In this edition of Pearls & Perspectives from the American Urological Association's (AUA) 2025 Annual Meeting, Dr. Amy Pearlman sat down with Corinna Hughes, a nurse practitioner at Mayo Clinic specializing in outpatient urology. A graduate of Mayo Clinic’s advanced practice provider (APP) fellowship, Hughes has established herself not only as a procedural urology provider but also as a widely followed educator on social media.

Hughes began her Instagram presence in 2020, recognizing a lack of visibility into APP fellowship experiences and career development. Her platform—@UroNursePractitioner—has since evolved into a hub for peer education, mentorship, and insight into the day-to-day realities of practicing urology as a nurse practitioner. With a mix of procedural discussion and humor, Hughes helps demystify both the training path and clinical responsibilities of APPs in this specialty.

The conversation highlighted the growth of urology-specific APP fellowships, which have expanded from 4–5 programs in 2020 to 15 nationwide. Hughes emphasized that while fellowship is not mandatory, it can be critical for those entering subspecialties like urology, especially when institutional support or mentorship is limited. She encouraged prospective applicants to closely evaluate a program’s procedural training opportunities and collaboration with physician faculty.

At Mayo, Hughes practices independently and collaboratively, with a diverse weekly schedule that includes cystoscopies, transperineal prostate biopsies, and a general clinic. She credits Mayo’s team-based approach and emphasis on procedural integration with enhancing job satisfaction and reducing burnout.

Hughes also spoke to the significance of increased APP-specific programming at the AUA. Sessions tailored to APPs, she said, not only support clinical development but also affirm their growing role in urology. As national organizations like the AUA expand opportunities for APP education and engagement, providers like Hughes are leading by example—both in clinic and online.

Follow her work on Instagram at @UroNursePractitioner.

In this episode of Pearls and Perspectives, Amy Pearlman, MD, reconnects with her former fellowship director, Ryan Terlecki, MD, vice chair of Urology at Wake Forest and a leader in genitourinary reconstruction. Recorded at the American Urological Association's (AUA) 2025 Annual Meeting in Las Vegas, NV, their conversation explores the evolving definition of reconstruction, emerging surgical education formats, and the practical realities shaping the field.

Terlecki reflects on the growing emphasis on surgical video presentations at specialty meetings such as GURS, noting a generational shift in how urologists consume educational content—from textbooks to digital, video-based instruction. He outlines the logistical and technical challenges of producing high-quality surgical video, emphasizing the need for training programs to build AV infrastructure and digital literacy into their education models. As surgical teaching evolves, so too does the delivery of care, and Terlecki underscores the increasing importance of clinic-based procedures and patient-centered strategies in reconstructive urology.

The discussion also touches on burnout, surgical case complexity, and workforce trends. Terlecki notes a shift away from high-intensity surgeries among some early-career urologists, a reality that programs must acknowledge to maintain sustainability and meet patient demand. The role of international collaboration is also highlighted, with Terlecki discussing his nonprofit work delivering practical reconstructive training in resource-limited settings and how technology—particularly surgical video and translation tools—can help scale impact.

Looking ahead, he advocates for broader inclusion of outpatient and office-based procedures in reconstructive forums and cautions against drawing rigid lines between academic and community practice. Importantly, he calls for embracing wellness and lifestyle interventions—such as weight management—as core elements of reconstructive care, particularly for conditions like buried penis. His message: reconstruction must evolve beyond the operating room to include holistic, accessible, and efficient models of care.

In this episode of Pearls & Perspectives from Urology Times, Amy Pearlman, MD, interviews Rachel Rubin, MD, a urologist and fellowship-trained sexual medicine specialist, about advancing sexual health education and care delivery. Speaking from the American Urological Association's (AUA) 2025 Annual Meeting in Las Vegas, NV, Rubin discusses her leadership in two key courses—one addressing the diagnosis and management of pelvic pain across all patient populations, and another supporting the rollout of new AUA guidelines on genitourinary syndrome of menopause (GSM).

Rubin offers insight into the guideline development process, which involved collaboration across multiple societies—including AUA, SUFU, AUGS, the Menopause Society, and ISSWSH—and incorporated patient perspectives alongside clinical evidence. The guidelines advocate for broader recognition of GSM as a urologic issue with systemic impact, including increased risk of recurrent UTIs, sepsis, and hospitalizations. Rubin underscores the evidence linking vaginal estrogen therapy to improved outcomes and reduced Medicare costs, pushing back on long-standing misconceptions about hormone therapy safety.

The conversation expands beyond AUA initiatives, as Rubin details her efforts to address the lack of sexual health training in urology and primary care. Through her virtual sexual medicine research collaborative, Rubin mentors medical students nationwide on topics ranging from sexual dysfunction in autoimmune diseases to genitourinary syndrome of lactation (GSL)—a condition she and her team helped define. She also highlights the importance of translating research into advocacy, noting how one of her team’s health economics papers was recently cited in state-level policy discussions.

Rubin emphasizes that empowering clinicians with actionable knowledge is key to improving care. Her educational content—ranging from online CME courses to public-facing talks—focuses on practical skills, prescription guidance, and risk framing to help providers treat patients more confidently. At a time when gaps in women’s sexual health care remain wide, Rubin’s message is clear: evidence-based care exists, and urologists must be equipped to deliver it.

In this episode of Pearls & Perspectives from Urology Times, host Amy Pearlman, MD, sits down with the legendary Larry Lipshultz, MD, professor of Urology at Baylor College of Medicine and a pioneering figure in the field of andrology.

Recorded at the American Urological Association's (AUA) 2025 Annual Meeting in Las Vegas, NV, this conversation explores the questions that continue to drive one of urology’s most prolific clinician-researchers—and the answers his team is working to uncover.

Lipshultz discusses his approach to identifying research opportunities, which are often sparked by unresolved clinical challenges he encounters in daily practice. With a fellowship program and a focus on intellectual curiosity, his team aims to consistently produce meaningful research—evidenced this year by 10 accepted abstracts at the AUA.

The latter part of the discussion centers around several of the team's current areas of investigation, including new diagnostic and therapeutic strategies for men with azoospermia and cryptospermia. Lipshultz describes cutting-edge work using high-resolution ultrasound to localize sperm-producing tubules and a novel technique involving fluorescent tagging and flow cytometry to identify rare sperm cells missed by standard analysis. This innovation has the potential to dramatically shift the landscape for men previously told they could not father children.

The episode also highlights Lipshultz’s groundbreaking work in managing testosterone therapy in men pursuing fertility. Rather than stopping testosterone altogether, his team has demonstrated that it’s possible to maintain exogenous testosterone while using LH (HCG) and FSH to preserve or stimulate sperm production—offering patients a path to fatherhood without compromising their quality of life.

Pearlman and Lipshultz also reflect on how practices have evolved, the importance of pre-treatment semen analyses, and the need for more nuanced, personalized care in reproductive urology.

In this episode of Pearls and Perspectives from the American Urological Association's (AUA) 2025 Annual Meeting, host Amy Pearlman, MD, reconnects with Martin Kathrins, MD of Mass General Brigham, to discuss his first clinical trial and new developments in the treatment of erectile dysfunction (ED).

In the episode, Kathrins shares his experience leading a pilot study on MED3000 (Eroxon), a topical, over-the-counter treatment for ED. According to Katherins, MED3000, unlike traditional therapies, works through local neural stimulation without biologically active drug ingredients. Originally developed as a placebo, the compound showed unexpected promise and was fast-tracked for wider availability. Kathrins discusses the opportunities—and hurdles—of designing a prospective clinical trial, highlighting the critical support of clinical research coordinators and the logistical challenges of recruiting both patients and partners for participation.

The study led by Kathrins was a 12-week open-label, non-randomized, single-arm trial evaluated the use of MED3000 in patients with ED following bilateral nerve-sparing radical prostatectomy (bnsRP). Eligible participants had normal erectile function prior to surgery, normal baseline testosterone levels, and no history of androgen deprivation therapy, radiation therapy, or biochemical recurrence. After a 4-week washout from other erectogenic aids, patients initiated MED3000 monotherapy and were assessed at 4-week intervals. Patients were encouraged to attempt sexual intercourse at least four times per month.

Outcome measures included the International Index of Erectile Function (IIEF), Self-Esteem and Relationship (SEAR) questionnaire, Expanded Prostate Cancer Index Composite (EPIC), and frequency of climacturia.

Twenty patients were initially enrolled; 19 (mean age 64.6±4.6 years) completed at least one on-treatment assessment, and 17 completed the full 12-week treatment phase. The cohort was predominantly white/non-Hispanic (n=17) with two Black/non-Hispanic participants. Following the washout, ED severity classification was 84% severe, 11% moderate, and 5% mild to moderate.

Across the study, paired t-tests comparing baseline to 4-, 8-, and 12-week scores for the IIEF total score, IIEF-EF domain, SEAR, EPIC total score, EPIC sexual domain, and climacturia frequency revealed no statistically significant changes at any time point. No adverse events were reported.

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During the episode, Kathrins emphasized the importance of reporting these "negative" results, as they help refine clinical guidance, manage patient expectations, and identify the right patient populations for future research.

As the episode progresses, Pearlman and Kathrins also explore broader implications for urologists: with MED300 now available OTC, patients are likely to ask about it, and providers must be ready to counsel them appropriately. Kathrins advises caution, noting that while MED3000 may have a role in the broader ED market—particularly among men without surgical histories—its efficacy for post-prostatectomy patients appears limited based on current data.

In this episode, guideline committee chair Melissa Kaufman, MD, PhD, FACS, highlights key points from the new AUA GSM guideline and illustrates its impact for clinical management of this condition.

In this 2-part episode of Pearls and Perspectives from the American Urological Association's (AUA) 2025 Annual Meeting in Las Vegas, NV, host Amy Pearlman, MD, speaks with Hossein Sadeghi-Nejad, MD, director of Men’s Health at NYU Langone, followed by an inspiring conversation with rising medical student researcher Nathalie Eid, BA, to explore the emerging impact of GLP-1 receptor agonists on testosterone levels and men’s health.

Sadeghi-Nejad shares clinical and research insights into how the widespread use of GLP-1 medications is reshaping the management of male patients, especially those struggling with obesity, infertility, and low testosterone. He explains the potential mechanisms behind GLP-1-induced hormonal changes, noting that some testosterone improvements appear independent of weight loss—a discovery that could redefine approaches to metabolic and reproductive health. Sadeghi-Nejad emphasizes the importance of cross-specialty collaboration and ongoing patient education around nutrition, strength training, and sarcopenia risk while using these therapies.

In the second half of the episode, Pearlman sits down with Nathalie Eid, a third-year medical student at NYU who recently presented her research at AUA 2025. Eid’s study, conducted in collaboration with Sadeghi-Nejad’s team, examines the relationship between GLP-1 therapy, testosterone levels, and sexual function. Their findings suggest that GLP-1 medications may directly influence hormonal pathways beyond simple weight loss effects, offering a potential new layer of complexity for clinicians managing hypogonadism in patients already undergoing metabolic treatment.

Together, Pearlman, Sadeghi-Nejad, and Eid highlight how urologists must adapt to a new clinical reality where GLP-1 therapies are common—and where their effects extend beyond glucose control and weight management. The episode reinforces the need for closer monitoring of testosterone levels, rethinking lab protocols, and considering how adjunctive therapies like testosterone replacement may need to be tailored when GLP-1 use is in play.

In this episode of Pearls and Perspectives, host Amy Pearlman, MD sits down with Andrew Y. Sun, MD, during the American Urological Association's (AUA) 2025 Annual Meeting in Las Vegas, NV to explore contemporary, practical approaches to testosterone therapy.

Sun, a urologist specializing in male sexual health at a large urology group in Dallas-Fort Worth, shares how his clinical practice has evolved with the growing use of oral testosterone therapies. Together, they discuss the "art" behind managing testosterone deficiency, moving beyond standard injections and pellets to creative strategies that prioritize both symptom relief and long-term patient goals like fertility preservation.

Sun explains how oral testosterone formulations—thanks to their short-acting pharmacokinetics—can preserve some endogenous testosterone production, unlike traditional injections that often completely suppress it. He details how he customizes treatment plans by blending oral testosterone with agents like Clomiphene to boost hormonal levels without fully shutting down the body's own system, offering a more physiologically balanced solution for men who may want children in the future.

Later, they delve into combination therapy strategies, including using oral testosterone alongside injectable TRT to better manage SHBG levels and mitigate side effects like polycythemia and acne—an approach that is gaining traction but rarely discussed in traditional guidelines or research.

Throughout the conversation, Sun challenges outdated perceptions about oral testosterone, emphasizing that modern formulations avoid the liver toxicity concerns associated with older agents like methyl testosterone. He encourages providers to consider oral testosterone as a first-line option for many patients, citing its convenience, patient preference, and physiological advantages.

In this episode of Pearls and Perspectives from Urology Times, host Amy Pearlman, MD, sits down with Helen Bernie, DO, MPH, at the American Urological Association's (AUA) 2025 Annual Meeting in Las Vegas for an in-depth discussion on some of the biggest questions facing men’s health and urology today.

Bernie, Director of Male Sexual and Reproductive Medicine at Indiana University, discusses her team’s impressive research output, including 10 abstracts presented at AUA. She offers an inside look at the year-long, collaborative process behind their studies, emphasizing the critical role of dedicated research fellows, medical students, and multi-institutional collaborations.

The conversation shifts to research on the safety of testosterone therapy in men with prostate cancer. Bernie and Pearlman explore how traditional thinking is evolving, highlighting new data that supports continuing testosterone therapy even during prostate cancer diagnosis, surgery, and recovery—challenging long-held fears and offering patients better quality of life. Both stress the importance of early conversations with urologic and radiation oncologists to ensure shared decision-making that centers patient wellbeing.

The episode also delves into clomiphene use in men and its impact on lipid profiles. Bernie shares insights from her practice, explaining how routine lipid and hormone panels can uncover hidden cardiovascular risks in young men presenting for issues like erectile dysfunction or infertility. She underscores the need for a broader, more preventive approach to men's health, rather than simply treating isolated symptoms.

Finally, they discuss the real-world challenges of oral testosterone therapy. Bernie explains findings from a phase 3 study suggesting that starting at higher doses could minimize lab monitoring burdens, reduce treatment delays, and improve patient satisfaction — a critical point for busy clinicians managing testosterone therapy in large practices.

Pearls and Perspectives is a new podcast from Urology Times, hosted by board-certified urologist Amy Pearlman, MD. This series explores the latest in urologic care, men’s health, and emerging innovations—all through a practical, patient-focused lens.

In this inaugural episode, Pearlman, who practices at the Coral Gables, Florida-based PRIME Institute, a concierge practice that she co-founded with her twin sister Michelle Pearlman, MD, a gastroenterologist, shares the story behind her path to urology, from early surgical experiences in medical school to the mentors who helped shape her career. She reflects on her commitment to making complex medical topics accessible, whether you’re a clinician, a patient, or simply curious about how the body works.

Listeners will also get a preview of what’s ahead on the podcast, including expert conversations on sexual health, testosterone therapy, GLP-1 medications, lifestyle medicine, and even technology trends like wearable toilet devices and sex tech. Pearlman’s goal? To offer clinical insights, real-world takeaways, and behind-the-scenes access to the ever-evolving field of urology.

Subscribe to Pearls and Perspectives on Apple and Spotify, and follow along for thoughtful, evidence-based conversations that aim to educate, challenge, and inspire. Remember, take care and stay curious!