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

Pearls & Perspectives: Evolving role of APPs in urology, with Corinna Hughes, DNP, at AUA 2025

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

Twelve-month physical functioning scores were comparable between the radical cystectomy arm and the bladder-sparing therapy arm.

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FDA updates in urology: April 2025

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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

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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.

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.

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: Urology's Role in GLP-1 RA Treatments, with Hossein Sadeghi-Nejad, MD, and Nathalie Eid, BA 

 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 

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.

This episodes explores the evolving role of GLP-1 medications in testosterone management and their impact on male sexual health and fertility.

Pearls & Perspectives: Urology's role in GLP-1 RA treatments, with Hossein Sadeghi-Nejad, MD, and Nathalie Eid, BA 

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

Pearls & Perspectives: Helen Bernie, DO, MPH, at AUA 2025

, host Amy Pearlman, MD, sits down with Helen Bernie, DO, MPH, at the 

 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.

Relevant disclosures for Pearlman include Boston Scientific Corporation. Relevant disclosures for Bernie include Boston Scientific and Coloplast.

Helen Bernie, DO, MPH, joins the show to discuss data from her Indiana University team from the floor 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 Managing Editor Ben Saylor spoke with Dr. Michael Lutz. He discusses common myths and misconceptions surrounding men’s health and the urologist’s role in dispelling them. Lutz is a partner in the Michigan Institute of Urology and president of the MIU Men’s Health Foundation.

“I think it's really important to understand the role of prevention and early detection,” says Michael Lutz, MD.

The urologist's role in dispelling men's health myths

® Assistant Editor Janelle Hart spoke with 

 He discusses why clinicians and patients are reluctant to incorporate holistic medicine into their health management, and how he believes this will change in the future. Espinosa is a holistic clinician and clinical assistant professor of urology at NYU Langone Health in New York City, New York.

“I think that the audience should know that there is a movement going on,” says Geo Espinosa, ND.

Destigmatizing Urology: Dr. Espinosa discusses lifestyle changes

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

A groundbreaking male contraceptive shows promising safety results, offering a reversible option for couples seeking effective birth control.

ADAM, a long-term, injectable male birth control, shows promise at AUA 2025

In February 2025, the FDA recommended a removal of the black box warning related to an increased risk of adverse cardiovascular outcomes for all testosterone products. This recommendation has important implications for urologists and the patients they treat.

Label change for testosterone: Implications for urologists, prescribers, and patients

The average life expectancy was 80.3 years among men with a total motile sperm count over 120 million, compared with 77.6 years among men with a total motile sperm count ranging from >0 to 5 million.

Study links poor semen quality with shorter life span

Bradley Roth, MS4, and Scott D. Lundy, MD, PhD, HCLD, consider some of the reasons that fertility restoration was found to have higher pregnancy success rates compared with sperm cryopreservation in a recent study.

Experts consider efficacy of fertility restoration vs sperm cryopreservation

, consider some of the reasons that fertility restoration was found to have higher pregnancy success rates compared with sperm cryopreservation in the study, “Routine Sperm Cryopreservation before Vasectomy Is Not Cost-Effective and Does Not Increase Live Birth Rates Compared to Surgical Sperm Retrieval or Vasectomy Reversal.”

Roth is a fourth-year medical student at the University of California, Irvine Medical Center, and Lundy is the section head of reproductive urology as well as a surgeon scientist at the Cleveland Clinic in Cleveland, Ohio.

 I'll let Dr. Lundy speak most on this because he actually performs these procedures, but I think a lot of it is the fact that urologists have gotten very good at vasectomy reversals, so the success rate from a surgical standpoint is very good. While there is a surgery that's involved in it vs just banking sperm, it tends to portend very good outcomes for these patients in terms of restoring fertility. The other thing that has to be kept in mind is that patients who are cryopreserving sperm, whatever theoretical future female partner they may have will have to undergo IUI or IVF or some sort of assistive technology, so that may be contributed to the discrepancy in success rates. But I'll let Dr Lundy expand upon that.

 I think it's important to recognize that if you freeze sperm before your vasectomy, that sperm is only good enough for IVF or occasionally for intrauterine insemination, both of which are procedures that cost additional money and have variable success rates. On the other hand, a vasectomy reversal in particular allows for natural conception for these couples and avoiding any of the costs and challenges associated with IVF. A big benefit of pursuing this approach is to allow for a spontaneous pregnancy, and in many cases, multiple spontaneous pregnancies, as couples have more than 1 child down the road. It is important to know that the success rates are based upon the best available data, which admittedly is limited for this population. While I would hesitate to say that reversal is truly better in terms of efficacy, I think this data suggests that it's at least as good, with our 90 plus percent success rates with the surgery in terms of restoring sperm to the ejaculate. We then also have to consider the female factor and how old the female partner is and whether she's had children before in our decision-making as well.

This transcript was AI generated and edited by human editors for clarity.

Videos

“While I would hesitate to say that reversal is truly better in terms of efficacy, I think this data suggests that it's at least as good,” says Scott D. Lundy, MD, PhD, HCLD.

Matthew J. Mutter, MD, highlights safety and efficacy data from an investigational device exemption (IDE) trial on the Separo vessel sealing system for vasectomy procedures.

Matthew Mutter, MD, shares data on Separo vessel sealing system for vasectomy

, highlights safety and efficacy data from an investigational device exemption (IDE) trial on the Separo vessel sealing system for vasectomy procedures. Mutter is the principal investigator of the safety profile study for the device and a general urologist in New Orleans, Louisiana.

This was a single-arm trial. The end point was what it would be for a vasectomy, and that's to make a man azoospermic after the procedure. Our limited patients, our 8 patients that we did, all of them at 6 months either reached azoospermia or [had] rare, non-modal sperm, which is perfectly acceptable within the AUA guidelines for a successful vasectomy. So, our end point was reached.

I want to add that the safety profile was impeccable for this. No one experienced a [device-related] adverse event. As far as pain scores were recorded, there was only 1 pain score above a 0 throughout the duration of the study.

"I want to add that the safety profile was impeccable for this. No one experienced a [device-related] adverse event," says Matthew J. Mutter, MD. 

Bradley Roth, MS4, and Scott D. Lundy, MD, PhD, HCLD, highlight key findings from the study, “Routine Sperm Cryopreservation before Vasectomy Is Not Cost-Effective and Does Not Increase Live Birth Rates Compared to Surgical Sperm Retrieval or Vasectomy Reversal.” 

Fertility restoration may offer benefits in cost, efficacy vs sperm cryopreservation

, highlight key findings from the study, “Routine Sperm Cryopreservation before Vasectomy Is Not Cost-Effective and Does Not Increase Live Birth Rates Compared to Surgical Sperm Retrieval or Vasectomy Reversal.”

 We ran 3 types of models in the cost-effectiveness analysis, 1 being weighted in favor of cryopreservation—so, the weights that we entered into the actual mathematical model would more or less favor cryopreservation—a balanced model, which might be the most reflective of the real-world situation, and then a model that favors vasectomy reversal. In the balanced model and the vasectomy reversal model, vasectomy reversal was the more cost-effective finding, whereas the only situation in which sperm cryopreservation was more cost-effective was in the extreme situation in which the situation was weighed in favor of sperm cryopreservation, which likely is not reflective of what the real-life situation is. That, I think, is the key finding of this study. Whether or not it's surprising. I'm not sure, but I think it's a good finding to give patients more of an idea of the risks and benefits of both potential options prior to vasectomy. While sperm cryopreservation is very safe, there might be hidden costa that patients aren't aware of, both [in] the upfront costs of preserving the sperm and then the annual cost of maintaining it at a facility. I think that just shed some light on what might not be popularly known among patients.

 One of the key aspects of fertility preservation is that most of this is not covered by insurance. This is an out-of-pocket cost to anyone who decides to store their sperm, both upfront and then annually as well. The goal here is to understand whether that's worth it from a patient perspective, and secondarily, to understand whether the outcomes and the success rates are different for each approach. In this study, we found that it was more cost prohibitive to routinely bank sperm simply because very few people ultimately choose to restore fertility, and all those who don't are simply using their money for a frozen specimen that they'll never use. That costs quite a bit of money over time. What was surprising to me was that the success rates were actually higher in the group where we restored fertility, either through a vasectomy reversal or through collecting sperm to use for IVF with a minor procedure. In our models, this suggests that the outcomes, as far as success rates, are the same, if not slightly better, in the fertility restoration compared to the cryopreservation [group], which suggests that in both cost and in efficacy, the restoration might be a better choice.

“While sperm cryopreservation is very safe, there might be hidden costs that patients aren't aware of, both [in] the upfront costs of preserving the sperm and then the annual cost of maintaining it at a facility,” says Bradley Roth, MS4. 

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