Recommended Papers and Information from Dr. Antoine Makhlouf.

“The following is a list of some of the urology papers that I have authored or
collaborated on. Note that these articles are intended to be read by other urologists,
and are too technical for most patients. Summaries for some are available at by following the links. The full text cannot be included online as the
copyright is held by the publishers or the respective journals. I included the "gist" of
each paper and how it influences my practice in italics.”

Makhlouf AA, Niederberger CS.
J Androl. 2006 Sep-Oct;27(5):637-40. This article is a discussion of when a patient should be cleared to stop contraception after a vasectomy. I consider the complete absence of any sperm, or the presence of dead non-moving sperm only on two separate occasions to be sufficient. However, not all urologists agree on this. Makhlouf AA, Niederberger C. J Androl. 2006 May-Jun;27(3):316-23. This is a discussion of the utility of DNA fragmentation testing in men with fertility problems. I recommend these tests in certain situations only (most commonly to help couples decide between artificial insemination and in vitro fertilization). Niederberger C, Makhlouf AA. J Androl. 2006 Jan-Feb;27(1):3-5.
This article is a discussion of the best strategy for couples trying to concieve when the
man had a vasectomy and the woman has diminished ovarian reserve (usually due to
age). In general, a vasectomy reversal is the more effective strategy; however, there are
situations where IVF (in vitro fertilization) may be a better option.

Wald M, Makhlouf AA, Niederberger CS.
This is a review of various techniques on surgically retrieving sperm from azospermic
males. I wrote the section on factors that can help predict success or failure of sperm
retrieval. The most important factor is the pathology result of previous biopsies.
Dietary Supplements and Male Fertility. Makhlouf AA, Niederberger CS. Seminars in
Preventive and Alternative Medicine
, 2: 196-204, 2006.
This is a review of the effect of dietary supplements on male fertility. In general, a heart healthy
diet rich in essential minerals and anti-oxidants seems to help male fertility to some extent.


Makhlouf AA, Thorner D, Ugarte R, Monga M.
Urology. 2009 Jan;73(1):4-8 This article shows that shockwave lithotripsy for stone treatment does not increase the risk of developing Diabetes. Phillips E, Hinck B, Pedro R, Makhlouf A, Kriedberg C, Hendlin K, Monga M. Urology. 2009 Nov;74(5):994-9.
This study found that Celecoxib was not very helpful as an adjunct for pain control in
patients with stone.

Duffey BG, Pedro RN, Kriedberg C, Weiland D, Melquist J, Ikramuddin S,
Kellogg T, Makhlouf AA, Monga M. J Urol. 2008 Apr;179(4):1401-6.
This study showed that patients who have undergone weight reduction surgery may be at increased risk of developing kidney stones. I counsel these patients to be more aggressive in maintaining good hydration and eating a low oxalate diet.

Makhlouf A, Kshirsagar A, Niederberger C.Int J Impot Res. 2006 Nov- This is a review of Phosphodiesterase 11, an enzyme related to Phosphodiesterase 5 which is the target of the erectile dysfunction drugs (Viagra, Cialis and Levitra). The function of Phosphodiesterase 11 is not known. Cialis blocks Phosphodiesterase 11 whereas Viagra and Levitra do not. Because Phosphodiesterase 11 is found in sperm , I recommend Viagra or Levitra over Cialis for men with erectile dysfunction who are also having difficulty conceiving. Makhlouf A, Kparker A, Niederberger CS. Urol Clin North Am. 2007 Nov;34(4):565-74, vii. This is a discussion of erectile dysfunction and its effect on depression and vice versa, and how best to manage it. Makhlouf AA, Mohamed MA, Seftel AD, Niederberger C.Int J Impot Res. 2008 This study showed that among men with erectile dysfunction, low testosterone correlated with the presence of depression symptoms. I routinely check the testosterone level on all men presenting with erectile dysfunction. Köhler TS, Kim J, Feia K, Bodie J, Johnson N, Makhlouf A, Monga M. Urology. 2008 Apr;71(4):693-7.
This paper looked at various cutoffs for determining what constitutes a "low
testosterone" level in aging men with erectile dysfunction. I do not think a single cutoff
value fits most men, and would recommend evaluating each case on its own.


Köhler TS, Pedro R, Hendlin K, Utz W, Ugarte R, Reddy P, Makhlouf A,
Ryndin I, Canales BK, Weiland D, Nakib N, Ramani A, Anderson JK,
Monga M.
This study showed that early use of the Vacuum Erection Device may be beneficial in improving erection quality after prostate surgery. Makhlouf AA, Boyd JC, Chapman TN, Theodorescu D. Urology. 2002 Oct;60(4):656-60. This study showed that surgery was no more expensive (in terms of costs to the health care system) than seed placement for prostate cancer. Makhlouf AA, Krupski TL, Kunkle D, Theodorescu D.BJU Int. 2004 This study showed that taking more than 6 needle samples at the time of prostate biopsy improves the diagnostic accuracy of the biopsy. It is now standard urologic practice to take at least 12 cores . With a proper anesthetic block , this is no more painful than the old 6 core techniques.


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