Philip S Li

Publications (32)91.89 Total impact

• Article: Sex disparities in cancer mortality: The risks of being a man in the U.S.

  Bobby B Najari, Michael Rink, Philip S Li, Pierre I Karakiewicz, Douglas S Scherr, Ridwan Shabsigh, Siegfried Meryn, Peter N Schlegel, Shahrokh F Shariat
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  ABSTRACT: PURPOSE: In the United States, more men are diagnosed with cancer than women. We sought to quantify the differential mortality rate between the sexes from non-sex specific cancers, and compare their cancer stage distribution. MATERIALS AND METHODS: In this descriptive epidemiologic study, incidence of new cancer cases, cancer deaths, and stage distributions for the past ten years in the United States were obtained from Surveillance Epidemiology and End Results (SEER) program results. Sex specific cancers were excluded. We compared male to female relative mortality rate for all cancers, as well as average male to female relative mortality rate weighted by cancer incidence over the past ten years. Sex specific stage distributions were also compared using Kendall's tau-c test. RESULTS: The male to female relative mortality rate for any cancer was 1.060 (95% CI: 1.055-1.065). The average male to female relative mortality rate for the same cancer was 1.126 (1.086-1.168). The discrepancy in incidence and mortality rates has been stable for the last 10 years. Of the top ten most common cancers, men had an unfavorable stage distribution in all but colorectal, urinary bladder, and brain cancers. CONCLUSIONS: Men are more likely to develop non-sex specific cancers than women, and are more likely to die from their cancer, even after controlling for the incidence. This discrepancy has been stable for the last decade. In seven of the 10 most commonly occurring non-sex specific cancers (78% of all incident cancers), men are more likely to be diagnosed with advanced stage.
  The Journal of urology 11/2012; · 4.02 Impact Factor
• Article: Pilot study of the correlation of multiphoton tomography of ex vivo human testis with histology.

  Bobby B Najari, Ranjith Ramasamy, Joshua Sterling, Amit Aggarwal, Seema Sheth, Philip S Li, Justin M Dubin, Sagit Goldenberg, Manu Jain, Brian D Robinson, Maria Shevchuk, Douglas S Scherr, Marc Goldstein, Sushmita Mukherjee, Peter N Schlegel
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  ABSTRACT: Although microdissection testicular sperm extraction has become first line therapy for sperm retrieval in men with nonobstructive azoospermia, there are challenges to the procedure, including difficulty differentiating between seminiferous tubules with normal and abnormal spermatogenesis. Multiphoton microscopy illuminates tissue with a near infrared laser to elicit autofluorescence, which enables real-time imaging of unprocessed tissue without labels. We hypothesized that we could accurately characterize seminiferous tubular histology in humans using multiphoton microscopy. Seven men with normal or abnormal spermatogenesis underwent testicular biopsies, which were imaged by multiphoton microscopy. We assessed these images in blinded fashion. The diagnosis rendered with multiphoton microscopy was then correlated with that of hematoxylin and eosin stained tissue. We evaluated the ability of multiphoton microscopy to differentiate normal from abnormal seminiferous tubules by examining autofluorescence characteristics and diameters, as imaged by multiphoton microscopy. Assessment was repeated with stained slides and results were compared. The overall concordance rate between multiphoton microscopy and stained slides was 86%. The seminiferous tubules of patients with nonobstructive azoospermia were smaller than those of controls when measured by multiphoton microscopy and staining (p <0.05). The proportion of normal tubules and the diameters obtained with multiphoton microscopy were not different from those obtained with hematoxylin and eosin (p >0.05). Multiphoton microscopy can be used to differentiate normal from abnormal spermatogenesis. Its characterization of seminiferous tubular architecture is similar to that provided by hematoxylin and eosin staining. Further investigation of the clinical applications of multiphoton microscopy may improve surgical sperm retrieval outcomes for patients with nonobstructive azoospermia.
  The Journal of urology 06/2012; 188(2):538-43. · 4.02 Impact Factor
• Article: Randomized trial of the Shang Ring for adult male circumcision with removal at one to three weeks: delayed removal leads to detachment.

  Mark A Barone, Quentin D Awori, Philip S Li, Raymond O Simba, Mark A Weaver, Jairus O Okech, Alex O Aduda, Peter Cherutich, Nicholas Muraguri, John Masasabi Wekesa, Jared Nyanchoka, Paul Perchal, Puneet Masson, Richard Lee, Marc Goldstein, Jackson Kioko, Ojwang' Lusi, David C Sokal
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  ABSTRACT: To assess healing with Shang Ring removal at different prespecified times; whether spontaneous detachment occurs with delayed removal; problems, complaints, and acceptability of wearing the device; satisfaction among participants; and acceptability of the procedure among providers. Fifty HIV-negative men underwent a Shang Ring circumcision in Kenya. Men were randomly assigned for device removal at 7 (15 men), 14 (15 men), or 21 days (20 men). Follow-up visits were at 7, 14, 21, 28, and 42 days after circumcision and 2 days after removal. Circumcision and device removal were conducted without significant problems. Mean times for circumcision and device removal were 6.5 (SD = 2.4) and 2.5 (SD = 0.8) minutes, respectively. Complete detachment of the device occurred in 22 (66.7%) men who wore it more than 7 days. Seven men (14.0%) with partial detachments requested removal 8-14 days postcircumcision due to pain/discomfort. Healing progressed normally in all participants; cumulative probabilities of complete healing were similar across groups. No severe or serious adverse events occurred. Acceptability among participants was high. Providers reported that Shang Ring circumcision was "very easy" compared with the forceps-guided procedure. The Shang Ring is safe and easy to use according to label instructions (7 day removal). Detachments occurred without significant problems, although some men requested removal of partially detached rings. Removal time had little effect on healing. These data help allay concerns about men not returning for ring removal and expand the evidence base suggesting the Shang Ring could facilitate rapid male circumcision rollout in sub-Saharan Africa.
  JAIDS Journal of Acquired Immune Deficiency Syndromes 02/2012; 60(3):e82-9. · 4.43 Impact Factor
• Article: Multiphoton imaging and laser ablation of rodent spermatic cord nerves: potential treatment for patients with chronic orchialgia.

  Ranjith Ramasamy, Joshua Sterling, Philip S Li, Brian D Robinson, Sijo Parekattil, Jie Chen, Diane Felsen, Sushmita Mukherjee, Marc Goldstein, Peter N Schlegel
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  ABSTRACT: Microsurgical denervation of the spermatic cord has been done to treat chronic orchialgia. However, identifying the site of spermatic cord nerves is not feasible with an operating microscope or robotic stereoscope. We used multiphoton microscopy, a novel laser imaging technology, to identify and selectively ablate spermatic cord nerves in the rat. The spermatic cords of adult male Sprague-Dawley® rats were initially imaged in vivo under a low power multiphoton microscopy laser. After assessing the number, diameter and site (vasal vs perivasal) of the nerves a higher power laser using the same objective was used to ablate the nerves. The precision of nerve ablation and the preservation of surrounding structures were determined by histological analysis. We assessed the heterogeneity of the number of nerves with the Wilcoxon signed rank test. The average number of nerves per spermatic cord was 10, which was similar bilaterally (p = 0.13). The vas and perivasal structures had a similar number of nerves (p = 0.4). The median diameter of all nerves was 32 μm. Confirmation of nerve ablation, and preservation of the vas deferens and vasculature were anatomically validated by histological analysis. Multiphoton microscopy can identify and ablate nerves selectively in vivo in the rat. It can potentially be used for spermatic cord denervation to treat chronic orchialgia. Such imaging may increase the efficacy of nerve ablation and can avoid the potential risks of testicular atrophy and hydrocele associated with spermatic cord microsurgical denervation.
  The Journal of urology 12/2011; 187(2):733-8. · 4.02 Impact Factor
• Article: Identification of spermatogenesis with multiphoton microscopy: an evaluation in a rodent model.

  Ranjith Ramasamy, Joshua Sterling, Erik S Fisher, Philip S Li, Manu Jain, Brian D Robinson, Maria Shevchuck, David Huland, Chris Xu, Sushmita Mukherjee, Peter N Schlegel
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  ABSTRACT: Microdissection testicular sperm extraction has replaced conventional testis biopsies for men with nonobstructive azoospermia and it has become first line treatment. The current problem is that the decision to retrieve tubules is based only on appearance and there is no guarantee that the tubules removed contain sperm. Multiphoton microscopy enables label-free immediate visualization of many biological processes in living tissue at subcellular resolution. We used multiphoton microscopy to study the different developmental stages of spermatogenesis using neonatal, pubertal and adult rat testes. We used a testis hypothermia plus ischemia model to study different testicular histopathologies with multiphoton microscopy. To assess the risk of photo damage DNA fragmentation in testis biopsies imaged at different intensities was assessed by TUNEL assay. Multiphoton microscopy identified the stage of spermatogenesis in a seminiferous tubule in fresh tissue without using exogenous labels. We noted significant differences in fluorescence and spectroscopic characteristics between tubules with and without sperm. Sertoli's-cell only tubules had abundant autofluorescence in the 420 to 490 and 550 to 650 nm wavelength ranges while tubules containing sperm had autofluorescence only in the 420 to 490 nm range. On DNA fragmentation assay sperm from tubules imaged by multiphoton microscopy had minimal DNA fragmentation at the laser intensities needed to distinguish tubules with and without sperm. Multiphoton microscopy has the potential to facilitate real-time visualization of spermatogenesis in humans and aid in clinical applications, such as testicular sperm extraction for men with infertility.
  The Journal of urology 12/2011; 186(6):2487-92. · 4.02 Impact Factor
• Article: [Progress in the clinical studies of male circumcision using the Shang Ring].

  Nian-qing Lü, Philip S Li, David Sokal, Yue Cheng, Yi-feng Peng, Mark Barone, Yi-ran Huang, Marc Goldstein
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  ABSTRACT: Male circumcision can reduce men's risk of HIV infection from heterosexual intercourse by 60% and is therefore recommended as an important strategy for HIV prevention in Africa by WHO and UNAIDS. However, rapid expansion of male circumcision efforts could be greatly facilitated by a safer, more effective and acceptable male circumcision surgical technique or device. Shang Ring is a simple technique developed in China. It allows a circumcision to be completed with minimal bleeding, without suturing, and in only 3-5 min and reported complications are few. A standardized adult male circumcision surgical protocol utilizing the Shang Ring device was developed in 2008 in China. Several surgical training courses using this protocol were successfully held in 2009 and 2010 in China. A recent pilot clinical study of the Shang Ring was conducted to evaluate its safety and efficiency in Kenya in 2009. The results and acceptability among study participants were excellent and confirmed many of the advantages seen in the earlier Chinese studies from Wuhu, Ningbo and Xi'an, suggesting that the Shang Ring is safe for further studies in Africa, thus, could facilitate more rapid roll-out of adult male circumcision through task shifting, surgical efficiencies and better acceptability. Further international investigations of the Shang Ring technique have now been planned for Kenya and Zambia in 2011. Moreover, adult male circumcision utilizing the Shang Ring device is now being considered as ope of the potential candidate techniques to be used in the scale-up of adult male circumcision services for HIV prevention in WHO priority countries in Africa. This review article summarizes Shang Ring related clinical studies, seminars and surgical workshops, publications and presentations conducted between February 2008 and December 2010 in China, the United States and Africa.
  Zhonghua nan ke xue = National journal of andrology 03/2011; 17(3):195-202.
• Source

  Available from: Peter Cherutich

  Article: The Shang Ring device for adult male circumcision: a proof of concept study in Kenya.

  Mark A Barone, Frederick Ndede, Philip S Li, Puneet Masson, Quentin Awori, Jairus Okech, Peter Cherutich, Nicholas Muraguri, Paul Perchal, Richard Lee, Howard H Kim, Marc Goldstein
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  ABSTRACT: To assess safety, preliminary efficacy, and acceptability of the Shang Ring, a novel disposable device for adult male circumcision in Kenya. Forty HIV-negative men were recruited in Homa Bay, Kenya. Circumcisions were performed by a trained physician or nurse working with 1 assistant. Follow-up was conducted at 2, 7, 9, 14, 21, 28, 35, and 42 days after circumcision. Rings were removed on day 7. Pain was assessed using a visual analog scale (VAS) (0 = no pain, 10 = worst possible). Men were interviewed at enrollment and on days 7 and 42. All 40 procedures were completed successfully. Mean procedure and device removal times were 4.8 (SD ± 2.0) and 3.9 (SD ± 2.6) minutes, respectively. There were 6 mild adverse events, including 3 penile skin injuries, 2 cases of edema, and 1 infection; all resolved with conservative management. In addition, there were 3 partial ring detachments between days 2-7. None required treatment or early ring removal. Erections with the ring were well tolerated, with a mean pain score of 3.5 (SD ± 2.3). By day 2, 80% of men were back to work. At 42 days, all participants were very satisfied with their circumcision and would recommend the procedure to others. Our results demonstrate that the Shang Ring is safe for further study in Africa. Acceptability of the Shang Ring among participants was excellent. With short procedure times, less surgical skill required, and the ease with which it can be used by nonphysicians, the Shang Ring could facilitate rapid roll-out of male circumcision in sub-Saharan Africa.
  JAIDS Journal of Acquired Immune Deficiency Syndromes 02/2011; 57(1):e7-12. · 4.43 Impact Factor
• Source

  Available from: shangring.cn

  Article: Male circumcision: Africa and beyond?

  Howard H Kim, Philip S Li, Marc Goldstein
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  ABSTRACT: Male circumcision has become an important component of HIV prevention strategies in Africa. Results of recent trials have renewed interest in this ancient procedure and its potential application in the reduction of sexually transmitted infections (STIs). With renewed interest comes controversy, which has always been a close companion to circumcision. Following the three randomized trials in Africa demonstrating the protective effects of male circumcision on HIV infection, studies have reported other benefits of circumcision including protection from certain STIs, including human papillomavirus and herpes simplex virus 2. With data accumulating on the public health benefits of circumcision and the endorsement of circumcision from WHO, investigators have begun to evaluate the feasibility, safety and cost of implementation of large-scale circumcision programs. Limitations of circumcision have also been explored. Male circumcision will likely play an important role in HIV/STI prevention programs in Africa; the inclusion of circumcision in the health policy of developed countries will require further investigation.
  Current opinion in urology 11/2010; 20(6):515-9. · 2.50 Impact Factor
• Source

  Available from: shangring.cn

  Article: The ShangRing device for simplified adult circumcision.

  Puneet Masson, Philip S Li, Mark A Barone, Marc Goldstein
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  ABSTRACT: Adult male circumcision reduces HIV transmission through vaginal intercourse and is being promoted in areas where HIV is widespread. Conventional surgical circumcision involves suturing and thus requires practitioners with surgical skills. It is also associated with complications, including bleeding and infection, especially in resource-poor settings. The ShangRing (Wuhu Snnda Medical Treatment Appliance Technology Co. Ltd, Wuhu City, China) has been used to perform thousands of circumcisions in adult men, principally in China. It consists of two concentric plastic rings that sandwich the foreskin of the penis, allowing circumcision without stitches or notable bleeding. As well as substantially reduced operative times, ShangRing adult male circumcision is associated with a low complication rate, and the technique can easily be taught to both physician and nonphysician personnel. The simple technique and successful outcomes associated with the ShangRing procedure mean that the device could enable standardization of adult male circumcision, helping HIV prevention efforts throughout the developing world.
  Nature Reviews Urology 10/2010; 7(11):638-42. · 4.41 Impact Factor
• Source

  Available from: shangring.cn

  Article: No-needle local anesthesia for adult male circumcision.

  Yifeng Peng, Puneet Masson, Philip S Li, Yue Chang, Long Tian, Richard Lee, Howard Kim, David C Sokal, Marc Goldstein
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  ABSTRACT: We used a local anesthetic jet injection technique for adult male circumcision. This method eliminates needle use and may decrease the fear of local anesthetic injection used for male circumcision. We recruited 60 men seeking voluntary adult male circumcision into the study from June to September 2009. We used a MadaJet Medical Injector to deliver a high pressure spray of 0.1 ml 2% plain lidocaine solution directly through the penile skin circumferentially around the proximal third of the penis. All men underwent circumcision using the Shang Ring and were evaluated for anesthetic safety, efficacy and acceptability. Pain was measured on a visual analog scale. The average volume of 2% lidocaine anesthetic solution delivered by jet injection was 0.1 ml with a mean total of 0.9 ml per circumcision procedure. More than 85% of men did not require supplemental anesthesia. Anesthetic onset required approximately 45 seconds from the time that injections were completed. Mean pain scores for immediate postoperative, 24-hour postoperative, ring removal and post-ring removal events were 0.1, 6.8, 2.2 and 0.9, respectively. In 4 patients (6.67%) mild urethral bleeding resolved with pressure, resulting in technique modification. No-needle jet injection is safe and effective for adult MC. The technique efficiently delivers local anesthesia with rapid onset in men undergoing circumcision. This needle-free approach may enhance the popularity of adult male circumcision.
  The Journal of urology 09/2010; 184(3):978-83. · 4.02 Impact Factor
• Article: [A recommendable standard protocol of adult male circumcision with the Chinese Shang Ring: outcomes of 328 cases in China].

  Yue Cheng, Yi-Feng Peng, Yi-Dong Liu, Long Tian, Nian-Qing Lü, Xin-Jun Su, Ze-Jun Yan, Jia-Sheng Hu, Richard Lee, Howard H Kim, David C Sokal, Philip S Li
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  ABSTRACT: Standardization of and training in adult male circumcision can significantly reduce its complication rate. Currently no such program exists for its standardization and training, making it difficult to guarantee the quality of male circumcision services. We therefore established a standardized surgical protocol for adult male circumcision in China using the Shang Ring, and applied it to a clinical study examining the performance of the Shang Ring in adult male circumcision. A total of 328 adult men aged 18-58 (mean 27.8) years, 25 with phimosis and 303 with redundant prepuce, underwent circumcision with the Shang Ring, and evaluation of the operation time, pain scores (using the visual analog scale), postoperative complications, time for wound healing, and their satisfaction with the postoperative appearance. The operation time was 4.7 +/- 1.3 minutes. The pain scores were 0. 2 +/- 0.6 during the surgery, 1.6 +/- 1.0 twenty hours postoperatively, 1.7 +/- 1.1 twenty hours prior to the ring removal, and 2.7 +/- 1.4 during the ring removal. Complications included infection in 2 (0.6%), bleeding in 2 (0.6%), and wound dehiscence in 2 (0.6%) of the patients. None of the patients with wound dehiscence required postoperative suturing and all were managed conservatively instead. Sixteen of the patients (4.9%) experienced penile edema. The time for complete wound healing after circumcision was 20.3 +/- 6.7 days. The rate of the patients'satisfaction was 99.7% (327/328). The standard protocol of adult male circumcision with the Shang Ring has the advantages of short operation time, slight pain, low rate of complications, and high satisfaction and acceptance of the patients. Strict standardization of the surgical protocol can maximize its clinical advantages for adult male circumcision.
  Zhonghua nan ke xue = National journal of andrology 08/2009; 15(7):584-92.
• Article: [Male circumcision is an effective "surgical vaccine" for HIV prevention and reproductive health].

  Kun-Long Ben, Jian-Chun Xu, Lin Lu, Nian-Qing Lü, Yue Cheng, Jian Tao, De-Kai Liu, Xiang-Dong Min, Xiao-Mei Cao, Philip S Li
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  ABSTRACT: Recent randomized controlled clinical trials in Africa have demonstrated that adult male circumcision (MC) efficiently decreases the rate of HIV, HPV and HSV-2 infections. Many studies have clearly shown that MC is a simple, safe, and cost-effective method for the prevention of sexually transmitted diseases and urinary tract infection, and for improving genital hygiene. While a 30% MC prevalence exists worldwide, only 5% or less of the Chinese males have undergone circumcision. In this review, we report recent trends in international MC and HIV prevention efforts, as well as the potential benefits and importance of promoting MC in China. We appeal to medical and public health authorities to pay close attention to the international experience in MC and HIV prevention.
  Zhonghua nan ke xue = National journal of andrology 06/2009; 15(5):395-402.
• Article: [The need for high-quality training and surgical standards for adult male circumcision in China].

  Philip S Li, Nian-Qing Lü, Yue Cheng, Yi-Feng Peng, Long Tian, Yi-Dong Liu, Kun-Long Ben, Jian-Chuns Xu, Richard Lee, Howard Kim, David C Sokal
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  ABSTRACT: Although HIV is a significant problem in Africa, HIV infection rates are rising rapidly in other regions such as Asia and South America. International health organizations have recognized the need to develop effective strategies to check the worldwide transmission of HIV. Studies have demonstrated the significant reduction of HIV, HPV, HSV-2 and other STD infection rates with male circumcision (MC). Although numerous MC techniques are available, there are no standardized protocols and surgical training programs. Studies have shown that the standardization of MC techniques coupled with training programs can significantly reduce complication rates. High complication rates have been a primary obstacle to the implementation of MC services. We recommend the establishment of surgical standards and training protocols prior to the promotion of MC services in China.
  Zhonghua nan ke xue = National journal of andrology 06/2009; 15(5):390-4.
• Article: Sign of the fox.

  Marc Goldstein, Philip S Li
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  ABSTRACT: A 47-year-old male and his 34-year-old wife presented with two years of infertility. He had poor semen quality and a low serum testosterone. Physical examination revealed a grade 3 left and a grade 2 right varicocele. He underwent bilateral subinguinal microsurgical varicocelectomy. The "sign of the fox" is the typical appearance of the wounds just prior to closure after bilateral repair.
  Urology 12/2008; 73(3):499. · 2.43 Impact Factor
• Article: Value of serum antisperm antibodies in diagnosing obstructive azoospermia.

  Richard Lee, Marc Goldstein, Brant W Ullery, Joshua Ehrlich, Marc Soares, Renee A Razzano, Michael P Herman, Mark A Callahan, Philip S Li, Peter N Schlegel, Steven S Witkin
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  ABSTRACT: The requisite presence of active spermatogenesis for antisperm antibody production may be useful in identifying obstructive azoospermia. The diagnostic performance of serum antisperm antibody was evaluated as a test for obstructive azoospermia. A total of 484 men with male infertility who had undergone antisperm antibody testing were evaluated. Demographic data, patient history, and followup were recorded. Obstruction was confirmed by surgical exploration. Sensitivity, specificity, positive and negative predictive values, and positive and negative likelihood ratios were calculated to quantify diagnostic performance. ROC curves were calculated and compared. Of 484 men 272 possessed documented obstruction of the vas or epididymis and 212 had documented infertility without azoospermia. The obstructed group had significantly increased antisperm antibody levels compared to the nonobstructed group. IgG, IgA, and IgM were analyzed as diagnostic tests for obstruction. The AUC for IgG, IgA and IgM ROC curves was 0.92, 0.85 and 0.67, respectively. The AUC for serum IgG against sperm tails was 0.92, 0.87 against sperm heads and 0.79 against sperm midpieces. IgG demonstrated the highest sensitivity (85%) with a specificity of 97% (chi-square test p <0.01). IgA possessed the highest specificity (99%), positive predictive value (99%) and positive likelihood ratio (70.0). The presence of serum antisperm antibody was highly accurate in predicting obstructive azoospermia, particularly after vasectomy. It can obviate the need for testis biopsy, the current but more invasive and costly gold standard of detection. This allows the surgeon to proceed directly to surgical reconstruction or sperm retrieval after a simple blood test.
  The Journal of urology 11/2008; 181(1):264-9. · 4.02 Impact Factor
• Article: A decision analysis of treatments for nonobstructive azoospermia associated with varicocele.

  Richard Lee, Philip S Li, Marc Goldstein, Glenn Schattman, Peter N Schlegel
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  ABSTRACT: To examine the economic impact of initial treatments for varicocele-associated nonobstructive azoospermia, specifically varicocelectomy versus microsurgical testicular sperm extraction (TESE) with IVF/intracytoplasmic sperm injection (ICSI). Decision analytic model based on 1) outcomes data from Society for Assisted Reproductive Technology (SART) database and peer-reviewed literature and 2) costing data from Medicare Resource-Based Relative Value Scale and sampling of high volume US IVF centers. Academic medical center. Simulation with a decision analytic model. Variation of successful spontaneous live delivery after varicocelectomy versus rate of successful live delivery after IVF/ICSI. Cost-effectiveness. Microsurgical TESE was more cost effective than varicocelectomy. In 1999, initial treatment with microsurgical TESE was more cost effective ($65,515) than varicocelectomy ($76,878). Relative cost-effectiveness was unchanged in 2005: $69,731 versus $79,576. The cost-effectiveness of both treatments improved in relation to projections by inflation. Sensitivity analyses suggest that the relative cost-effectiveness of TESE versus varicocelectomy can only be changed with either substantial improvement in spontaneous live delivery rates after varicocelectomy or with deterioration in IVF success rates. Microsurgical TESE appears to be more cost effective than varicocelectomy for treatment of varicocele-associated nonobstructive azoospermia when indirect costs are considered. The cost-effectiveness of both treatments has improved with time. These results may be tailored with institution-specific data to allow more individualized results.
  Fertility and sterility 09/2008; 92(1):188-96. · 3.97 Impact Factor
• Article: Reassessing reconstruction in the management of obstructive azoospermia: reconstruction or sperm acquisition?

  Richard Lee, Philip S Li, Peter N Schlegel, Marc Goldstein
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  ABSTRACT: Treatments for male factor infertility secondary to reconstructable obstructive azoospermia include either surgical reconstruction or direct sperm retrieval. We examine the risks and benefits of both types of therapies and discuss their respective medical and economic implications. Most male factor infertility studies comparing vasectomy reversal with sperm retrieval favor the former as the more cost-effective therapy for obstructive azoospermia. Analysis should include assessment of direct procedural costs and indirect costs, including the cost of complications, lost productivity, and multiple gestation pregnancies. When considering sperm retrieval, the impact of in vitro fertilization-related indirect costs, specifically that driven by multiple gestation pregnancies, is significant.
  Urologic Clinics of North America 06/2008; 35(2):289-301, x. · 1.82 Impact Factor
• Article: The functional and structural consequences of cavernous nerve injury are ameliorated by sildenafil citrate.

  John P Mulhall, Alexander Müller, John F Donohue, Michael Mullerad, Keith Kobylarz, Darius A Paduch, Raanan Tal, Philip S Li, Leona Cohen-Gould, Peter T Scardino
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  ABSTRACT: Radical prostatectomy (RP) is associated with erectile dysfunction (ED). A single, placebo-controlled, human study has assessed the effects of regular sildenafil use after RP and demonstrated an increased chance of preservation of preoperative erectile function. Aim. This study was undertaken to define the effects of such a regimen in an animal model. Using the cavernous nerve (CN) crush injury model, animals were divided into a number of groups: no CN injury (sham), bilateral CN injury exposed to either no sildenafil (control) or sildenafil at two doses (10 and 20 mg/kg) subcutaneously daily for three different durations (3, 10, 28 days). At these time points, CN electrical stimulation was used to assess erectile function by mean intracavernosal pressure (ICP)/mean arterial pressure (MAP) ratio. For the structural analyses, whole rat penes were harvested. Staining for Masson's trichrome was utilized to calculate the smooth muscle-collagen ratio. Immunohistochemical antibody staining was performed for endothelial (CD31 and eNOS) and neural (GAP43, NGF, and nNOS) factors and immunoblotting was performed to analyze the AKT/eNOS pathway. Terminal deoxynucleotidyl transferase biotin-dUTP nick end labeling (TUNEL) assay was used for the assessment of apoptotic indices and the CN architecture was evaluated by transmission electron microscopy (TEM). Erectile function was improved with sildenafil in a time- and dose-dependent fashion with maximization of erectile function recovery occurring with daily 20 mg/kg at the 28-day time point. Sildenafil use resulted in smooth muscle-collagen ratio protection and CD31 and eNOS expression preservation. Sildenafil reduced apoptotic indices significantly compared with control. Animals exposed to sildenafil had increased phosphorylation of akt and eNOS. Tem demonstrated distinct differences in architecture between control and sildenafil groups toward an increased amount of myelinized nerve fibers. Sildenafil use in the CN crush injury model preserves erectile function that appears to be mediated predominantly through preservation of smooth muscle content and endothelial function as well as through reduction in apoptosis.
  Journal of Sexual Medicine 06/2008; 5(5):1126-36. · 3.55 Impact Factor
• Article: [An innovative male circumcision technique in China and HIV prevention].

  Nian-Qing Lu, Philip S Li, Yi-Ran Huang
  Zhonghua nan ke xue = National journal of andrology 04/2008; 14(3):195-6.
• Article: Simultaneous vasectomy and varicocelectomy: indications and technique.

  Richard K Lee, Philip S Li, Marc Goldstein
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  ABSTRACT: When men present for vasectomy, incidental varicoceles may be discovered. After varicocelectomy, the deferential veins become the only avenue for testicular venous return and could be compromised during nonmicroscopic vasectomy. We discuss the indications and technique required to safely perform simultaneous vasectomy and varicocelectomy. From 1992 to 2005, 18 (4.8%) of 379 men presenting for vasectomy had incidental palpable varicoceles and low or low normal serum testosterone levels. All underwent microsurgical subinguinal varicocelectomy. All spermatic, cremasteric, and gubernacular veins were ligated. The vas was then isolated under magnification, the deferential vessels were preserved, and the vas was transected, cauterized, and clipped. All 18 men (mean age 39.6 years) had grade II to III varicoceles on physical examination. We performed 27 microsurgical varicocelectomies with simultaneous microsurgical vasectomy. On average, the first follow-up visit occurred 14 weeks postoperatively. The mean testosterone level increased from 348 ng/dL preoperatively to 416 ng/dL postoperatively. No complications, episodes of testicular atrophy, vasectomy failures, or varicocelectomy recurrences developed. The incidence of varicoceles in fertile men presenting for vasectomy (4.8%) was lower than in the general population (15%); fertile men appear to be less likely to possess varicoceles. Men presenting for vasectomy with incidental palpable varicoceles could benefit from simultaneous vasectomy-varicocelectomy. This should be performed microsurgically to identify and ligate both spermatic veins and vasa deferentia and to preserve not only the testicular artery, but also the deferential vessels to minimize the risk of testicular atrophy and the risk of insufficient venous drainage.
  Urology 09/2007; 70(2):362-5. · 2.43 Impact Factor