Ethan D Grober

Mount Sinai Hospital, Toronto, Toronto, Ontario, Canada

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Publications (72)227.25 Total impact

  • Ethan D Grober
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    ABSTRACT: Testosterone deficiency, or hypogonadism, is common and may have deleterious effects on men, including decreased overall well-being, reduced sexual function and bone loss. Despite data demonstrating strong links between testosterone deficiency and significant comorbid conditions (including type 2 diabetes and metabolic syndrome as well as the health benefits of testosterone-replacement therapy [TRT]), some physicians are still hesitant to initiate these therapies. Their reluctance is based on a number of prevailing myths associating TRT with adverse prostate health and recent concerns highlighting the possibility of increased cardiovascular risk.
    07/2014; 8(7-8 Suppl 5):S145-7.
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    ABSTRACT: To formulate nomograms based on pre-repair characteristics to predict improvements in semen parameters after varicocele repair. Model using multivariable linear regression based on prospectively collected database, with performance was quantified by concordance correlation coefficient and Pearson correlation coefficient after internal validation with bootstrapping. A male infertility specialty clinic. Men presenting for fertility evaluation from 2003-2012 having varicocele repair. None. Semen parameters before and after varicocele repair. Men undergoing varicocele repair (surgical or embolization) were identified via a prospectively collected database. The relationship of pre-repair semen and clinical characteristics to improvements in semen parameters was modeled using multivariable linear regression, then the model performance was quantified by concordance correlation coefficient and Pearson correlation coefficient after internal validation with bootstrapping. A total of 376 men who had undergone varicocele repair had data available for analysis. After varicocelectomy, the total motile count (TMC) varied depending on the initial left varicocele grade, ejaculate volume, sperm concentration, and motility. The final sperm concentration depended on the initial left varicocele grade, sperm concentration, and motility. The postvaricocelectomy sperm motility varied depending on the patient's age, left varicocele grade, sperm motility, morphology, and TMC. The final percentage of normal forms depended on the prevaricocelectomy sperm morphology, age, right varicocele grade, normal morphology, and TMC. Nomograms using prevaricocelectomy semen parameters and clinical features were developed to predict postvaricocelectomy TMC, sperm concentration, motility, and morphology. The concordance correlation coefficients were 0.45, 0.47, 0.65, and 0.36, respectively. Clinical factors provide substantial ability to predict postvaricocele repair semen parameters. These nomograms may be used by clinicians to predict postvaricocele repair semen parameters.
    Fertility and sterility 05/2014; · 4.30 Impact Factor
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    ABSTRACT: Objective To determine whether men with Klinefelter syndrome (KS) have the same phenotype as men with mosaic KS. Design Subject identification via prospectively collected database. Setting Male infertility specialty clinic. Patient(s) Men undergoing a fertility evaluation from 2005 to 2012 at a single male infertility specialty clinic and having a karyotype demonstrating KS (mosaic or non-mosaic). Intervention(s) None. Main Outcome Measure(s) Testicular size, and semen and hormone parameters, genetic evaluation, and signs of testosterone (T) deficiency using validated questionnaires. Result(s) Of 86 men identified with KS, 6 (6.7%) were mosaic KS, and 80 (93.3%) were non-mosaic KS. Men with mosaic KS had lower baseline luteinizing hormone (LH) levels (10.31 IU/L ± 5.52 vs. 19.89 IU/L ± 6.93), lower estradiol levels (58.71 ± 31.10 pmol/L vs. 108.57 ± 43.45 pmol/L), larger mean testicular volumes (11 ± 7.3 mL vs. 6.35 ± 3.69 mL), and a higher mean total sperm count (4.43 ± 9.86 M/mL vs. 0.18 ± 1.17 M/mL). A higher proportion of men with mosaic KS had sperm in the ejaculate: 3 (50%) of 6 versus 3 (3.75%) of 80. The Sexual Health Inventory for Men (SHIM) and Androgen Deficiency in the Aging Male (ADAM) questionnaire scores were not different between groups. Conclusion(s) Men with mosaic KS seem to be more well androgenized than their non-mosaic KS counterparts, both with respect to hormones and sperm in the ejaculate.
    Fertility and sterility 04/2014; · 4.30 Impact Factor
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    ABSTRACT: To evaluate whether hormonal markers predict erectile dysfunction (ED) and symptoms of T deficiency syndrome (TDS), which are commonly found in the population of infertile men. Retrospective study utilizing a prospectively maintained infertility database. A tertiary referral center. A total of 1,750 of 2,783 men presenting for evaluation of infertility between 1995 and 2010 completed validated questionnaires. Androgen Deficiency in the Aging Male (ADAM) and Sexual Health Inventory for Men questionnaires were administered. Baseline risk factors for ED and TDS were also measured. Subjects underwent serum hormone evaluation for total T, calculated bioavailable T, sex hormone-binding globulin, E2, LH, FSH, and PRL. Multivariable logistic regression modeling was used to determine the significance of hormonal markers in predicting ED (Sexual Health Inventory for Men score <22) and/or a positive ADAM score. The prevalence of ED and a positive response to the ADAM questionnaire were 30.5% and 45.2%, respectively, in this population (mean age, 36 years). Low serum T (total T < 10 nmol/L) was found in 29.4%. Neither T nor bioavailable T was significantly associated with the symptoms of ED or TDS on multivariable regression analysis. Erectile dysfunction and TDS in young, infertile men seem to be unrelated to hormone changes.
    Fertility and sterility 03/2014; · 4.30 Impact Factor
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    ABSTRACT: To develop a novel clinical test using microarray technology as a high-resolution alternative to current methods for detection of known and novel microdeletions on the Y chromosome. Custom Agilent 8x15K array comparative genomic hybridization (aCGH) with 10,162 probes on an average probe spacing of 2.5 kb across the euchromatic region of the Y chromosome. Clinical diagnostic laboratory. Men with infertility (n = 104) and controls with proven fertility (n = 148). Microarray genotyping of DNA. Gene copy number variation determined by log ratio of probe signal intensity against a DNA reference. Our aCGH experiments found all known AZF microdeletions as well as additional unbalanced structural alterations. In addition to complete AZF microdeletions, we found that AZFc partial deletions represent a risk factor for male infertility. In total, aCGH-based detection achieved a diagnostic yield of ∼11% and also revealed additional potentially etiologic copy number variations requiring further characterization. The aCGH approach is a reliable high-resolution alternative to multiplex polymerase chain reaction for the discovery of pathogenic chromosome Y microdeletions in male infertility.
    Fertility and sterility 01/2014; · 4.30 Impact Factor
  • Ethan D Grober, Edward Karpman, Majid Fanipour
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    ABSTRACT: To analyze the vasectomy reversal (VR) outcomes specifically among patients with vasal obstructive intervals (VOIs) of >10 years. The VOI has been shown to be a significant predictor of outcome after VR. Although no strict cutoff exists, couples have frequently been discouraged from considering a VR strictly according to the interval from vasectomy. From 2006 to 2011, all consecutive VRs performed by 2 fellowship-trained microsurgeons were analyzed. The patients were stratified into 4 categories according to the duration of the VOI: <10, 10-15, >15-20, and >20 years. The postoperative semen parameters, patency rates, and pregnancy outcomes were compared among the 4 groups. Of 535 consecutive VRs, 177 patients (33%) had a VOI of >10 years. The couple characteristics, type of VR required, postoperative semen quality, and patency and pregnancy rates among the 4 groups were analyzed. The men with longer VOIs were older (P <.001) and had older female partners (P = .006). Although the VOI influenced the type of reversal performed, favorable semen concentrations (average >20 million/mL in all groups) and patency (average >90%) and pregnancy rates (range 24%-39%) were achieved in men with a VOI >10 years. Although the interval since vasectomy has a significant effect on the type of VR required, provided a surgeon is proficient in both microsurgical vasovasostomy and vasoepididymostomy, favorable semen parameters and patency and pregnancy rates can be achieved in men with a VOI >10 years. Couples should not be discouraged from considering VR simply according to the VOI.
    Urology 11/2013; 83(2). · 2.13 Impact Factor
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    ABSTRACT: To analyze how frequently and why men presenting with infertility take testosterone (T) and if negative effects of T on semen parameters are reversed following cessation. Analysis of a prospectively collected database. Male Infertility clinic. Men presenting for fertility evaluation from 2008 to 2012. None. The frequency and reason for T use in the infertile male population, and semen and hormonal parameters while on T and following discontinuation. A total of 59/4,400 men (1.3%) reported taking T. T was prescribed by a variety of physicians, including endocrinologists (24%), general practitioners (17%), urologists (15%), gynecologists (5%), and reproductive endocrinologists (3%). Only one of the men admitted that he had obtained T from an illicit source. More than 82% of men were prescribed T for the treatment of hypogonadism, but surprisingly, 12% (7/59) were prescribed T to treat their infertility. While on T, 88.4% of men were azoospermic, but by 6 months after T cessation, 65% of the men without other known causes for azoospermia recovered spermatogenesis. In Canada, T was not commonly used by men presenting for fertility investigation (1.3%). Close to 2/3 of infertile men using T recovered spermatogenesis within 6 months of T discontinuation.
    Fertility and sterility 10/2013; · 4.30 Impact Factor
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    ABSTRACT: To determine the degree of improvement in semen parameters after finasteride discontinuation. A prospective database of men presenting for a fertility evaluation was analyzed for semen and hormone parameters before and after discontinuation of finasteride. A male infertility specialty clinic. Men presenting for fertility evaluation from 2008-2012 on finasteride. None. Semen and hormone parameters before and after discontinuation of finasteride. At presentation, 27 (0.6%) of 4,400 men on finasteride. The mean duration of treatment with finasteride was 57.4 months, and mean dose was 1.04 mg/day. There was an average 11.6-fold increase in sperm counts after finasteride discontinuation. Of the men with severe oligospermia (<5 M/mL), 57% had counts increase to >15 M/mL after finasteride cessation. No man had a decrease in sperm count. There was no change in hormone parameters, sperm motility, or sperm morphology. Finasteride, even at low doses, may cause reduced sperm counts in some men. In this population, counts improved dramatically for the majority of men after finasteride discontinuation. The hormone parameters, sperm motility, and sperm morphology were unchanged after cessation. Finasteride should be discontinued in subfertile men with oligospermia, and used with caution in men who desire fertility.
    Fertility and sterility 09/2013; · 4.30 Impact Factor
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    ABSTRACT: INTRODUCTION AND OBJECTIVES: In fertile men, exogenous testosterone (T) negatively impacts spermatogenesis and discontinuation leads to recovery. Recovery of spermatogenesis in men who are taking T and are infertile is unknown. In this study we sought to analyze the semen and hormonal parameters in men presenting for male infertility evaluation on T and after T cessation. METHODS: Men presenting for a fertility evaluation from 2008- 2012 on T were identified via a prospectively collected database. Data were analyzed for semen and hormonal parameters while on T and after discontinuation. RESULTS: 4400 men were evaluated for male infertility and 56 (1.3%) reported being on T at the time of the initial office consult. These men were a medically heterogeneous population, including men with Klinefelters syndrome (8), history of bilateral undescended testicles (7), Kallmans syndrome (5), other causes of testicular failure (6) and men without known pathology using T for athletics (3) or symptoms of T deficiency (17). Of these men, 24 (42.9%) had semen and blood hormone testing only while on T, 26 (46.4%) had testing on T and after discontinuation, and 6 (10.7%) had no testing. 34/50 (68%) tested men were azoospermic while on T at presentation. While on T, the average serum T was 14.74 nmol/L, and sperm count 4.11 M/mL. After T discontinuation, the average T was 11.79 nmol/L, and sperm count 26.84 M/mL. The mean time between measurements was 8.52 months. 10/26 (38.5%) men tested remained azoospermic despite repeated sperm testing for over 6 months. Of these 10 men, 2 had Klinefelters syndrome, 1 had Kallmans syndrome, 1 had Sertoli cell only syndrome, 1 had bilateral undescended testicles, and 1 had chemotherapy-induced azoospermia. If these men were excluded, then 4/20 (20%) without known previous causes for azoospermia were persistently azoospermic following the cessation of T. CONCLUSIONS: Infertile men on T represent a heterogeneous group with different underlying conditions, many of which could lead to infertility. T cessation resulted in a fairly rapid increase in sperm counts (4.11 M/mL. to 26.84 M/mL). A subset of men with no other cause for the azoospermia remained azoospermic despite T cessation; this may have been present before the men started T and may represent an underlying condition unrelated to the use of T. While men in reproductive years should be discouraged from using T unless medically required, this study is reassuring and indicates that at least 80% of infertile men who have no other cause for azoospermia recover spermatogenesis when T is discontinued.
    The Journal of urology 05/2013; 189(4S):e779. · 3.75 Impact Factor
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    ABSTRACT: OBJECTIVE: To determine the coital frequency among infertile couples and which factors are associated with less frequent coitus. DESIGN: Cross-sectional study. SETTING: Tertiary-level male infertility clinic. PATIENT(S): A total of 1,298 infertile men. INTERVENTION(S): Administration of computer-based survey, semen analysis, and serum hormone evaluation. MAIN OUTCOME MEASURE(S): Monthly coital frequency. RESULT(S): A total of 1,298 patients presented to clinic for infertility consultation and completed the computer-based survey. The median male age was 35 years (interquartile range [IQR] 32-39 years) and the median duration of infertility was 2 years (IQR 1-4 years) before consultation. Median monthly coital frequency was seven (IQR 5-10; range 0-40); 24% of couples were having intercourse ≤4 times per month. Overall, 0.6%, 2.7%, 4.8%, 5.8%, and 10.8% of the men reported having intercourse 0, 1, 2, 3, and 4 times per month, respectively. When simultaneously taking into account the influence of age, libido, erectile function, and semen volume on coital frequency, older patients had 1.05 times higher odds (per year of age) of less frequent coitus (odds ratio 1.05, 95% confidence interval 1.03-1.08). In addition, patients with better erectile function had 1.12 times higher odds (per point on Sexual Health Inventory for Men scale) of more frequent coitus (odds ratio 1.12, 95% confidence interval 1.09-1.18). CONCLUSION(S): Similar to the general population, most infertile couples report having coitus more than four times per month. Older male age and erectile dysfunction are independent risk factors for less frequent coitus among infertile men, which could have an impact on fertility. Coital frequency should be considered in infertility assessments.
    Fertility and sterility 05/2013; · 4.30 Impact Factor
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    ABSTRACT: INTRODUCTION AND OBJECTIVES: Over the last decade there has been a gradual increase in testosterone (T) prescribing. We sought to analyze patterns of T prescribing in men presenting for infertility evaluation. METHODS: Men presenting for fertility evaluation from 2008-2012 on T were identified via a prospective database. Data were analyzed for prevalence, prescriber, formulation, dosage and indication. RESULTS: 4400 men were evaluated for male infertility, and 56 (1.3%) were on T at presentation. Prescribers included: Endocrinologists (10, 17.9%), General Practitioners (5, 8.9%), Urologists (3, 5.3%), and independently obtained (4, 7.1%). Formulations and dosages included: Gel (26, 46.4%): most commonly 5mg every other day (QOD), range: 5mg QOD to 10mg daily; Intramuscular injection (25, 44.6%), most commonly 200mg every 2 weeks, range: 50-300mg every 2 weeks; Oral (1, 1.8%), 80mg QOD; Pellet (1, 1.7%), dose unknown; and unknown formulation and dose (5, 8.9%). Indications for T included: symptoms of hypogonadism (27, 48.2%), symptoms � low serum T (21, 37.5%), low serum T (4, 7.1%), athletic purposes (3, 5.4%), and subfertility (1, 1.8%). Co-existing conditions included: Klinefelters syndrome (8, 14.3%), history of bilateral undescended testicles (7, 12.5%), Kallmans syndrome (5, 8.9%), Sertoli only syndrome (2, 3.6%), chemotherapy induced testicular failure (2, 3.6%), prolactinoma (2, 3.6%), anejaculation (1, 1.8%), and opioid induced testicular failure (1, 1.8%). CONCLUSIONS: At our infertility center, T was not commonly used by men presenting for infertility investigation. Most men on T were being treated for appropriate conditions, with appropriate routes and dosages. Endocrinologists and General Practitioners were the most common prescribers, and educational efforts to emphasize the negative impacts of T on spermatogenesis should be focused on these groups. There are a group of men that obtain their T independently, and a group that uses T for athletic purposes. While this was a small fraction of the men in our population of infertile men, as the use of T increases, this fraction will undoubtedly grow.
    The Journal of urology 05/2013; 189(4S):e939. · 3.75 Impact Factor
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    ABSTRACT: Introduction.  In an effort to reduce the incidence of postoperative surgical site infections (SSIs), many hospitals have adopted a strict practice of preoperative hair removal using clippers, as opposed to razors. However, the skin of the male genitalia is delicate, elastic with irregular skin folds and may be ill-suited for clippers. Aim.  To compare shave quality and the degree of skin trauma using two methods of preoperative hair removal on the scrotal skin: clippers vs. razors. Methods.  Patients undergoing surgery involving the male genitalia requiring preoperative hair removal were randomized to hair removal using clippers or a razor. Immediately following hair removal, a standardized digital photograph was taken of the male genitalia. All digital photos were evaluated in a blinded fashion by groups of urologic surgeons and surgical nurses using a standardized five-point global rating scale. The incidence of SSIs was monitored. Main Outcome Measures.  Primary outcomes included blinded global ratings of (i) the completeness of the preoperative hair removal within the surgical field and (ii) degree of skin trauma following hair removal. The incidence of SSIs within 3 months of surgery was monitored throughout the study period. Results.  Two hundred fifteen consecutive patients were randomized (107 clipper, 108 razor). Overall, preoperative hair removal on the male genitalia using a razor resulted in significantly less skin trauma (P = 2.5E-10) and a more complete hair removal within the surgical field (P = 0.017) compared with clippers. SSIs were identified in four patients during follow-up (1.8%-two using clippers; two, razors). Conclusions.  Our data suggest that preoperative hair removal on the scrotal skin using a razor results in less skin trauma and improved overall shave quality with no apparent increased risk of SSIs. Based on these findings, surgeons should be permitted their choice of razors or clippers for preoperative preparation of the male genitalia. Grober ED, Domes T, Fanipour M, and Copp JE. Preoperative hair removal on the male genitalia: Clippers vs. razors. J Sex Med **;**:**-**.
    Journal of Sexual Medicine 08/2012; · 3.15 Impact Factor
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    ABSTRACT: : Varicocele remains the most commonly identified correctable cause of male factor infertility. Surgical correction is the most commonly performed technique to treat varicoceles with a technical failure rate of less than 5%. An attractive alternative to surgery is the selective catheterization and embolization of the gonadal vein. This data are limited by small series. : We reviewed a total of 158 patients. These patients underwent embolization for clinical varicoceles and male factor infertility between 2004 and 2008. Of these, 56% underwent attempted bilateral embolization, 43% unilateral left-sided embolization and 1.3% unilateral right-sided embolization. : Of these patients who underwent attempted bilateral embolization, 19.3% did not experience a successful obliteration of the right gonadal vein and 2.3% (2/88) experienced a failure rate in the embolization of the left gonadal vein. Of the 2 attempts at unilateral right-sided embolization, there were no failures. Of the 68 unilateral left-sided embolization attempts, there was a 4.4% failure rate. Of all of the right-sided embolization attempts, 18.9% failed, while 3.2% of the left-sided attempts failed. : This review represents the largest contemporary series of varicocele embolization outcomes currently in the literature. Our 19.3% technical failure rate for bilateral varicocele embolization is higher than the current published rate of 13% and is largely related to failure to successfully occlude the right gonadal vein. This supports our belief that bilateral varicoceles are best managed with a primary microsurgical approach, where technical failure rates are expected to be less than 5% based on published data. Men with unilateral left-sided varicoceles should be offered both options as they have similar failure rates, but with embolization offering some clear advantages to the patient.
    Canadian Urological Association journal = Journal de l'Association des urologues du Canada 08/2012; 6(4):266-8. · 1.92 Impact Factor
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    ABSTRACT: To determine the incidence of bacteriospermia and elevated seminal leukocytes (ESL) in a subfertile male population and correlate these results with semen parameters. Retrospective cohort study. Canadian tertiary-level male infertility clinic and university-affiliated andrology and microbiology laboratories. Four thousand nine hundred thirty-five nonazoospermic subfertile men. Analysis and concurrent culture of 7,852 semen samples. Incidence of bacteriospermia and ESL and comparison of semen parameters between these groups. The rate of bacteriospermia was 15% (22 species), and the rate of ESL was 19%, with no statistical correlation between these groups. Bacteriospermic patients (without ESL) had a statistically significant deterioration in DNA fragmentation index (DFI) only, compared with patients without bacteriospermia and ESL (24.1 vs. 21.8%). ESL alone was associated with a statistically significant deterioration in sperm concentration (20.6 vs. 55.3 × 10(6)/mL), motility (21.8 vs. 26.9%), normal morphology (12.3 vs. 17.4%), and DFI (26.5 vs. 21.8%), with no additional deterioration identified with bacteriospermia. Bacteriospermia and ESL were prevalent, but not statistically associated, in subfertile men. Bacteriospermia alone was associated with an increase in DFI only, but the presence of ESL was the dominant factor associated with deterioration in semen parameters.
    Fertility and sterility 02/2012; 97(5):1050-5. · 4.30 Impact Factor
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    ABSTRACT: Prostatitis is an inflammation of the prostate gland which affects approximately 10% of men. Despite its frequency, diagnosing prostatitis and monitoring patient response to treatment remains frustrating. As the prostate contributes a substantial percentage of proteins to seminal plasma, we hypothesized that a protein biomarker of prostatitis might be found by comparing the seminal plasma proteome of patients with and without prostatitis. Using mass spectrometry, we identified 1708 proteins in the pooled seminal plasma of 5 prostatitis patients. Comparing this list to a previously published list of seminal plasma proteins in the pooled seminal plasma of 5 healthy, fertile controls yielded 1464 proteins in common, 413 found only in the control group, and 254 found only in the prostatitis group. Applying a set of criteria to this dataset, we generated a high-confidence list of 59 candidate prostatitis biomarkers, 33 of which were significantly increased in prostatitis as compared to control, and 26 of which were decreased. The candidates were analyzed using Gene Ontology and Ingenuity Pathway analysis to delineate their subcellular localizations and functions. Thus, in this study, we identified 59 putative biomarkers in seminal plasma that need further validation for diagnosis and monitoring of prostatitis.
    Clinical Proteomics 02/2012; 9(1):2.
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    ABSTRACT: Infertility affects approximately 15% of couples with equivalent male and female contribution. Absence of sperm in semen, referred to as azoospermia, accounts for 5-20% of male infertility cases and can result from pretesticular azoospermia, non-obstructive azoospermia (NOA), and obstructive azoospermia (OA). The current clinical methods of differentiating NOA cases from OA ones are indeterminate and often require surgical intervention for a conclusive diagnosis. We catalogued 2048 proteins in seminal plasma from men presented with NOA. Using spectral-counting, we compared the NOA proteome to our previously published proteomes of fertile control men and postvasectomy (PV) men and identified proteins at differential abundance levels among these clinical groups. To verify spectral counting ratios for candidate proteins, extracted ion current (XIC) intensities were also used to calculate abundance ratios. The Pearson correlation coefficient between spectral counting and XIC ratios for the Control-NOA and NOA-PV data sets is 0.83 and 0.80, respectively. Proteins that showed inconsistent spectral counting and XIC ratios were removed from analysis. There are 34 proteins elevated in Control relative to NOA, 18 decreased in Control relative to NOA, 59 elevated in NOA relative to PV, and 16 decreased in NOA relative to PV. Many of these proteins have expression in the testis and the epididymis and are linked to fertility. Some of these proteins may be useful as noninvasive biomarkers in discriminating NOA cases from OA.
    Journal of Proteome Research 12/2011; 11(3):1503-11. · 5.06 Impact Factor
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    ABSTRACT: To determine the utility and cost of Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) screening in infertile males. Cohort study. Canadian tertiary-level male infertility clinic and university-affiliated laboratories. 5,588 male infertility patients. CT and NG testing on 8,972 urine and semen samples. Prevalence of CT and NG infection in infertile males versus general male population in Canada over 8 years (2003-2010) and the reagent cost to detect one case of CT or NG. In infertile males, the prevalence rate for CT and NG was 0.304% and 0.0537%, which was statistically significantly lower (3.4- and 8.1-fold lower, respectively) than the age-adjusted general population prevalence. With the reagents costing $86.20 per patient tested, the reagent cost alone to diagnose one case of CT or NG was $38,669. The prevalence of CT and NG in this study are among the lowest reported in the male infertility literature. These findings question the utility of CT/NG screening in this low-risk population and emphasize that decisions about the utility of screening must be based on the prevalence rates of the disease in the studied population.
    Fertility and sterility 12/2011; 97(2):299-305. · 4.30 Impact Factor
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    ABSTRACT: The post-vasectomy pain syndrome is a rare but serious and debilitating complication of vasectomy. For men with the post-vasectomy pain syndrome vasectomy reversal is a surgical option after medical management has failed. However, there is a paucity of data in the literature defining its therapeutic efficacy. In this study we better define the role and effect of vasectomy reversal in the treatment of men with the post-vasectomy pain syndrome. Three urologists in Toronto, Ontario performed 149 publically funded vasectomy reversals between January 2000 and September 2010. The electronic health records were reviewed and 23 of the 149 (15%) procedures were performed for the post-vasectomy pain syndrome. Of these men who underwent 14 vasovasostomies 13 completed a telephone conducted questionnaire (response rate 56%). Patient demographics, preoperative and postoperative pain scores, and quality of life were retrospectively assessed. Orchialgia occurred a mean ± SD of 19 ± 42.5 months after vasectomy and the men (mean age 43.8 ± 5.2 years) experienced pain for 50.3 ± 34.9 months before vasovasostomy. After vasovasostomy improvement of pain occurred in 93% (13 of 14) and 50% were rendered pain-free with an average improvement in pain intensity scores of 65% (p <0.005). Of the men 15% (2 of 13) had a recurrence of pain to baseline but overall 79% (11 of 14) had a durable positive response. Quality of life was significantly improved after vasovasostomy (p <0.005) and 93% (13 of 14) of the patients said they would undergo the same operation again. Vasovasostomy is an effective treatment modality for the post-vasectomy pain syndrome, and it can achieve robust and durable long-term improvement in pain intensity and quality of life.
    The Journal of urology 12/2011; 187(2):613-7. · 3.75 Impact Factor
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    ABSTRACT: While there are a number of studies documenting a positive effect of varicocelectomy on semen parameters, the length of time required following varicocelectomy for semen quality to improve is not well established. Therefore, in this study we identified the changes with time in semen parameters after varicocelectomy. The records and database of 304 patients who underwent varicocele repair for subfertility were reviewed retrospectively. All men had at least 2 preoperative semen analyses as well as semen testing at 3 and 6 months postoperatively. For the 100 patients who met the study inclusion criteria mean sperm counts increased significantly by 3 and 6 months after varicocelectomy (by 53% and 38% by 3 and 6 months, p = 0.0003 and 0.001, respectively). By 3 and 6 months the combined groups had a mean 2.5 and 1.5-fold higher total motile count compared to the preoperative total motile count, respectively. There was no further improvement in semen parameters in those men followed for more than 6 months. There were no statistically significant differences in the improvement in semen volume, motility, count or total motile count comparing the results at 3, 6 and more than 9 months postoperatively. Sperm parameters improve by 3 months after varicocele repair and then do not improve further. This finding should allow physicians to decide quickly if varicocelectomy has been effective and, then, if required, plan on the use of other therapies to manage the couples' infertility.
    The Journal of urology 11/2011; 187(1):227-31. · 3.75 Impact Factor
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    ABSTRACT: To compare the use of structured reporting software and the standard electronic medical records (EMR) in the management of patients with bladder cancer. The use of a human factors laboratory to study management of disease using simulated clinical scenarios was also assessed. eCancerCare(Bladder) and the EMR were used to retrieve data and produce clinical reports. Twelve participants (four attending staff, four fellows, and four residents) used either eCancerCare(Bladder) or the EMR in two clinical scenarios simulating cystoscopy surveillance visits for bladder cancer follow-up. Time to retrieve and quality of review of the patient history; time to produce and completeness of a cystoscopy report. Finally, participants provided a global assessment of their computer literacy, familiarity with the two systems, and system preference. eCancerCare(Bladder) was faster for data retrieval (scenario 1: 146 s vs 245 s, p=0.019; scenario 2: 306 vs 415 s, NS), but non-significantly slower to generate a clinical report. The quality of the report was better in the eCancerCare(Bladder) system (scenario 1: p<0.001; scenario 2: p=0.11). User satisfaction was higher with the eCancerCare(Bladder) system, and 11/12 participants preferred to use this system. The small sample size affected the power of our study to detect differences. Use of a specific data management tool does not appear to significantly reduce user time, but the results suggest improvement in the level of care and documentation and preference by users. Also, the use of simulated scenarios in a laboratory setting appears to be a valid method for comparing the usability of clinical software.
    Journal of the American Medical Informatics Association 08/2011; 18(6):835-41. · 3.57 Impact Factor

Publication Stats

1k Citations
227.25 Total Impact Points


  • 2009–2014
    • Mount Sinai Hospital, Toronto
      • • Department of Urology
      • • Department of Pathology and Laboratory Medicine
      Toronto, Ontario, Canada
  • 2004–2014
    • University of Toronto
      • • Division of Urology
      • • Department of Surgery
      Toronto, Ontario, Canada
    • Government of Ontario, Canada
      XIA, Ontario, Canada
  • 2013
    • CUNY Graduate Center
      New York City, New York, United States
  • 2011
    • The Princess Margaret Hospital
      Toronto, Ontario, Canada
    • Samuel Lunenfeld Research Institute
      Toronto, Ontario, Canada
  • 2007
    • Baylor College of Medicine
      • Department of Urology
      Houston, Texas, United States