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

In this episode of Pearls and Perspectives, 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 American Urological Association's (AUA) 2025 Annual Meeting 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.