterize PSA screening trends in the Veterans Health Administration (VA) before and after the USPSTF recommendation and to determine if PSA screening was more likely to be ordered based on a veteran's race or age.Using the VA Corporate Data Warehouse, we created 10 annual groups of PSA-eligible men covering 2009-2018. We identified all PSA tests performed in the VA to determine yearly rates of PSA screening. All statistical tests were 2-sided.The overall rate of PSA testing in the VA decreased from 63.3% in 2009 to 51.2% in 2018 (P < .001). PSA screening rates varied markedly by age group during our study period, with men aged 70-80 years having the highest initial rate and greatest decline (70.6% in 2009 to 48.4% in 2018, P < .001). Men aged 55-69 years had a smaller decline (65.2% in 2009 to 58.9% in 2018, P < .001) whereas the youngest men, aged 40-54 years, had an increase in PSA screening (26.2% in 2009 to 37.8% in 2018, P < .001).In this analysis of PSA screening rates among veterans before and after the 2012 USPSTF recommendation against screening, we found that overall PSA screening decreased only modestly, continuing for more than one-half of the men in our study. Veterans of different races had similar screening rates, suggesting that VA care may minimize racial disparities. Veterans of varying ages experienced statistically significantly differences in PSA screening trends.

  View details for DOI 10.1093/jnci/djaa120

  View details for PubMedID 32797212

  View details for PubMedCentralID PMC8096364

• Transvaginal Paravaginal Native Tissue Anterior Repair Technique: Initial Outcomes. Urology Rude, T., Sanford, M., Cai, J., Sevilla, C., Ginsberg, D., Rodriguez, L. V. 2021; 150: 125-129

  Abstract

  To present the surgical technique and initial outcomes for a novel lattice-work technique, developed to increase the durability of the native tissue repair.All patients undergoing transvaginal anterior prolapse repair with a single surgeon with at least 30 days of follow-up were prospectively enrolled starting in 2017. All patients received the same repair (Fig. 1). 2.0 polydioxanone (PDS) sutures are placed at the level of the obturator fascia/arcus tendineus distally and proximally on each side. The midline anterior colporrhaphy is performed with 4 2.0 PDS sutures which are then intertwined with the obturator sutures and tied to form a lattice of sutures to reinforce the cystocele repair and elevate the central defect repair laterally. Clinic notes, objective physical exam, and standardized subjective patient questionnaires (Pelvic Floor Disorders Inventory) were evaluated for patient outcomes. Recurrence was defined anatomically (Pelvic organ prolapse-Q Ba ≥-1) and subjectively (bothersome vaginal bulge).There were 109 patients enrolled with a mean follow-up time was 12 months. Over the follow-up period, there were 12 anatomic recurrences (11%). This was not associated with concomitant apical or posterior repair. Mean time to recurrence was 13.9 months. There were no intraoperative complications. Transient urinary retention was the most notable complication (19%, managed conservatively). Rate of de novo stress urinary incontinence was low at 4%.This novel lattice-work technique is simple to perform and has excellent short term anatomic outcomes. Transient postoperative retention was observed; however, all cases self-resolved. Further follow-up is ongoing to characterize the long-term durability of this repair.

  View details for DOI 10.1016/j.urology.2020.06.070

  View details for PubMedID 32711009

• The Role of Health Insurance in Patient Reported Satisfaction with Bladder Management in Neurogenic Lower Urinary Tract Dysfunction Due to Spinal Cord Injury. The Journal of urology Rude, T., Moghalu, O., Stoffel, J., Lenherr, S., Myers, J. B., Elliott, S., Welk, B., Herrick, J. S., Presson, A. P., Ginsberg, D. A. 2021; 205 (1): 213-218

  Abstract

  Neurogenic lower urinary tract dysfunction is a significant source of morbidity for individuals with spinal cord injury and is managed with a range of treatment options that differ in efficacy, tolerability and cost. The effect of insurance coverage on bladder management, symptoms and quality of life is not known. We hypothesized that private insurance is associated with fewer bladder symptoms and better quality of life.This is a cross-sectional, retrospective analysis of 1,226 surveys collected as part of the prospective Neurogenic Bladder Research Group SCI Registry. We included patients with complete insurance information, which was classified as private or public insurance. The relationship between insurance and bladder management, bladder symptoms and quality of life was modeled using multinomial logistic regression analysis. Spinal cord injury quality of life was measured by the Neurogenic Bladder Symptom Score.We identified 654 privately insured and 572 publicly insured individuals. The demographics of these groups differed by race, education, prevalence of chronic pain and bladder management. Publicly insured patients were more likely to be treated with indwelling catheters or spontaneous voiding and less likely to take bladder medication compared to those with private insurance. On multivariate analysis insurance type was not associated with differences in bladder symptoms (total Neurogenic Bladder Symptom Score) or in urinary quality of life.There is an association between insurance coverage and the type of bladder management used following spinal cord injury, as publicly insured patients are more likely to be treated with indwelling catheters. However, insurance status, controlling for bladder management, did not impact bladder symptoms or quality of life.

  View details for DOI 10.1097/JU.0000000000001346

  View details for PubMedID 32856985

• Mirabegron versus solifenacin in multiple sclerosis patients with overactive bladder symptoms: a prospective comparative non-randomized study. Urology Brucker, B. M., Jericevic, D., Rude, T., Enemchukwu, E., Pape, D., Rosenblum, N., Charlson, E. R., Zhovtis-Ryerson, L., Howard, J., Krupp, L., Peyronnet, B. 2020

  Abstract

  OBJECTIVE: To determine the patient-perceived effectiveness and tolerability of mirabegron compared to solifenacin in a multiple sclerosis (MS) population with overactive bladder (OAB) symptoms.MATERIALS AND METHODS: MS patients with OAB symptoms who were not on medication for their urinary symptoms at enrollment were prospectively recruited. Patients enrolled in years 1-2 were prescribed mirabegron, whereas patients enrolled in years 3-4 were prescribed solifenacin. At enrollment and 6-week followup, patients completed several patient reported outcome measures (PROMs). The primary outcome was change in Overactive Bladder Questionnaire Short Form (OAB-q SF) symptom severity and minimal clinically important difference (MCID) achievement. The Patient Assessment of Constipation Symptoms (PAC-SYM) was used to assess bowel function over the treatment period.RESULTS: 61 patients were enrolled. The majority of the mirabegron (70%) and the solifenacin (69%) group achieved the OAB-q SF symptom severity MCID. The solifenacin group had a statistically significant greater decrease in its end of study OAB-q SF score (Delta = -37.87 versus -20.43, p=0.02). Constipation improved in the mirabegron group and worsened in the solifenacin group (DeltaPAC-SYM =-0.38 versus +0.22; p=0.02), with 30% of patients prescribed solifenacin experiencing worsening above the MCID threshold.CONCLUSION: Among MS patients, we demonstrated similar response rates to mirabegron and solifenacin, with approximately 50-70% achieving each PROM's MCID. Though this small study showed some short-term evidence that improvement in urinary symptom severity was greater with solifenacin, this potential benefit must be weighed against the observed risk of worsening constipation. Further studies are needed to confirm these findings.

  View details for DOI 10.1016/j.urology.2020.08.008

  View details for PubMedID 32822687

• The Role of Urodynamics in the Pre-transplant Evaluation of Renal Transplant. Current urology reports Rude, T., Nassiri, N., Naser-Tavakolian, A., Ginsberg, D. 2019; 20 (5): 26

  Abstract

  The goal of this study is to delineate the role of advanced urologic evaluation with urodynamics prior to renal transplantation. We seek to report on its indications, possible findings, and subsequent treatment pathways.This body of literature is largely comprised of retrospective, single-site studies. Patient selection for urodynamics can be determined based on patient history and voiding symptoms. Many of these renal transplant patients have urodynamic abnormalities such as decreased bladder capacity and compliance. Appropriate treatment of these abnormalities allows for average rates of graft survival. Urodynamic evaluation is not needed in every renal transplant recipient. However, in patients with oliguria or bladder dysfunction, urodynamics can often reveal significant pathology. The well-selected patient with lower urinary tract symptoms may also benefit from urodynamic evaluation. Treatment options are widely variable, from observation to reconstructive surgery, and should be based on the patient and urodynamic findings.

  View details for DOI 10.1007/s11934-019-0887-3

  View details for PubMedID 30953228

• Analysis of National Trends in Hospital Acquired Conditions Following Major Urologic Surgery Before and After Implementation of the Hospital Acquired Condition Reduction Program. Urology Rude, T. L., Donin, N. M., Cohn, M. R., Meeks, W., Gulig, S., Patel, S. N., Wysock, J. S., Makarov, D. V., Bjurlin, M. A. 2018; 119: 79-84

  Abstract

  To define the rates of common hospital acquired conditions (HACs) in patients undergoing major urologic surgery over a period of time encompassing the implementation of the Hospital Acquired Condition Reduction program, and to evaluate whether implementation of the HAC reimbursement penalties in 2008 was associated with a change in the rate of HACs.Using American College of Surgeons National Surgical Quality Improvement Program data, we determined rates of HACs in patients undergoing major inpatient urologic surgery from 2005 to 2012. Rates were stratified by procedure type and approach (open vs laparoscopic and/or robotic). Multivariable logistic regression was used to determine the association between year of surgery and HACs.We identified 39,257 patients undergoing major urologic surgery, of whom 2300 (5.9%) had at least one hospital acquired condition. Urinary tract infection (2.6%) was the most common, followed by surgical site infection (2.5%) and venous thrombotic events (0.7%). Multivariable logistic regression analysis demonstrated that open surgical approach, diabetes, congestive heart failure, chronic obstructive pulmonary disease, weight loss, and American Society of Anesthesiology class were among the variables associated with higher likelihood of HAC. We observed a nonsignificant secular trend of decreasing rates of HAC from 7.4% to 5.8% HACs during the study period, which encompassed the implementation of the Hospital Acquired Condition Reduction program.HACs occurred at a rate of 5.9% after major urologic surgery, and are significantly affected by procedure type and patient health status. The rate of HAC appeared unaffected by National Reduction program in this cohort. Better understanding of the factors associated with HACs is critical in developing effective reduction programs.

  View details for DOI 10.1016/j.urology.2018.04.044

  View details for PubMedID 29885778

• Burden of Disease for Urethral Stricture Managed by Repeat Endoscopic Treatment vs Single Endoscopic Treatment or Urethroplasty in the Veterans Affairs Population. Urology practice Rude, T. L., Khurana, K., Yamaguchi, Y., Walter, D., Makarov, D., Zhao, L. C. 2018; 5 (4): 299-304

  Abstract

  Male urethral stricture disease is a challenging urological condition that affects nearly a third of men 65 years old or older. Management options include dilation and urethrotomy as well as urethroplasty, an open approach with increased morbidity and durability. Presently optimal management remains debated. In this study we focus on emergent procedures required by male patients in the Veterans Health Administration after stricture treatment as an indicator of clinically significant complications, comparing treatment approaches.We performed an institutional review board approved, retrospective, cohort study of male veterans with urethral stricture from 2005 to 2014. Our independent variable was immediate or delayed urethroplasty or continued endoscopic treatments. Our dependent variable was a stricture related procedure performed in the emergent or urgent care setting. We used a binary logistic regression model to model the likelihood of an adverse outcome as predicted by treatment type.In our cohort of 9,632 patients 1.8% underwent immediate urethroplasty and 3% underwent delayed urethroplasty. Of the operated men 5.3% had an adverse outcome (5% following delayed urethroplasty or continued endoscopic treatments and 1% after immediate urethroplasty, p = 0.04). On multivariate analysis repeat endoscopy and delayed urethroplasty trended toward worsening odds of adverse outcomes (p = 0.07 and p = 0.08, respectively).In the Veterans Health Administration system men who undergo repeated scheduled endoscopic treatments for urethral stricture may be at increased risk for emergent procedures, even if they eventually progress to urethroplasty, compared to men who undergo urethroplasty immediately after a failed endoscopic intervention.

  View details for DOI 10.1016/j.urpr.2017.07.002

  View details for PubMedID 37312311

• 3D printed renal cancer models derived from MRI data: application in pre-surgical planning. Abdominal radiology (New York) Wake, N., Rude, T., Kang, S. K., Stifelman, M. D., Borin, J. F., Sodickson, D. K., Huang, W. C., Chandarana, H. 2017; 42 (5): 1501-1509

  Abstract

  To determine whether patient-specific 3D printed renal tumor models change pre-operative planning decisions made by urological surgeons in preparation for complex renal mass surgical procedures.From our ongoing IRB approved study on renal neoplasms, ten renal mass cases were retrospectively selected based on Nephrometry Score greater than 5 (range 6-10). A 3D post-contrast fat-suppressed gradient-echo T1-weighted sequence was used to generate 3D printed models. The cases were evaluated by three experienced urologic oncology surgeons in a randomized fashion using (1) imaging data on PACS alone and (2) 3D printed model in addition to the imaging data. A questionnaire regarding surgical approach and planning was administered. The presumed pre-operative approaches with and without the model were compared. Any change between the presumed approaches and the actual surgical intervention was recorded.There was a change in planned approach with the 3D printed model for all ten cases with the largest impact seen regarding decisions on transperitoneal or retroperitoneal approach and clamping, with changes seen in 30%-50% of cases. Mean parenchymal volume loss for the operated kidney was 21.4%. Volume losses >20% were associated with increased ischemia times and surgeons tended to report a different approach with the use of the 3D model compared to that with imaging alone in these cases. The 3D printed models helped increase confidence regarding the chosen operative procedure in all cases.Pre-operative physical 3D models created from MRI data may influence surgical planning for complex kidney cancer.

  View details for DOI 10.1007/s00261-016-1022-2

  View details for PubMedID 28062895

  View details for PubMedCentralID PMC5410387

• Optogenetic disruption of sleep continuity impairs memory consolidation PROCEEDINGS OF THE NATIONAL ACADEMY OF SCIENCES OF THE UNITED STATES OF AMERICA Rolls, A., Colas, D., Adamantidis, A., Carter, M., Lanre-Amos, T., Heller, H. C., de Lecea, L. 2011; 108 (32): 13305-13310

  Abstract

  Memory consolidation has been proposed as a function of sleep. However, sleep is a complex phenomenon characterized by several features including duration, intensity, and continuity. Sleep continuity is disrupted in different neurological and psychiatric conditions, many of which are accompanied by memory deficits. This finding has raised the question of whether the continuity of sleep is important for memory consolidation. However, current techniques used in sleep research cannot manipulate a single sleep feature while maintaining the others constant. Here, we introduce the use of optogenetics to investigate the role of sleep continuity in memory consolidation. We optogenetically targeted hypocretin/orexin neurons, which play a key role in arousal processes. We used optogenetics to activate these neurons at different intervals in behaving mice and were able to fragment sleep without affecting its overall amount or intensity. Fragmenting sleep after the learning phase of the novel object recognition (NOR) task significantly decreased the performance of mice on the subsequent day, but memory was unaffected if the average duration of sleep episodes was maintained at 62-73% of normal. These findings demonstrate the use of optogenetic activation of arousal-related nuclei as a way to systematically manipulate a specific feature of sleep. We conclude that regardless of the total amount of sleep or sleep intensity, a minimal unit of uninterrupted sleep is crucial for memory consolidation.

  View details for DOI 10.1073/pnas.1015633108

  View details for Web of Science ID 000293691400068

  View details for PubMedID 21788501

  View details for PubMedCentralID PMC3156195

• Association Between Cerebral Shape and Social Use of Language in Williams Syndrome AMERICAN JOURNAL OF MEDICAL GENETICS PART A Gothelf, D., Searcy, Y. M., Reilly, J., Lai, P. T., Lanre-Amos, T., Mills, D., Korenberg, J. R., Galaburda, A., Bellugi, U., Reiss, A. L. 2008; 146A (21): 2753-2761

  Abstract

  Williams syndrome (WS) is a neurogenetic disorder resulting from a hemizygous microdeletion at band 7q11.23. It is characterized by aberrant development of the brain and a unique profile of cognitive and behavioral features. We sought to identify the neuroanatomical abnormalities that are most strongly associated with WS employing signal detection methodology. Once identified with a Quality Receiver Operating Characteristic Curve (QROC), we hypothesized those brain regions distinguishing subjects with WS from controls would be linked to the social phenotype of individuals with this disorder. Thirty-nine adolescents and young adults with WS and 40 typically developing controls matched for age and gender were studied. The QROC identified a combination of an enlarged ventral anterior prefrontal cortex and large bending angle of the corpus callosum to distinguish between WS and controls with a sensitivity of 85.4% and specificity of 75.0%. Within the WS group, bending angle significantly correlated with ventral anterior prefrontal cortex size but not with other morphometric brain measures. Ventral anterior prefrontal size in subjects with WS was positively associated with the use of social engagement devices in a narrative task assessing the use of social and affective language. Our findings suggest that aberrant morphology of the ventral anterior prefrontal cortex is a pivotal contributing factor to the abnormal size and shape of the cerebral cortex and to the social-affective language use typical of individuals with WS.

  View details for DOI 10.1002/ajmg.a.32507

  View details for Web of Science ID 000260985400008

  View details for PubMedID 18924169

  View details for PubMedCentralID PMC2643356