Urology Times Podcasts

In this episode of The UroOnc Minute, Adam B. Weiner, MD, is joined by Nikita R. Bhatt, MBBS, MCh, MMed, FRCS, to discuss the WASHOUT study, a prospective international collaboration examining outcomes among patients admitted with emergency hematuria.

In this episode of The UroOnc Minute, recorded live at the 2026 European Association of Urology Annual Congress in London, host Adam B. Weiner, MD, welcomes Maarten Albersen, MD, PhD, of University Hospitals Leuven, Belgium, for a focused discussion on the evolving molecular landscape of penile cancer. Framing the conversation around a rare but impactful genitourinary malignancy, the episode highlights both the current limitations and future promise of biomarker-driven care in a space that has historically lacked personalization.

In this episode, Adam B. Weiner, MD, sits down with Giorgio Gandaglia, MD, to discuss the ongoing controversy surrounding pelvic lymph node dissection in prostate cancer.

In this episode of The UroOnc Minute, host Adam B. Weiner, MD, is joined by Dr. Alfonso Gomez de Liaño Lista for a timely discussion on a practice-changing development in muscle-invasive bladder cancer: the phase 3 KEYNOTE-B15 trial.

In this episode of The UroOnc Minute, Adam B. Weiner, MD, speaks with Alexander Light, MBBS, about evolving strategies for salvage treatment in patients with radiorecurrent prostate cancer.

In this episode of the UroOnc Minute, Wesley Yip, MD, joins host Adam B. Weiner, MD, to discuss key takeaways from the LITESPARK-022 trial, exploring the role for adjuvant pembrolizumab plus belzutifan in patients with clear cell renal cell carcinoma.

 In this episode of Pearls and Perspectives, host Amy Pearlman, MD, is joined by Polly Rodriguez, CEO and co-founder of Unbound, for a candid and wide-ranging conversation at the intersection of sexual health, innovation, and patient advocacy. Rodriguez shares the deeply personal experience that shaped her mission: a cancer diagnosis at age 21 that led to early menopause—without warning from her care team about the profound sexual health consequences that would follow. That gap in care became the catalyst for building a company focused on accessible, body-safe, and stigma-free sexual wellness products.Together, Pearlman and Rodriguez explore the persistent disconnect between medical treatment and quality-of-life conversations, particularly when it comes to sexual health. Rodriguez reflects on how discussions during her cancer care centered on fertility but overlooked equally critical issues such as pain with sex, loss of libido, and vaginal dryness—symptoms that significantly affect long-term well-being. Pearlman builds on this by emphasizing the importance of normalizing these conversations in clinical practice, offering practical frameworks for clinicians to introduce sexual health in a way that is brief, inclusive, and non-intimidating for patients.The discussion then shifts to the broader landscape of sexual wellness, where Rodriguez outlines the challenges of building a company in a largely unregulated and stigmatized industry. She highlights gaps in safety standards, noting that many sexual wellness products are not subject to FDA oversight, and explains how Unbound prioritizes body-safe materials, affordability, and modern design. The conversation also touches on systemic disparities in how products for male vs female sexual health are marketed and regulated, underscoring the ongoing barriers to innovation and education in this space.From a clinical perspective, the episode offers practical insights into how sexual wellness products—such as lubricants and vibrators—can play a meaningful role in patient care, particularly for individuals recovering from cancer treatment or experiencing menopause-related symptoms. Rodriguez and Pearlman discuss the nuances of different product types, from water-based vs silicone lubricants to emerging technologies like suction-based stimulation, framing these tools not as luxury items but as essential components of sexual health and recovery.Importantly, the conversation expands beyond products to address the psychological and relational dimensions of intimacy. Rodriguez speaks to the process of reconnecting with one’s body after illness, while Pearlman highlights how open communication and a willingness to explore can transform partnered relationships. Both emphasize that pleasure, curiosity, and agency are lifelong aspects of health—ones that deserve the same attention and normalization as any other clinical outcome.The episode ultimately reinforces a central message: Sexual health is not ancillary to overall health—it is integral. By bridging the gap between medicine, innovation, and patient experience, Pearlman and Rodriguez advocate for a more holistic, informed, and stigma-free approach to care.

In this episode of The Expert APProach: Conversations in Uro-Oncology, host Joy Maulik, CRNP, sits down with Melissa Kestler, DNP, FNP-BC, for a thoughtful discussion centered on advanced practice provider (APP) leadership, clinical growth, and the evolving role of APPs in urologic oncology.Kestler shares her professional journey into urology, reflecting on how curiosity, mentorship, and a willingness to step outside of traditional role expectations helped shape her career. What stands out in her story is not just the acquisition of clinical skills, but the intentional development of confidence—particularly in procedural competency and independent clinical decision-making. She emphasizes that growth in this field often requires APPs to advocate for their own training opportunities while also being supported by forward-thinking physician partners.A central theme of the conversation is the importance of practicing at the top of one’s license. Kestler highlights how APPs can meaningfully expand access to care, improve efficiency, and enhance patient outcomes when they are empowered to take on more advanced responsibilities. This includes not only clinic-based care but also procedural work, care coordination, and longitudinal patient management. She underscores that this evolution is not about replacing physicians, but about strengthening the care team in a way that meets the increasing demands of modern health care.Maulik and Kestler also explore the realities of navigating complex patient populations in uro-oncology. From managing treatment adverse events to supporting patients through emotionally and physically taxing diagnoses, Kestler speaks to the depth of the APP–patient relationship. Education emerges as a recurring pillar—ensuring patients understand their disease, treatment options, and expectations is just as critical as the treatments themselves.Leadership is another key focus. Kestler discusses how APPs are increasingly stepping into leadership roles, whether formally through administrative titles or informally through mentorship, program development, and clinical innovation. She encourages APPs to seek out these opportunities, noting that leadership does not always require a title—it often begins with initiative, consistency, and a commitment to improving care delivery.The conversation also touches on interdisciplinary collaboration. Kestler reinforces the value of strong partnerships between APPs, physicians, nurses, and administrative teams, particularly in complex fields like uro-oncology where coordinated care is essential. These collaborative models not only improve patient outcomes but also help reduce provider burnout by distributing responsibilities more effectively.Ultimately, this episode paints a clear picture of a field in transition—one where APPs are no longer seen solely as support roles, but as integral contributors to both clinical excellence and healthcare innovation. Kestler’s insights serve as both a roadmap and an encouragement for APPs looking to expand their impact, reminding listeners that growth in this space is driven by curiosity, collaboration, and a willingness to lead.

In this episode of The UroOnc Minute, host Adam B. Weiner, MD, is joined by Veeru Kasivisvanathan, MBBS, MSc, PhD, FRCS, to discuss the role of biparametric vs multiparametric MRI for prostate cancer detection.

At EAU 2026, Adam B. Weiner, MD, spoke with Nikita Bhatt, MD, about the growing interest in prehabilitation to optimize patients ahead of cystectomy.

In this episode of Pearls & Perspectives, host Amy Pearlman, MD, is joined by Bishara Korkor, MS, for a forward-looking discussion on how innovation is reshaping everyday urologic care. Centered around Emano Flow, the conversation explores how a seemingly routine diagnostic tool—uroflowmetry—can be reimagined to better serve both patients and providers.What quickly becomes clear is that traditional uroflow testing, although foundational, often falls short of capturing how patients truly void in real life. The clinical setting can feel unnatural and even uncomfortable, leading to results that may not fully reflect a patient’s true physiology. Emano Flow seeks to address this gap by creating a more intuitive, patient-centered experience—one that allows individuals to void more naturally, ultimately producing more meaningful and reliable data.A major emphasis throughout the discussion is the patient experience. Urologic testing can carry a level of anxiety and awkwardness that is often underestimated. By reducing these barriers and making the process feel less clinical and more organic, patients are more at ease, more engaged, and better able to participate in their own care. This shift doesn’t just improve comfort—it enhances the quality of the diagnostic information clinicians rely on.At the same time, the conversation highlights the realities of modern practice management. Efficiency is no longer optional. With increasing demands on time and staffing, tools like Emano Flow are designed not only to improve diagnostics but also to integrate seamlessly into clinical workflows. By minimizing disruptions, reducing staff burden, and streamlining processes, the technology aligns with the broader goal of delivering high-quality care without sacrificing operational efficiency.Underlying all of this is a larger movement within urology toward more data-driven decision-making. As tools evolve to capture more accurate and actionable information, clinicians are better equipped to move beyond subjective symptom reporting and toward more precise, individualized care strategies.Of course, innovation only succeeds if it can be adopted in the real world. The discussion acknowledges that new technologies must be intuitive, clinically meaningful, and easy to incorporate into existing systems. When done right, they don’t add complexity—they remove friction.Ultimately, this episode reflects a broader shift in the field: a move toward diagnostics that are not only more accurate, but also more human-centered. Through platforms like Emano Flow, urology continues to evolve in a way that elevates both the patient experience and the efficiency of care delivery.

In this episode of The UroOnc Minute, recorded at the 41st Annual Congress of the European Association of Urology, host Adam B. Weiner, MD, connects with Giancarlo Marra, MD, of the University of Turin, Italy, to discuss a highly relevant and evolving topic in urologic oncology: transperineal vs transrectal prostate biopsy.

In this episode of The UroOnc Minute, host Adam B. Weiner, MD, speaks with Christian D. Fankhauser, MD, MPH, leader of the Urology Clinic Kantonsspital Winterthur in Zürich, Switzerland. The discussion focuses on the evolving role of biomarkers in testicular cancer, a disease that is highly curable but still poses important challenges related to treatment toxicity and long-term survivorship.

In this episode of The Expert APProach: Conversations in Uro-Oncology, the conversation expands beyond clinical care to explore leadership, advocacy, workforce evolution, and the future of independent urology.Host Joy Maulik, CRNP, sits down with Celeste Kirscher, CAE, MHSA, CEO of LUGPA, and LUGPA President Scott Sellinger, MD, FACS, who discuss how the definition of “independent practice” has evolved into a broader concept: physician-directed care. In an era of hospital consolidation and complex ownership models, LUGPA serves as a counterweight—supporting practices that remain led by physicians and focused on patient access and quality outcomes.A central theme is the widening gap between clinical work and health care policy. Most physicians, Sellinger notes, understandably prioritize patient care over reimbursement models, regulatory changes, and payer dynamics. This makes strong dyad leadership—physician and administrator working together—essential. Kirscher emphasizes that advocacy is everyone’s responsibility, even if not everyone feels comfortable engaging in it. Through structured advocacy efforts in Washington, DC, LUGPA helps clinicians translate bedside realities into policy conversations that directly affect patient access to care.The discussion also highlights the expanding role of advanced practice providers (APPs). Over the past 25 years, APP integration has grown from novel to indispensable. With workforce shortages and increasing patient demand, APPs now function across office, hospital, procedural, and leadership settings. Both guests affirm that utilizing clinicians at the top of their licensure is no longer optional—it is necessary for sustainable, high-quality urologic care.Technology and innovation round out the conversation. Artificial intelligence is expected to first transform administrative workflows—scheduling, billing, and operational efficiencies—whereas clinical AI applications in radiology, pathology, and precision oncology continue to mature. Sellinger underscores the importance of germline and somatic genetic testing in advanced prostate cancer, noting that despite clear guideline recommendations, testing remains underutilized nationwide. Expanding access to precision medicine remains a critical opportunity.Finally, Kirscher highlights LUGPA’s commitment to educating residents and early-career urologists—not only in clinical excellence but also in the business and leadership aspects of practice. The message is clear: choosing a physician-directed path does not mean going it alone.The episode closes on a powerful reminder from Sellinger about why urology remains deeply rewarding: its breadth, its diversity of patients, and—most importantly—the ability to offer meaningful solutions that improve and extend lives.This conversation reinforces that sustaining independent, physician-directed urology requires more than clinical skill—it demands advocacy, leadership development, workforce integration, and a commitment to shaping the future of health care.

In this episode, host Amy Pearlman, MD, sits down with Bruce R. Kava, MD, for a a discussion on his career path from oncologic surgery to sexual medicine, revision penile prosthetics, and cancer survivorship.

In this episode of The Expert APProach: Conversations in Uro-Oncology, host Joy Maulik, CRNP, sits down with Michael Ritmiller, PA-C, MPAS, a neuro-urology physician assistant whose career has been defined by deep clinical expertise, procedural skill, and a commitment to comprehensive, patient-centered care.Ritmiller shares his background as a Navy veteran and surgical corpsman and describes his transition into physician assistant practice, where he has spent more than 2 decades caring for patients with complex neurogenic bladder conditions. His work spans spinal cord injury, stroke, traumatic brain injury, and other neurologic disorders that profoundly affect bladder function.A major focus of the discussion is the role of video urodynamics in evaluating voiding dysfunction. Ritmiller explains how advanced urodynamic testing allows clinicians to assess not only bladder pressures and flow, but also bladder anatomy, sphincter coordination, reflux, and long-term risk to the upper urinary tract. He emphasizes that voiding dysfunction is often neurologic in origin and reflects impaired communication between the brain, spinal cord, and bladder rather than a purely urologic problem.The conversation explores how he formulates individualized treatment plans by evaluating the patient as a whole—incorporating neurologic exam findings, caregiver input, functional status, cognition, and risk factors. Management strategies may include medications, intermittent catheterization, Botox injections, urethral bulking agents, suprapubic tube placement, or staged procedural interventions, with careful attention to safety, bleeding risk, autonomic dysreflexia, and patient education.Ritmiller also provides a nuanced discussion of urinary tract infections in neurogenic patients, highlighting the importance of symptom-based treatment rather than relying solely on urine cultures. He outlines his approach to recurrent infections, reflux-associated risk, and advanced management options such as intravesical gentamicin instillations for select patients.Beyond clinical care, the episode highlights the evolving role of advanced practice providers in urology. Ritmiller advocates for APPs practicing at the top of their license to address workforce shortages, reduce burnout, and improve access to high-quality care. He reflects on the importance of mentorship, humility, lifelong learning, and institutional support in developing procedural confidence and subspecialty expertise.The conversation concludes with a shared emphasis on team-based care, professional growth, and the impact that empowered APPs can have on patients, practices, and communities.

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.

In this special Urology on the Beach edition of Pearls & Perspectives, host Amy Pearlman, MD, sits down with Emad Ibrahim, MD, HCLD, to tackle a topic that is both critically important and routinely overlooked: sexual and reproductive health in patients with spinal cord injury.

In this episode, Amy Pearlman, MD, speaks with Phillip M. Pierorazio, MD, about integrating mindfulness and wellness into a demanding surgical career and the evolving complexities of modern prostate cancer care.

In this episode of The UroOnc Minute, host Adam B. Weiner, MD, is joined by Brian M. Shuch, MD, associate professor of urology at the University of California, Los Angeles and a nationally recognized expert in kidney cancer, for a concise yet wide-ranging update on the evolving role of adjuvant therapy in renal cell carcinoma (RCC).

In this special Urology on the Beach edition of Pearls & Perspectives, host Amy Pearlman, MD, speaks with Thomas Masterson, MD, assistant professor of clinical urology at Desai Sethi Urology Institute in Miami, Florida, about emerging tools and evolving concepts in male infertility and men’s health, with a focus on what lies beyond the traditional semen analysis.Masterson explains that although semen analysis remains the cornerstone of male fertility evaluation, it only assesses external sperm characteristics—concentration, motility, and morphology—and provides limited insight into the genetic integrity of sperm. DNA fragmentation testing offers a window into the quality of the DNA carried by sperm and may help identify potentially correctable contributors to recurrent pregnancy loss, repeated in vitro fertilization failure, and cases of unexplained infertility.The conversation explores the growing role of at-home semen testing kits as screening tools, their advantages in accessibility and privacy, and their limitations compared with in-lab testing—particularly for detecting very low sperm counts and accurately assessing motility. Masterson emphasizes the importance of establishing a baseline semen analysis in men considering or already receiving testosterone therapy, as exogenous testosterone commonly suppresses sperm production and can complicate later fertility evaluation.Pearlman and Masterson also discuss advanced paternal age, noting that although men can produce sperm throughout life, sperm quality may decline over time, with small increases in risks such as autism and certain genetic conditions. Options such as sperm cryopreservation are reviewed as a consideration for select men, particularly those facing gonadotoxic therapies.Beyond fertility, the episode touches on erectile function as a general marker of health, the limitations of using morning erections as a diagnostic tool, and the broader need to normalize conversations around male sexual health. The discussion closes with reflections on gender differences in health-seeking behavior and the importance of creating spaces that encourage men to engage more openly in discussions about sexual and reproductive health.

In this special Urology on the Beach edition of Pearls & Perspectives, host Amy Pearlman, MD, sits down with Gerard Henry, MD, to reflect on more than 2 decades of progress in penile prosthetics and how meticulous technique, data collection, and innovation—often driven from private practice—have reshaped infection prevention and device outcomes. Henry recounts his early work demonstrating that bacteria are commonly present even in clinically “uninfected” penile implant revisions and how revision washout protocols dramatically reduced infection rates, helping establish what is now standard of care. He shares longitudinal data showing a steady decline in culture-positive bacteria over the past 40 years and discusses emerging research comparing traditional cultures with DNA-based testing, which may reveal organisms missed by standard methods.The conversation explores evolving strategies that have further lowered infection risk, including no-touch principles, chlorhexidine skin preparation, antibiotic and customizable implant coatings, and growing interest in antiseptic-based solutions rather than antibiotics alone. Henry emphasizes that gram-negative organisms, particularly Pseudomonas, are more commonly implicated than historically taught, underscoring the need to rethink antimicrobial targeting.Beyond infection prevention, Henry highlights practical surgical innovations such as the “mummy wrap” and finger-sweep dissection, along with the importance of maintaining long-term clinical databases to generate meaningful real-world evidence. He advocates for innovation within private practice, encouraging clinicians to start with procedures they perform most often, systematically collect data, and consider intellectual property development through patents.The episode closes with a look toward future technologies, including Henry’s work on seal-based vasectomy using ligation energy technology, and a broader discussion of how cross-pollination from other specialties can inspire the next generation of urologic advances.

In this special Urology on the Beach edition of Pearls & Perspectives, host Amy Pearlman, MD, sits down with Raveen Syan, MD, FPMRS, to discuss the rapidly evolving landscape of female pelvic medicine and reconstructive surgery, with a focus on overactive bladder, voiding dysfunction, and patient-centered innovation.Syan shares how she designs real-world case discussions that mirror the longitudinal nature of urologic care, emphasizing that many patients require ongoing management rather than one-time fixes. She reflects on what she learns from moderating expert panels, including how leaders in the field evaluate emerging technologies, interpret new data, and individualize decisions around medical vs procedural therapies.The conversation highlights the steady pace of innovation in urogynecology, from onabotulinumtoxinA and sacral neuromodulation to improvements in device technology and implantable neuromodulation options. Syan explains how updated American Urological Association/ Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction guidelines now allow clinicians to move directly to minimally invasive therapies without requiring medication trials, a shift that better aligns with patient preferences and avoids the adverse-event burden of anticholinergics.They also explore why so many patients with urinary incontinence remain untreated, pointing to lack of awareness, stigma, and limited screening in primary care. Syan underscores the importance of education and outreach, particularly in underserved populations, and notes that patients today are increasingly informed and engaged in shared decision-making.The episode closes with a personal reflection on surgeon wellness, the value of developing interests outside of medicine, and how embracing discomfort through new hobbies can build resilience—both in life and in the operating room.

In this episode of First Assist: GU Oncology Unpacked, host Taylor Goodstein, MD, is joined by Katie S. Murray, DO, MS, professor of urology at New York University Grossman School of Medicine chief of the Urology Service at Bellevue Hospital Center, New York, New York, for a comprehensive, case-based discussion on modern testicular cancer management, with a focus on thoughtful risk stratification, multidisciplinary collaboration, and surgical judgment in challenging clinical scenarios.Murray walks through key principles in evaluating patients with seminoma and nonseminomatous germ cell tumors, including how tumor markers, histology, and pre-chemotherapy imaging shape treatment pathways. She highlights the unique role of PET imaging in the post-chemotherapy seminoma setting, where surveillance can often be safely pursued, while reinforcing why surgery remains essential for residual disease in nonseminomatous tumors.The conversation explores complex post-chemotherapy decision-making, including how to interpret residual masses, when observation may be appropriate, and how intraoperative assessment can influence the extent of resection. Murray shares practical insights into surgical planning, lymph node template selection, management of pelvic and low retroperitoneal disease, and strategies to minimize vascular and bowel complications.Beyond operative technique, the episode addresses patient counseling, including expectations around fertility, anejaculation, and postoperative complications such as chyle leak. The discussion also covers high-stakes scenarios such as desperation RPLND, emphasizing that these cases require multidisciplinary consensus, careful imaging review, and an all-or-none surgical approach.Murray closes with advice for trainees and practicing clinicians alike: Know the guidelines, prepare deliberately for each case, and never manage testicular cancer in isolation. With its blend of technical pearls and big-picture perspective, this episode offers practical guidance for clinicians caring for patients across the full spectrum of testicular cancer.

In this episode of Pearls and Perspectives, host Amy Pearlman, MD, sits down with Ariana L. Smith, MD, to explore how clinicians navigate evidence gaps, evolving guidelines, and emerging innovation in overactive bladder care.

In this special Urology on the Beach edition of Pearls and Perspectives, host Amy Pearlman, MD, sits down with Mark L. Gonzalgo, MD, PhD, MBA, to discuss his recent appointment as chair of the Department of Urology at the University of Miami and his vision for leading a large academic urology department. Gonzalgo shares how the role has shifted his daily focus toward supporting faculty, trainees, and patients, emphasizing that advocacy is one of the most important responsibilities of a department chair.The conversation then turns to prostate cancer screening and second opinions, particularly in men with rising prostate-specific antigen (PSA) levels who may be considering testosterone therapy. Gonzalgo highlights the importance of baseline PSA testing, individualized risk assessment, and thoughtful, evidence-based evaluation before initiating testosterone, underscoring the value of informed patient counseling and comprehensive workup.Gonzalgo also explores how prostate cancer diagnosis and management continue to evolve, including the growing role of molecular testing, advanced imaging, and emerging blood-based biomarkers. He stresses that new technologies should be adopted only when supported by high-quality clinical trial data, ensuring safety, accuracy, and real-world benefit for patients.The episode concludes with a discussion of the collaborative energy and educational value of Urology on the Beach, and why meetings like this remain critical for staying current in a rapidly changing field.

In this episode of The UroOnc Minute, host Adam B. Weiner, MD, speaks with Stephen J. Freedland, MD, about the role of diet and nutrition in prostate cancer risk and outcomes.

In this episode of The Expert APProach: Conversations in Uro-Oncology, host Joy Maulik, CRNP, sits down with Jennifer Bepple, MD, MMCi—a dual board-certified urologist and informaticist—to explore how digital health, artificial intelligence (AI), and data-driven innovation are reshaping urologic care. Bepple brings a pragmatic, patient-first lens to technology, emphasizing that meaningful innovation starts not with shiny tools, but with real clinical problems that demand better solutions.Bepple reframes AI as a broad umbrella rather than a single solution, cautioning against buzzwords while highlighting its potential to streamline workflows, restore human connection, and return clinicians’ focus to patients. Rather than replacing providers, she advocates for a “centaur model” of care—where clinicians remain the decision-makers and technology serves as the engine supporting efficiency, access, and safety.A central theme of the conversation is access to care. Bepple discusses how digital health tools, including telehealth and AI-enabled workflows, can meet patients where they are—geographically, socially, and emotionally—while reducing no-show rates and improving continuity of care. She challenges the notion that technology makes medicine impersonal, arguing instead that it can help clinicians reclaim the relational aspects of care that have been eroded by administrative burden.The discussion also spotlights the evolving and expanding role of advanced practice providers (APPs). Bepple emphasizes APP subspecialization, leadership development, and inclusion in operational, strategic, and business decisions as essential solutions to workforce shortages and fragmented care. She underscores the importance of maximizing every provider to the top of their license and fostering cultures rooted in mutual respect, autonomy, and shared purpose.Closing the episode, Bepple offers practical advice for APPs interested in leadership or digital health: start with the problem that keeps you thinking, not the technology itself. She encourages clinicians to stay technologically literate, critically evaluate digital tools for safety, value, and scalability, and expand their professional networks beyond traditional silos.This episode delivers an empowering, forward-looking conversation on how APPs and physicians alike can lead healthcare transformation—by staying curious, embracing innovation thoughtfully, and keeping patients at the center of every solution.

In this episode of Pearls & Perspectives, Amy Pearlman, MD, sits down with Nicoletta Heidegger, MA, MEd, LMFT, a certified sex therapist, licensed marriage and family therapist, educator, and host of the award-nominated podcast Sluts and Scholars. Their conversation bridges sexual medicine and sex therapy, offering urologists and clinicians practical insight into how multidisciplinary collaboration can dramatically improve patient care and sexual outcomes.Why sex therapy matters in urologyHeidegger emphasizes that sexual concerns are almost never purely biological or purely psychological—they are biopsychosocial. Although urologists play a critical role in diagnosing and managing physical contributors (hormones, pain, medications, anatomy), sex therapists address shame, trauma, communication, desire, and relationship dynamics that often determine whether treatment succeeds.Key clinical takeawaysPatients want to talk about sex—they just need permission. Even clinicians receive limited sexual health training, making proactive, curious questioning essential.Anatomy education is foundational. Many patients have never learned basic sexual anatomy or seen accurate models of structures like the clitoris, contributing to misinformation, frustration, and poor outcomes.Pain should never be normalized. Outside of consensual kink, sexual pain should always be taken seriously and addressed collaboratively.Sex therapy is not “it’s all in your head.” Framing referrals as part of comprehensive care—not a dismissal—improves patient acceptance and outcomes.Who should be referred to a sex therapist?Heidegger notes that sex therapy can benefit:• patients with persistent sexual pain or dysfunction• individuals struggling with desire, arousal, orgasm, or anxiety around sex• couples with mismatched desire or communication issues• patients navigating gender, orientation, trauma, or shame• individuals or couples who want to proactively improve pleasure and intimacy.Desire, libido, and common mythsThe episode challenges several pervasive myths:• Libido is not simply “high” or “low.”• Many people experience responsive (not spontaneous) desire.• Needing lube, toys, or medication does not mean lack of attraction.• Orgasms and pleasure look different for every body and every relationship.Delayed ejaculation and male sexual performanceHeidegger and Pearlman explore delayed ejaculation, noting contributors such as:• conditioning from self-pleasure that doesn’t translate to partnered sex• performance pressure and partner expectations• medications (e.g., SSRIs)• pelvic floor tension and anxiety.Solutions include normalizing diverse orgasm pathways, adjusting self-stimulation patterns, reducing outcome pressure, and improving communication.Safer sex, STI disclosure, and communicationThe conversation highlights:• the importance of comprehensive STI testing (including oral and rectal sites)• normalizing STI discussions and moving away from shame-based language• giving patients scripts for disclosure and consent conversations• introducing frameworks like the STARS model (Safety, Turn-ons, Avoids, Relationship expectations, STI status).Sexual technique and skill-buildingGood sex is not about being “good at sex”—it’s about attunement, curiosity, and feedback. Heidegger shares resources for skill-building, including:• educational platforms (e.g., OMGYES, Pleasure Mechanics, Beducated)• sex coaching and workshops• somatic sex education (where legally available).Equine-assisted therapyHeidegger also discusses her work with equine-assisted therapy, using horse-human interactions to help patients develop boundaries, communication, nervous system regulation, and relational awareness—skills that translate directly into intimacy and sexual relationships.Bottom line for cliniciansThis episode reinforces that:• No single provider can (or should) address every aspect of sexual health.• Collaboration between urology and sex therapy leads to better, more sustainable outcomes.• Empowering patients with education, language, and referrals is a form of care—not abdication.Chapters2:22 How Heidegger got into the field7:01 Talking about anatomy with patients10:11 Who should see a sex therapist?27:03 Talking about sex30:18 Discussing STIs48:41 Dispelling myths56:34 How to direct patients on having better sex

In this episode, Jeremy Y.C. Teoh, MBBS, FRCSEd (Urol), FCSHK, FHKAM (Surgery), joins host Adam Weiner, MD, to discuss the evolving role of en bloc resection of bladder tumor (ERBT) in the management of non–muscle-invasive bladder cancer (NMIBC).

In this episode, Timothy Daskivich, MD, joins host Adam Weiner, MD, to discuss survivorship and long-term quality-of-life considerations in prostate cancer care.

In this episode, Farnoosh Nik-Ahd, MD, joins host Adam Weiner, MD, to discuss emerging guidance on prostate cancer screening in transgender women.

In this episode of First Assist: GU Oncology Unpacked, host Taylor Goodstein, MD, welcomes back Pretesh Patel, MD, associate professor of radiation oncology at Emory University, for an in-depth discussion on the evolving role of radiation therapy across the spectrum of advanced prostate cancer. Building on their prior conversation about localized disease, Patel focuses on treatment intensification, post-prostatectomy management, and the expanding role of metastasis-directed therapy.The conversation opens with emerging evidence supporting triplet therapy—radiation, androgen deprivation therapy (ADT), and abiraterone acetate (Zytiga)—for very high-risk localized prostate cancer. Patel explains how data from STAMPEDE have influenced practice patterns, leading to closer collaboration with medical oncology and more frequent use of systemic intensification alongside dose-escalated radiation.The discussion then shifts to the post-prostatectomy setting, where recent trials have reshaped the adjuvant vs early salvage radiation debate. Patel outlines how PSA kinetics, imaging, and modern PSMA-PET scanning inform decision-making, while emphasizing that early salvage radiation remains beneficial even when PET imaging is negative. The role of genomic classifiers is explored, particularly in guiding decisions around adding ADT to salvage radiation, though prospective predictive data are still evolving.A significant portion of the episode is dedicated to oligometastatic and oligoprogressive disease. Patel reviews how SBRT is increasingly used to treat limited metastatic lesions, delay systemic therapy, and preserve quality of life. He highlights practical considerations, including patient selection, bone health, fracture risk, and the balance between local control and systemic disease management. The nuances of treating nodal-only recurrence and comprehensive nodal irradiation are also addressed, supported by emerging randomized data.The episode concludes with a forward-looking discussion on innovations shaping radiation oncology, including PSMA-guided treatment planning, AI-driven prognostic tools, and the growing role of radioligand therapy such as lutetium-177 PSMA. Patel emphasizes the importance of multidisciplinary collaboration as imaging, systemic therapies, and radiation techniques continue to converge.This episode offers practical insights for clinicians navigating complex prostate cancer cases and underscores how precision imaging and tailored radiation strategies are redefining care for patients with advanced disease.Chapters0:38 Triplet therapy for high-risk localized disease3:48 Salvage vs adjuvant radiation therapy13:52 Radiating a prostatectomy bed vs radiating a prostate17:13 PSMA-PET21:34 Oligometastatic disease33:12 Bone health

In this episode of Pearls & Perspectives, host Amy Pearlman, MD, sits down with Emad Ibrahim, MD, HCLD, associate professor of Urology & Neurological Surgery, director of the Clinical Andrology Laboratory, and director of the Male Fertility Research Program of The Miami Project to Cure Paralysis. With over 20 years of experience, Ibrahim offers an unparalleled look into the intersection of male fertility, sexual health, and spinal cord injury—an area where few clinicians have specialized training.Ibrahim explains the unique challenges men face after spinal cord injury, including neurogenic erectile dysfunction, ejaculatory dysfunction, and particularly the distinctive sperm abnormalities seen in this population (high counts but low motility/viability). He walks through the stepwise approach used in his program—from specialized vibratory stimulation devices to office-based electroejaculation—highlighting how these techniques can reliably produce ejaculates for fertility use without the need for surgery.A major portion of the conversation centers on his cutting-edge research, including a $3.25M Department of Defense grant studying probenecid as a treatment to reduce inflammasome-driven sperm dysfunction in spinal-cord-injured men. He also discusses the difficulty of recruiting patients for double-blind trials and the promise this work holds for transforming future care.The episode also dives into:• how spinal cord injury affects sexual function differently in men vs women• practical guidance for primary care and urology clinicians on counseling these patients• the use of vibratory devices (including the Ferticare and Viberect Pro)• the role of electroejaculation and how few providers are trained to perform it• cryopreservation workflows, including infectious disease requirements and coordination with IVF centers• the impact of lifestyle factors like heat exposure• counseling men on testosterone therapy, vasectomy, and age-related fertility• why in-lab semen analysis is far more reliable than at-home testing• the future of reproductive medicine, including prepubertal testicular tissue preservation.Ibrahim emphasizes the importance of awareness: many men with spinal cord injury are never told that fertility and sexual function support is available. His program is designed not just to provide options—but to provide hope.Chapters2:55 Ibrahim's clinical journey11:03 Offering sexual/fertility services to patients with spinal cord injuries19:29 Devices Ibrahim offers to patients31:34 Device use in patients without spinal cord injury41:28 Cryopreservation49:26 Saunas/hot tubs and sperm count

In this inaugural episode of The UroOnc Minute from Urology Times, host Adam Weiner, MD, sits down with Michael S. Leapman, MD, MHS, associate professor of urology at Yale School of Medicine, to discuss evolving approaches to active surveillance in prostate cancer, particularly among patients with intermediate-risk disease.

In this debut episode of The UroOnc Minute, host Adam Weiner, MD, a urologic oncologist and surgeon-scientist at Cedars-Sinai Medical Center, introduces listeners to a new Urology Times podcast designed for busy clinicians who want concise, high-impact insights into genitourinary oncology.

In this inspiring episode of The Expert APProach, host Joy Maulik, CRNP, sits down with Tricia Zubert, APRN, CNP, one of the nation’s most respected advanced practice providers (APPs) in sexual medicine and male infertility. With nearly 20 years of experience at Park Nicollet Health Services in Minneapolis, Minnesota, Zubert shares the story behind her career, the evolution of her clinic, and the critical role APPs now play in reproductive and sexual health.Zubert recounts how she transitioned from family medicine into sexual health after taking time off to raise her children—and how a forward-thinking urology team encouraged her to join a field that was rapidly evolving. What began as a leap of faith became a deeply fulfilling career centered on high-touch, emotionally sensitive, whole-person care.She describes the unique multidisciplinary model at her clinic, which began 45 years ago with a nurse practitioner and psychologist and has since expanded to include urologists, APPs, therapists, and collaborative genetic counseling. This “village model” allows the team to provide seamless, integrative, and emotionally attuned care to patients and couples navigating infertility, sexual dysfunction, psychological challenges, and complex hormonal changes.Throughout the conversation, Zubert highlights the expanding technological and clinical landscape—from laser therapies and Testopel to emerging female sexual health interventions and menopausal care. She underscores the need for more clinicians (especially APPs) to step into this space, noting the growing demand and the shortage of specialists trained in menopause, sexual dysfunction, and male infertility.Zubert also reflects on the evolving leadership role of APPs in urology. She explains how collaboration, trust, and mutual respect among multidisciplinary teams enable APPs to practice at the top of their licensure—often leading consultations, managing complex care, conducting follow-ups, preparing patients for surgery, and even co-leading educational programs at the national level.She emphasizes that APP leadership begins with advocacy, education, and the confidence to request training opportunities, contribute expertise, and help shape clinic models that optimize access and patient experience.Other topics explored include:• how couples navigate the emotional intensity of infertility• the psychological dimensions of Peyronie disease and sexual dysfunction• the growing visibility of menopause care and the urgent need for trained providers• the impact of cancer treatments on fertility and sexual function• guiding patients through misinformation and digital health content• why APP-led education is essential for the future of urology.With warmth, authenticity, and passion, Zubert offers a masterclass in what empathetic, patient-centered sexual health care looks like—and how APPs can transform the landscape through collaboration, curiosity, and leadership.

In this special episode of Pearls & Perspectives, recorded live at the 26th Annual Fall Scientific Meeting of the Sexual Medicine Society of North America in Grapevine, Texas, host Amy Pearlman, MD, brings together an energetic cohort of researchers working with Mohit Khera, MD, MBA, MPH. Each trainee highlights cutting-edge work poised to reshape how clinicians diagnose, counsel, and treat patients in sexual and reproductive medicine.Key Research Highlights1. The Androgen Receptor and Individualized Testosterone TherapyNelson Mills (Rice University) Mills presents compelling early data showing that men with longer androgen receptor (AR) gene lengths may require much higher testosterone levels to feel symptomatically normal. These patients often appear “eugonadal” by labs but feel hypogonadal clinically. AR length testing (via simple PCR) could one day guide personalized TRT dosing.Why it matters: This may fundamentally shift T-therapy from lab-based to receptor-based decision-making.2. Genetic Insights & Device Innovation in Peyronie DiseaseArnaav Walia (Rutgers MS3) His work with Khera explores:• genetic predisposition to Peyronie disease and predictors of response to collagenase clostridium histolyticum (CCH, Xiaflex).• early-phase trials using radiofrequency energy to stimulate superficial tissue vasculature and improve curvature.Why it matters: Brings precision medicine and device-based therapy into earlier stages of Peyronie’s care.3. Using CCH During the Active Phase of Peyronie DiseasePeyton Coady (University of Tennessee, MS3)A retrospective cohort shows patients treated with CCH during the active phase achieve similar outcomes to those treated in the stable phase.Why it matters: This counters traditional guidelines urging clinicians to “wait for stabilization”—a recommendation patients understandably despise.4. Rethinking Azoospermia: Finding Hidden Sperm With AIBlair Stocks, MD, PhD (Baylor College of Medicine [BCM] faculty) and Aidan Boyne (BCM MS3)Using high-speed flow cytometry imaging and a customized AI algorithm, the team identifies sperm in men previously diagnosed as azoospermic. Manual review of samples can take 8 hours—AI processes images in milliseconds. Early findings: 40% of men labeled azoospermic actually have viable sperm present.Why it matters: This could dramatically alter fertility counseling, offer hope to thousands, and reduce unnecessary invasive procedures.5. High-Frequency Ultrasound for ED & Testicular MappingAnother project uses high-resolution testicular and penile ultrasound to:• identify micro-regions of sperm production for targeted retrieval • detect early vascular changes that may predict future erectile dysfunction—and potentially cardiovascular disease.Why it matters: May become a noninvasive screening tool for infertility and systemic vascular health.Why This Matters for Clinicians and PatientsThis vibrant research group is addressing persistent clinical frustrations:• Why do some men need “high-normal” T levels?• Can we intervene earlier in Peyronie disease?• Are we missing viable sperm in men told they have none?• Can imaging or genetics help us personalize therapy?Across the board, their work offers answers that could transform guidelines, reduce invasive procedures, improve diagnostic accuracy, and empower clinicians with more personalized tools.

In this dynamic episode of Pearls & Perspectives, recorded live at the 26th Annual Fall Scientific Meeting of the Sexual Medicine Society of North America in Grapevine, Texas, host Amy Pearlman, MD, sits down with Ryan Griggs, DO, a fellowship-trained urologist specializing in men’s health at Monterey Men’s Health and Salinas Valley Urology. Together, they explore some of the hottest debates and most exciting innovations in urology today — from penile implant infection prevention to next-generation vasectomy technology.Griggs opens up about what it’s like to be “on the hot seat” at major conferences, facing tough questions from peers after presenting research that challenges long-held surgical practices. His latest work compares antibiotic vs antiseptic irrigation protocols in penile implant surgery—a topic that has divided the field. With antibiotic resistance rising and antiseptics showing promise in lab and clinical settings, Griggs argues it’s time to re-evaluate tradition and embrace science-backed change.The conversation then pivots to another innovation: a “seal vasectomy” procedure in development with Signati Medical. Unlike standard techniques that require a scrotal incision, this new method uses a proprietary handpiece to seal and excise the vas deferens through the skin—no cutting, no poking, and minimal discomfort. Early clinical results are promising, showing complete success and no wound complications. The device is now moving through the FDA process, with the potential to redefine how vasectomies are performed and make the procedure more accessible across practice settings.Pearlman and Griggs also tackle the real-world challenges of innovation—from surgeon comfort zones and patient perceptions to equipment logistics in private practice. Griggs notes that true change in urology often comes from patient demand.Before wrapping, Griggs gives a glimpse into his next research focus—exploring alternative fill solutions for penile implants. Working with Gerard Henry, MD, and Edward Karpman, MD, he’s studying an antiseptic-infused implant fill designed to reduce infection risk, drawing inspiration from what he calls the “Kinder Egg effect.” Early findings show the approach is safe for the device and may alter the biofilm environment around implants, potentially lowering complications in revision surgeries.Chapters1:41 Penile implant infection7:19 "Seal vasectomy" procedure14:32 Filling penile implants with alternative substances

In this energizing episode of Pearls & Perspectives, recorded live at the 26th Annual Fall Scientific Meeting of the Sexual Medicine Society of North America in Grapevine, Texas, host Amy Pearlman sits down with Mohit Khera, MD, MBA, MPH, past president of the Society and one of the leading voices in men’s and women’s sexual health. Together, they unpack the latest research, insights, and philosophy driving the future of hormonal medicine and preventive health.Khera reflects on the behind-the-scenes effort that goes into building a national meeting like SMSNA and gives credit to Petar Bajic, MD, and the organizing team for curating a record-breaking year of content and abstracts. His own research group contributed over 20 presentations, covering topics from testosterone and Peyronie disease to muscle mass, metabolism, and sexual function.A key highlight of the discussion is the emerging research on testosterone in women, an area long underfunded and under-studied. Khera explains his collaborations with Gabrielle Lyon, MD, and Louise Newsom, BSc(Hons) MBChB (Hons) MRCP FRCGP Dhealth, exploring how muscle mass predicts sexual function, and why testosterone’s benefits on energy, mood, bone, and muscle extend far beyond men.The conversation broadens into the concept of “healthspan vs. lifespan.” Khera emphasizes that the goal of medicine should be living well—not just living longer—and that preserving muscle and bone strength through diet, exercise, sleep, and stress management is central to healthy aging.Pearlman and Khera dive into the next phase of medicine, where lifestyle modification becomes the true front line of prevention—before prescriptions or procedures. Khera calls it “Medicine 3.0”: preventing low testosterone, diabetes, heart disease, and sexual dysfunction through proactive, evidence-based lifestyle change.In a memorable exchange, Khera notes that sexual health can be a “gateway” to broader wellness for men—patients who might ignore hypertension or diabetes often take action when it comes to improving sexual performance.The episode closes with passion and purpose: a call to clinicians and listeners alike to prioritize lifestyle, maintain muscle and bone, and focus on healthspan—living stronger, longer, and better.

In this episode of First Assist: GU Oncology Unpacked, host Taylor Goodstein, MD, sits down with Pretesh Patel, MD, associate professor of radiation oncology at Emory University, for an in-depth conversation about modern approaches to radiation therapy in prostate cancer. Patel breaks down complex terminology, evolving technologies, and patient-centered strategies for delivering precise, effective, and individualized radiation care.The discussion begins with an overview of radiation modalities — from external beam radiation (IMRT, SBRT/SABR, proton therapy) to brachytherapy (LDR and HDR). Patel explains how imaging advances, fiducial markers, and rectal spacers have made treatments safer and more accurate, and how hypofractionation—fewer sessions with higher daily doses—has become standard for many prostate cancer patients.Goodstein and Patel explore how image guidance and adaptive radiation planning have revolutionized precision, even allowing real-time treatment plan adjustments. They also discuss patient experience, outlining what to expect from fiducial placement to simulation scans and the short, painless daily treatments that define SBRT.Patel highlights how biologic factors like the prostate’s low alpha-beta ratio make it especially responsive to higher-dose, shorter-course radiation. He details patient-specific considerations—such as urinary function, prostate size, and median lobe anatomy — that help determine whether external beam, brachytherapy, or combination therapy is best.As the conversation deepens, Patel outlines treatment paradigms for different risk groups:Low-risk: active surveillance preferred; if treated, short-course SBRT or brachytherapy without ADTFavorable intermediate-risk: radiation alone often sufficientUnfavorable intermediate-risk: radiation plus 4 to 6 months of ADT, guided by genomic and AI-based classifiers like Decipher and ArteraAI.High-risk: combination approaches—brachytherapy boost plus external beam—and longer-term ADT (18 to 36 months).Patel shares insight into ADT decision-making, comparing GnRH agonists and antagonists, discussing cardiac considerations, flare effects, and recovery timelines.The episode concludes with an honest conversation about toxicities and survivorship—urinary and sexual function, bowel changes, and the dramatic reduction in rectal injury seen with modern imaging and rectal spacers. Patel emphasizes the importance of shared decision-making, balancing cancer control with quality of life, and integrating patient priorities into every step of radiation planning.Chapters00:22 Defining radiation in prostate cancer6:44 IGRT guidance12:30 The patient's experience with radiation21:27 When hypofractionation is not recommended28:10 Risk groups35:15 Timing of ADT40:10 High-risk prostate cancer52:31 Timing of sexual dysfunction

In this episode of Pearls & Perspectives, host Amy Pearlman, MD, sits down with Alexander Tatem, MD, a fellowship-trained urologist specializing in men’s health and prosthetic urology, live from the 26th Annual Fall Scientific Meeting of the Sexual Medicine Society of North America in Grapevine, Texas. The two dive into the evolving landscape of urologic collaboration, innovation, and mindset — from empowering advanced practice providers to addressing imposter syndrome and expanding the boundaries of Peyronie disease treatment.Tatem shares his experience attending the Women in Prosthetic Urology event, where his physician assistant, Kristen Gumpf, PA-C, served on a panel celebrating diversity and mentorship in a historically male-dominated subspecialty. He reflects on how essential women and advanced practice providers have become in men’s health practices — not just as team members, but as leaders driving clinical and cultural change.The conversation takes an introspective turn as Pearlman and Tatem discuss imposter syndrome, a challenge often associated with women in medicine but one that transcends gender. Tatem shares how he combats self-doubt by focusing on patient outcomes, team collaboration, and continuous learning rather than external comparisons.They also explore how APPs can practice at the top of their license, contributing meaningfully to research, education, and patient outreach. Together, they advocate for a more inclusive and transparent dialogue about professional growth and self-confidence within urology.Switching gears, Tatem discusses his latest research on treating ventral curvature in Peyronie disease using collagenase clostridium histolyticum (Xiaflex)—a study showing that outcomes can be both safe and effective, challenging long-held assumptions from earlier clinical trials. He emphasizes that ventral injections, when performed carefully, should be accessible to trained urologists across practice settings, not just tertiary centers.The episode closes on a personal note as Tatem shares his upcoming professional milestones, ongoing innovations in the penile implant space, and his plans to take his children to see The Lion King—a reminder that while urology is about restoring connection and intimacy for patients, maintaining relationships outside of the clinic is just as vital.

At the 2025 Sexual Medicine Society of North America meeting in Grapevine, Texas, urologist Amy Pearlman, MD, spoke with Hans-Jürgen Gruss, MD, chief medical officer of a US- and UK-based biotech company developing a new investigational therapy for premature ejaculation (PE).Gruss explained that his interest in the field stemmed from decades of clinical research focused on quality-of-life disorders in urology. Premature ejaculation, affecting an estimated 6%–8% of men, remains a significant unmet need—particularly in the United States, where no treatment has received Food and Drug Administration approval. Existing strategies, such as topical delay sprays, pelvic-floor therapy, and off-label antidepressants, often yield inconsistent outcomes or undesirable side effects.The company’s candidate, KH-001, is derived from a plant long used in traditional South African medicine. The active alkaloid targets the serotonin transporter, acting through the same molecular pathway as selective serotonin reuptake inhibitors (SSRIs) but with distinct pharmacologic advantages. Preclinical and early clinical findings indicate that KH-001 binds selectively and with high potency to the serotonin receptor without affecting other central nervous system targets, suggesting a potentially improved safety profile.Unlike conventional SSRIs, which require chronic daily use to achieve efficacy, KH-001 has demonstrated rapid absorption and clearance in healthy volunteers, enabling an on-demand dosing approach. Men would take the oral therapy approximately 15 minutes before sexual activity, with no accumulation or prolonged systemic exposure. The goal is to offer a treatment that minimizes long-term adverse effects while delivering consistent, time-specific efficacy.The pathway toward FDA approval presents both opportunities and challenges. Because the United States lacks an approved PE therapy, regulators must first define meaningful clinical endpoints. Gruss emphasized the importance of establishing consensus on outcome measures, such as intravaginal ejaculation latency time and patient-reported satisfaction, as well as refining patient-selection criteria. Internationally, dapoxetine—an SSRI approved in more than 60 countries—provides a regulatory precedent, though it has not been licensed in the US due to efficacy-threshold questions.Both experts noted that defining sexual dysfunction by strict timing thresholds oversimplifies a highly variable experience. Individual expectations, partner dynamics, and situational factors all influence how men perceive their sexual performance. More flexible, patient-centered endpoints may better capture meaningful improvements in intimacy and quality of life.If successful in clinical development, KH-001 could represent a first-in-class, plant-derived, fast-acting oral therapy designed specifically for premature ejaculation. Its introduction would fill a long-standing therapeutic gap and expand the landscape of men’s sexual-health options beyond current behavioral or off-label pharmacologic approaches.References:  Kanna Health. Kanna Health announces FDA and MHRA approvals to begin its Phase 1 clinical trial for the development of KH-001 as first FDA-approved treatment for premature ejaculation. BioSpace. Published November 16, 2023. Accessed October 14, 2025. https://www.biospace.com/kanna-health-announces-fda-and-mhra-approvals-to-begin-its-phase-1-clinical-trial-for-the-development-of-kh-001-as-first-fda-approved-treatment-for-premature-ejaculation Martijn Vosbergen. Premature Ejaculation. SMSNA. Published 2025. Accessed October 14, 2025. https://www.smsna.org/patients/conditions/premature-ejaculation

At the 2025 Sexual Medicine Society of North America (SMSNA) meeting in Grapevine, Texas, host Amy Pearlman, MD, and clinical psychologist and sex therapist Lauren Walker, PhD, discussed how language, adaptability, and trauma-informed practices are transforming the patient experience in sexual medicine.Walker’s research explores the importance of terminology in shaping comfort and participation in care. Her study of men with erectile dysfunction after prostate cancer examined the use of a harnessed external penile prosthesis (EPP). When surveyed, patients strongly favored the term “external penile prosthesis” over “strap-on,” viewing it as more legitimate, respectful, and consistent with medical terminology already familiar within urology. The finding underscores how language can normalize treatment options and reduce stigma.A central theme of the conversation was the idea of sexual flexibility, or the willingness to redefine sexual satisfaction and intimacy beyond traditional expectations. In rehabilitation after prostate cancer or antidepressant-related sexual dysfunction, flexibility allows patients and partners to prioritize pleasure and connection rather than a return to pre-diagnosis sexual function. Clinicians can support this by educating patients about anatomy and gradually introducing alternative methods of stimulation, such as prostate massage, in a manner that promotes comfort and trust.Walker also presented her SMSNA award-winning work on implementing trauma-informed care across all areas of pelvic health. The project reframes trauma awareness as a structured, teachable set of behaviors applicable to every clinician performing pelvic or genital exams. Key principles include fostering patient autonomy, minimizing environmental triggers, and communicating clearly about procedures. Simple changes—such as covering instruments until needed, inviting patients to state their goals for the visit, and presenting exams as optional—can build a sense of safety without extending appointment times.Pearlman emphasized the importance of creating physical spaces that accommodate patients with past trauma or heightened anxiety. In her practice, she established a secondary consultation room designed for a calmer, less clinical environment. Offering this choice has improved comfort and engagement across genders and backgrounds.Walker’s team is now recruiting participants for a national study assessing practical trauma-informed strategies in pelvic healthcare. The study invites clinicians of any specialty to review proposed recommendations and provide feedback on feasibility and relevance. Details are available through the SMSNA website and on Instagram at @DrLaurenWalker.

At the Sexual Medicine Society of North America meeting in Grapevine, Texas, host Amy Pearlman, MD, sat down with Rachel Rubin, MD, to discuss the new Genitourinary Syndrome of Menopause (GSM) guidelines, the evolving relationship between research, advocacy, and communication, and how clinicians can amplify impact through education and collaboration.Rubin, a urologist specializing in sexual medicine, described the release of the AUA-endorsed GSM guidelines, which are also supported by the Menopause Society, the International Society for the Study of Women’s Sexual Health, and other major professional groups, as “revolutionary.” The cross-specialty endorsement, she explained, officially positions GSM as a urologic and sexual-medicine issue rather than a condition confined to gynecology. The goal, she said, is not only to codify evidence-based management but also to ensure clinicians learn how to implement it in practice.Rubin emphasized that communication and marketing principles—often overlooked in medicine—are essential for translating guidelines into behavior change. She recalled that recommendations on vaginal estrogen for UTI prevention existed as early as 2019 but had minimal clinical uptake. Her approach to lecturing, which emphasizes meeting audiences where they are, simplifying complex content, and mixing data with real-world stories, aims to make guidelines actionable immediately.That philosophy guided her recent FDA testimony advocating removal of the boxed warning from vaginal estrogen products. Preparing for the panel, she said, required the same strategic storytelling and coordination she applies to teaching: balancing emotion, data, and a clear call to action. The resulting five-minute presentation, now publicly available online, doubles as an educational tool clinicians can share with patients to explain the safety and preventive benefits of vaginal estrogen.Beyond public speaking, Rubin has become a prolific content creator. Through her YouTube channel and social platforms, she distills evidence on hormonal and sexual health into digestible segments—often filmed spontaneously in her office or car. She attributes her success not to polish but to authenticity and repetition. With half the population experiencing menopause, she views social media as a necessary extension of patient education and professional outreach.Rubin also discussed building her Sexual Medicine and Research Team (SMART), which has grown from a handful of students to hundreds of multidisciplinary contributors worldwide. The grassroots group produces systematic reviews, survey studies, and case reports that broaden sexual-medicine scholarship across specialties. Looking ahead, Rubin is most enthusiastic about expanding clinician education through structured, CME-accredited courses on hormone-therapy prescribing. Her long-term vision combines research, education, and advocacy: creating a self-sustaining ecosystem in which informed providers, empowered patients, and accessible science drive meaningful change.References: Kaufman MR, Ackerman AL, Amin KA, et al. The AUA/SUFU/AUGS Guideline on Genitourinary Syndrome of Menopause. J Urol. 2025;214(3):242-250. doi: 10.1097/JU.0000000000004589 American Urological Association. American Urological Association Releases New Guideline on Genitourinary Syndrome of Menopause - American Urological Association. Auanet.org. Published April 28, 2024. Accessed October 12, 2025. https://www.auanet.org/about-us/media-center/press-center/american-urological-association-releases-new-guideline-on-genitourinary-syndrome-of-menopause Chapters00:41 GSM guidelines5:57 Speaking at the FDA Expert Panel on Menopause and Hormone Replacement Therapy for Women10:21 Creating content18:31 Dr Rubin's research

In this episode of The Expert APProach: Conversations in Uro-oncology, host Joy Maulik, CRNP, sits down with Mark T. Edney, MD, senior physician at Chesapeake Urology and chair of Public Policy for the American Urological Association (AUA). Together, they explore how leadership, teamwork, and advocacy are shaping the future of urology and the growing role of advanced practice providers (APPs) in delivering high-quality, patient-centered care.With over 2 decades of experience, Edney reflects on how his passion for health policy and advocacy evolved alongside his clinical career. From early state-level initiatives in Maryland to national-level work with the AUA, he shares how policy efforts aim to both protect and advance urologic care—defending scope of practice, promoting innovation, and ensuring access for patients across the country.The conversation then turns to one of the most pressing challenges in medicine: workforce shortages. Edney highlights how APPs have become essential partners in urology. Once rare in the specialty, APPs are now integral in office care, hospital consults, and subspecialty programs such as advanced prostate cancer management, stone disease, and men’s health. He emphasizes that empowering APPs with training, autonomy, and leadership opportunities not only improves patient access but also enhances job satisfaction and practice efficiency.Looking ahead, Edney discusses emerging areas such as telehealth, artificial intelligence, and genetic profiling in prostate cancer care. He announces the AUA’s new Urology Telehealth & Technology Committee, which will guide integration of AI and digital tools into practice and policy.His message is clear: the future of urology depends on collaboration—between physicians, APPs, and policymakers alike—to innovate, advocate, and deliver equitable care to every patient, everywhere.Chapters0:00 Introducing Dr Edney2:36 What drives Dr Edney5:46 Surgical vs office time8:08 The evolving role of APPs14:12 APPs and practice leadership20:33 The uro-oncology space

In this episode of Pearls & Perspectives, host Amy Pearlman, MD, welcomes Katherine Chan, MD, MPH, a pediatric urologist and former vice chair of research at University of North Carolina School of Medicine in Chapel Hill, to discuss her unexpected yet purposeful transition into the world of bladder cancer drug development.Chan shares how her passion for research and desire to impact patients on a broader scale led her from academia to industry. She highlights the surprising rigor behind industry-sponsored clinical trials and the extensive collaboration required to run large global studies—dispelling common misconceptions about bias and scientific quality.Now part of enGene, Chan describes her role in developing detalimogene voraplasmid, a nonviral gene therapy for non–muscle invasive bladder cancer (NMIBC). Unlike viral-based agents, this therapy offers easier handling, storage, and redosing, making it more practical for community urologists. Currently being studied in the global LEGEND trial (NCT04752722), the agent targets BCG-unresponsive NMIBC using a dual mechanism that activates both innate and adaptive immunity.The conversation explores the broader challenges in NMIBC research, including trial recruitment, tumor heterogeneity, and the growing need for collaboration between academia, community practice, and industry. Chan also emphasizes the importance of visibility and networking—particularly through platforms like LinkedIn—for urologists interested in becoming key opinion leaders or transitioning to industry roles.Looking ahead, Chan sees artificial intelligence and sub-specialized “centers of excellence” as shaping the future of bladder cancer care. Her key message: This is an unprecedentedly exciting time in bladder cancer, with new, patient-friendly therapies on the horizon. For patients, she underscores one takeaway—there are more options than ever before, and hope is stronger than ever.Chapters1:30 How a pediatric urologist gets into the bladder cancer space12:04 How to become a key opinion leader19:01 The NMIBC treatment landscape25:55 Naming detalimogene voraplasmid31:09 Where enGene stands in the clinical trial process37:21 Implications of treatment for community urologists

In this episode of First Assist: GU Oncology Unpacked, host Taylor Goodstein, MD, speaks with Tullika Garg, MD, MPH, FACS, a urologic oncologist at Geisinger Medical Center in Danville, Pennsylvania, about the nuances of caring for older adults with genitourinary malignancies. Garg—who has authored the American Urological Association Core Curriculum chapter on geriatric oncology—shares her passion for improving outcomes in a population that represents the majority of new cancer diagnoses yet remains underrepresented in clinical trials.Garg emphasizes the need to move beyond chronological age, using tools such as the Cancer and Aging Resilience Evaluation and the Cancer and Aging Research Group chemotherapy toxicity calculator to assess physiologic fitness. She encourages urologists to employ frameworks like the 3-talk model of shared decision-making—team talk, option talk, and decision talk—to align treatment plans with patient goals and values. Even simple questions such as, “What’s a typical day like for you?” or “What are you looking forward to?” can uncover key insights about function and priorities.The discussion spans practical approaches to frailty screening, prehabilitation, and nutritional optimization, as well as strategies for discussing palliative options when surgery or chemotherapy may not be feasible. Garg also reviews perioperative considerations—minimizing delirium, avoiding anticholinergics and opioids, and the importance of early mobility and home health support.She and Goodstein explore cancer-specific issues, from immunotherapy use in older patients to balancing risks of androgen deprivation therapy in prostate cancer. Garg closes with a call for trainees to recognize and challenge ageism in clinical practice, urging clinicians to treat each older adult as an individual—not by number, but by capacity and life goals.Chapters0:52 How Dr Garg became interested in geriatric oncology10:02 Assessing geriatric patients14:36 Patient resources for improving fitness21:54 Exercise vs nutrition29:55 Immune checkpoint inhibitors35:50 Drugs to avoid in older patients40:58 Robotic vs open surgery49:00 Being mindful of ageism

In this episode of Speaking of Urology, Gregory E. Tasian, MD, MSc, MSCE, (Children’s Hospital of Philadelphia), Jonathan S. Ellison, MD, (Medical College of Wisconsin), and patient partner Annabelle Pleskoff reflect on the origins, design, and key findings of the PKIDS trial—a nearly decade-long, patient-centered study aimed at improving surgical outcomes for children and adolescents with kidney and ureteral stones.