Episodes

  • Pearls & Perspectives: From Guidelines to Practice—Navigating the TRT Treatment Spectrum, with Alex Tatem, MD

    Pearls & Perspectives: From Guidelines to Practice—Navigating the TRT Treatment Spectrum, with Alex Tatem, MD
    May 17 2025
    In this episode of Pearls & Perspectives, host Amy Pearlman, MD, sits down with Alex Tatem, MD, a urologist with Urology of Indiana and corporate director of men’s health for US Urology Partners, for a deep dive into the practical and nuanced realities of testosterone therapy.
    Together, they unpack what it means to deliver meaningful care in a landscape crowded with confusion, outdated messaging, and inconsistent training. Tatem shares his path from fellowship under Larry I. Lipshultz, MD, to leading national men’s health strategy, blending clinical experience with a personal perspective on testosterone deficiency. He outlines the most effective and sustainable treatment options—from injectables like cypionate and enanthate to newer oral therapies like Kyzatrex—explaining how he customizes regimens based on body composition, aromatization risk, and patient lifestyle.
    Pearlman and Tatem dig into the art of hormone management, discussing injection technique, frequency, side effect mitigation, and how to guide patients through formulation decisions. They touch on evolving views around estradiol, the limitations of past training models, and how a few key lab values (like LH, FSH, and prolactin) can dramatically change management—especially in younger men or those considering fertility.
    Later, they address broader questions about medical trust, guideline gaps, and testosterone’s misunderstood cardiovascular risk profile. Tatem calls for providers to be the first line of preventive care for aging men, noting that although testosterone has become culturally controversial, proper management is rooted in physiology, long-term health, and personalized care.
    Together, Pearlman and Tatem demystify testosterone therapy, positioning it not just as a treatment—but as a critical tool for enhancing longevity, independence, and quality of life.
    You can learn more about Tatem here.


    Chapters
    0:00:00 - Introduction and Professional Backgrounds
    0:08:59 - Personal and Professional Interest in Testosterone
    0:24:33 - Injection Techniques and Patient Preferences
    0:43:33 - Topical Testosterone Formulations
    0:50:17 - Alternative Testosterone Delivery Methods
    0:58:34 - Advice for Early Career Urologists
    1:00:52 - Rebuilding Patient Trust in Hormone Management
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    1 hr and 1 min
  • Pearls & Perspectives: Understanding and addressing priapism, with Serge Carrier, MD, and Gregory Broderick, MD

    Pearls & Perspectives: Understanding and addressing priapism, with Serge Carrier, MD, and Gregory Broderick, MD
    May 3 2025
    In this episode of Pearls & Perspectives, host Amy Pearlman, MD, is joined by Gregory Broderick, MD, of Mayo Clinic Florida, and Serge Carrier, MD, of McGill University, for a timely discussion recorded ahead of their plenary session at the 2025 American Urological Association (AUA) Annual Meeting in Las Vegas, NV. Together, they break down the clinical and procedural nuances of priapism—from test injections in the office to surgical intervention in the ER.

    Broderick and Carrier, both long-time contributors to AUA guideline development, walk through a staged, case-based approach to managing prolonged erections. Pearlman opens with the common scenario of an in-office diagnostic injection leading to prolonged tumescence—an awkward, and potentially dangerous, outcome if not handled properly. They discuss the importance of efficient protocols, availability of phenylephrine, and why sending a patient “to another room to take care of it” is neither practical nor safe.

    Carrier emphasizes the urgency of intervention once priapism crosses the ischemic threshold. He outlines what to do when patients show up with erections lasting more than 12 hours, including aspiration, phenylephrine use, and when to escalate to surgical shunting. Broderick reinforces that every minute counts, sharing insights from decades of resident training and why aspiration should be performed until bright red blood returns—signaling better oxygenation and a higher chance of pharmacologic success.

    The conversation also touches on the blurred lines between urology clinics and online or non-specialist men’s health centers. With compounded GLP-1s leaving the market, Pearlman and Broderick anticipate an increase in ED treatments from non-urologists and warn of the risks that come with uncontrolled injection protocols. They underscore the importance of ownership—if you're initiating penile injections, you're responsible for teaching, titrating, and reversing them safely.

    Looking ahead, the panel stresses collaboration, not criticism, when it comes to non-traditional ED care providers. Their message: priapism is rare, but when it happens, there’s no room for delay, denial, or delegation.
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    10 mins
  • Pearls & Perspectives: Evolving role of APPs in urology, with Corinna Hughes, DNP, at AUA 2025

    Pearls & Perspectives: Evolving role of APPs in urology, with Corinna Hughes, DNP, at AUA 2025
    May 1 2025
    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.
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    10 mins
  • Pearls & Perspectives: Future of reconstructive urology, with Ryan Terlecki, MD, at AUA 2025

    Pearls & Perspectives: Future of reconstructive urology, with Ryan Terlecki, MD, at AUA 2025
    Apr 30 2025
    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.
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    21 mins
  • Pearls & Perspectives: Advancing sexual health in urology, with Rachel Rubin, MD, at AUA 2025

    Pearls & Perspectives: Advancing sexual health in urology, with Rachel Rubin, MD, at AUA 2025
    Apr 29 2025
    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.
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    21 mins
  • Pearls & Perspectives: Innovation in male fertility care with Larry Lipshultz, MD, at AUA 2025

    Pearls & Perspectives: Innovation in male fertility care with Larry Lipshultz, MD, at AUA 2025
    Apr 29 2025
    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.
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    10 mins
  • Pearls & Perspectives: Martin Kathrins, MD, on MED3000 and learning from failed trials

    Pearls & Perspectives: Martin Kathrins, MD, on MED3000 and learning from failed trials
    Apr 28 2025
    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.

    AUA Study from Martin Kathrins, MD

    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.
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    10 mins
  • Speaking of Urology: Melissa Kaufman, MD, on AUA’s new guideline on genitourinary syndrome of menopause

    Speaking of Urology: Melissa Kaufman, MD, on AUA’s new guideline on genitourinary syndrome of menopause
    Apr 28 2025
    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.
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    11 mins