Pearls & Perspectives: Elevating Survivorship in Urologic Care, with Bruce R. Kava, MD

Welcome back to Pearls & Perspectives!

In this episode of Pearls and Perspectives, host Amy Pearlman, MD, sits down with Bruce R. Kava, MD, for a wide-ranging, deeply human conversation recorded on-site at Urology on the Beach in Miami, Florida. Drawing on more than 26 years of experience, Kava reflects on his career path from oncologic surgery to sexual medicine, revision penile prosthetics, and, increasingly, cancer survivorship. He shares how being asked early in his career to take on prosthetic surgery reshaped his perspective on quality-of-life care, and how the gratitude and joy of restoring intimacy has remained a powerful motivator decades later.

Kava also unpacks the clinical and emotional complexities of revision penile prosthesis surgery, offering insight into why these cases can be both technically challenging and uniquely rewarding. From advances in infection prevention to the long-term reality of device malfunction, he highlights the importance of experience, surgical nuance, and thoughtful patient counseling. Beyond the operating room, the conversation turns to some of the most difficult moments in urologic practice, including counseling men with penile cancer about partial or total penectomy. Kava discusses communication strategies for delivering life-altering news, the psychological toll these diagnoses can carry, and the responsibility clinicians have to preserve dignity, hope, and support whenever possible.

The episode also explores the evolving concept of survivorship in prostate cancer care, extending beyond prostate-specific antigen monitoring to encompass sexual health, continence, mental well-being, nutrition, and the long-term effects of androgen deprivation therapy. Pearlman and Kava examine unanswered questions around testosterone recovery, emerging interest in peptides and other nontraditional approaches, and the growing role urologists can play as long-term stewards of survivorship care. The conversation closes with a candid reflection on burnout, leadership, and purpose, as Kava shares what continues to energize him after decades in practice: staying grounded in patient impact and holding fast to the ideals that first drew him to medicine.