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Benjamin P. Saylor is associate editor of Urology Times, an Advanstar Communications publication.

Articles

The findings also lend further credence to the muscle-invasive bladder cancer treatment regimen, investigators reported.

NIAGARA: ctDNA analysis highlights durvalumab’s impact in MIBC

"This final analysis of this study continues to support nivo+ipi as a standard of care for patients with untreated RCC," says Robert J. Motzer, MD. 

Nivolumab/ipilimumab continues to show improved survival, durable response in aRCC

"The pre-specified thresholds for statistical significance were not met for the dual primary end points of overall survival in cisplatin-ineligible and PD-L1 positive patients," said Michiel Van der Heijden, MD, PhD.

Mixed results reported for nivolumab/ipilimumab in cisplatin-ineligible mUC

According to the authors, these data reinforce EV plus pembrolizumab as the first-line standard of care for la/mUC. 

EV plus pembrolizumab doubles CR rate vs chemotherapy in la/mUC

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Clinical Focus

Leonard G. Gomella, MD, FACS; Maha Hussain, MD, FACP, FASCO; Daniel P. Petrylak, MD

18th Annual Interdisciplinary Prostate Cancer Congress® and Other Genitourinary Malignancies

Jason Hafron, MD; Aaron D. Berger, MD; Arpeet Shah, MD

Medical Crossfire® in Adjunctive Testing: Charting a New Course in Prostate Cancer Risk Assessment

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

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Together, they unpack what it means to deliver meaningful care in a landscape crowded with confusion, outdated messaging, and inconsistent training.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.

Explore the latest insights on testosterone therapy, its benefits, and practical applications from leading urologists in men's health.

Pearls & Perspectives: Understanding and addressing priapism, with Serge Carrier, MD, and Gregory Broderick, MD

, 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.

Experts discuss urgent priapism management strategies, emphasizing timely intervention and collaboration for optimal patient outcomes.

Pearls & Perspectives: Evolving role of APPs in urology, with Corinna Hughes, DNP, at AUA 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.

Corinna Hughes, DNP, sits down with Amy Pearlman, MD, to discuss the evolving recognition of APPs in urology. 

Pearls & Perspectives: Future of reconstructive urology, with Ryan Terlecki, MD, at AUA 2025

, 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 

 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.

A discussion on evolution of surgical education, importance of video training, and the future of patient-centered care in reconstruction.

Pearls & Perspectives: Advancing sexual health in urology, with Rachel Rubin, MD, at AUA 2025

, 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 

 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.

Rachel Rubin, MD, discusses advancements in sexual health education and guidelines at the AUA meeting. 

Welcome back to Pearls & Perspectives, with Amy Pearlman, MD! 

Pearls & Perspectives: innovation in male fertility care with Larry Lipshultz, MD, at AUA 2025

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.

 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 

. 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 

. 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.

Discover groundbreaking insights in urology as Larry Lipshultz, MD, shares innovative research and strategies for male fertility challenges.

Pearls & Perspectives: Innovation in male fertility care with Larry Lipshultz, MD, at AUA 2025

Pearls & Perspectives: Martin Kathrins, MD, on MED3000 and learning from failed trials

, 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.

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.

Kathrins discusses the intricacies of leading a clinical trial and why "negative" trials are important to informing care strategies. 

Pearls & Perspectives, with Amy Pearlman, MD

Pearls & Perspectives: Updates in Testosterone Therapy, with Andrew Sun, MD at AUA 2025

, host Amy Pearlman, MD sits down with Andrew Y. Sun, MD, during the 

 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.

Andrew Sun, MD, joins Pearls & Perspectives to discuss innovative approaches to testosterone therapy for enhanced health outcomes.

Pearls & Perspectives: Updates in testosterone therapy, with Andrew Sun, MD at AUA 2025

Introducing Pearls & Perspectives, with Amy Pearlman, MD!

, 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.

 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!

Pearls & Perspectives, hosted by Amy Pearlman, MD, is the latest multimedia program from Urology Times.

 Assistant Editor Janelle Hart speaks with 

 He discusses the role of the urologist in destigmatizing male infertility and why this condition is especially difficult for patients to live with. Schlegel is a James J. Colt professor of urology at Weill Cornell Medicine in New York City, New York.

“The urologist's role is to try to normalize what is going on and provide easier access,” says Peter N. Schlegel, MD.

Destigmatizing Urology: Dr. Schlegel discusses male infertility

New research reveals GLP-1 receptor agonists may enhance sperm counts in overweight men.

AUA 2025: GLP-1 RAs could improve sperm count in overweight men

A phase 3 trial reveals a combination therapy for premature ejaculation significantly enhances treatment outcomes.

Sildenafil/Clomipramine Combo Boosts Outcomes in Premature Ejaculation

“The study suggests that exercise would be an effective intervention for men with prostate cancer who express concern about sexual dysfunction, and that exercise medicine should be considered a key part of their treatment,” says Daniel Galvão, PhD. 

Exercise may improve erectile function in men with prostate cancer

A recap of the FDA submissions and regulatory decisions in urology from January 2025.

FDA Updates in Urology: January 2025

"Wearable devices are increasingly being used to understand and improve male sexual dysfunctions," write the authors.

AI and wearables: The new age of smart sex

With the FDA’s recent class-wide labeling changes for testosterone products

® it will be easier for clinicians to counsel patients regarding testosterone therapy.

“It definitely makes it easier for providers, because even if, as a provider, you know that there's not a really high risk, you feel obligated to go into an extended discussion on potential risks of cardiovascular [events] because if your patient is that 1 very low-risk patient who has a myocardial infarction or something—which may not even be related to testosterone—that patient's now going to come back and say, ‘Hey, you put me on testosterone. I had a heart attack. It's because of this; the FDA had a black box [warning]. You didn't warn me enough about it. I didn't understand the risks.' ”

With the FDA’s recent class-wide labeling changes for testosterone products1, urologist Landon Trost, MD, told Urology Times® it will be easier for clinicians to counsel patients regarding testosterone therapy

An expert discusses patient counseling in wake of FDA’s labeling changes for testosterone

Trost, founder and director of the Male Fertility and Peyronie’s Clinic in Orem, Utah, was also asked whether, with the FDA requiring product-specific blood pressure data on labels, he anticipated changing his prescribing habits based on the specific formulation of testosterone. He said, “I don't think so. I don't think this will lead to many changes in clinical practice as far as I don't think you'll start to see people getting routine blood pressure measurements or anything like that. The absolute increases in blood pressure with these studies was very mild. I think it's something you mention [to patients]. I think it's something you screen for…I think it's something to be aware of, something to note, but it's not like you're seeing a 30-point jump in blood pressure. These are very, very mild. And so it's again, something to be aware of, but it won't necessarily have dramatic impacts on practice.”

1. FDA issues class-wide labeling changes for testosterone products. News release. FDA. February 28, 2025. Accessed March 3, 2025. https://www.fda.gov/drugs/drug-safety-and-availability/fda-issues-class-wide-labeling-changes-testosterone-products

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“It definitely makes it easier for providers [to counsel patients]," says Landon Trost, MD.

Following the FDA’s class-wide labeling changes for testosterone products,

 John P. Mulhall, MD, was asked how these changes might affect patient counseling and shared decision-making regarding testosterone therapy.

“In a practice like mine, where approximately 30% of the practice is low testosterone, it'll have actually very little negative effect, because we have a discussion [and] have had a discussion for the past decade with our patients about the limitations in the Basaria, Vigen, and Finkle papers that have colored the thinking about MACE [major adverse cardiovascular events] and testosterone therapy. The overwhelming majority of the evidence that preceded those papers, and all of the evidence that has come after those…suggests that actually, testosterone therapy is not a concern, and that's been confirmed in the TRAVERSE study,” said Mulhall, a urologic surgeon at Memorial Sloan Kettering Cancer Center in New York, New York who chaired the guidelines committee for the American Urological Association’s “Evaluation and Management of Testosterone Deficiency” guideline.

Mulhall added, “Basically, it will not change my practice very much at all, but in routine urological practice and in primary care, what this should translate into is a comfort level among physicians to prescribe testosterone therapy, knowing that testosterone therapy is not associated with the development of major adverse cardiovascular events.”

Following the FDA’s class-wide labeling changes for testosterone products,1 John P. Mulhall, MD, was asked how these changes might affect patient counseling and shared decision-making regarding testosterone therapy.

New FDA warnings on testosterone: How will they affect prescribing?

"In a practice like mine, where approximately 30% of the practice is low testosterone, it'll have actually very little negative effect," says John P. Mulhall, MD.

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