Pearls & Perspectives: Expanding Options in Male Incontinence, with Laura Horodyski, MD

In this special Urology on the Beach edition of Pearls & Perspectives, host Amy Pearlman, MD, sits down with Laura Horodyski, MD, thoughtful conversation on what fellowship truly teaches, the evolving challenges of reconstructive urology, and the importance of offering patients a full spectrum of treatment options.Horodyski reflects on her fellowship with Michael Metro, MD, sharing that although surgical technique is expected, the most valuable lessons were in patient management—navigating complications, guiding patients through emotionally charged decisions, and mastering bedside communication. These “hidden curriculum” skills, she notes, often take years to develop without dedicated mentorship.The discussion transitions to practical pearls, including techniques for performing comfortable office cystoscopy—emphasizing gentle lidocaine instillation, minimal irrigation, and patient-centered distraction strategies to improve the experience.A major focus of the episode is reconstructive urology, particularly the unpredictable and long-term effects of pelvic radiation. Horodyski describes radiation as an “X factor,” noting the wide variability in tissue response and the delayed complications—such as strictures and calcifications—that may arise years after treatment. She underscores the importance of multidisciplinary collaboration with radiation oncology and ongoing patient education about potential late effects.The conversation also highlights her passion for treating male stress urinary incontinence. For Horodyski, these cases are among the most rewarding in urology due to their profound impact on quality of life. She emphasizes the importance of offering personalized options—including slings, artificial urinary sphincters, and emerging interest in adjustable continence balloons (ProACT)—so that treatment aligns with each patient’s goals and comfort level.Finally, she reflects on the value of operating alongside trusted colleagues and the strength of collaborative subspecialty practice, where shared expertise leads to innovative solutions for complex cases.This episode underscores that excellence in reconstructive urology extends beyond surgical skill—it requires empathy, adaptability, multidisciplinary partnership, and a commitment to expanding options that restore dignity and quality of life.