Ryan P. Terlecki, MD, FACS

Ryan P. Terlecki, MD, FACS

Atrium Health Wake Forest Baptist

Winston-Salem, North Carolina

Ryan P. Terlecki, MD, FACS, is a reconstructive urologist for Atrium Health Wake Forest Baptist Medical Center, an academic Level 1 trauma center in Winston-Salem, North Carolina. Dr. Terlecki holds the rank of Professor and the title of Vice Chair of Research for the Department of Urology. In addition, Dr. Terlecki is Director of the Men’s Health Clinic, Director of Medical Student Education, and Fellowship Director for Reconstructive Urology. He holds a joint appointment in the Department of Obstetrics and Gynecology. Dr. Terlecki earned his medical degree from Wayne State University School of Medicine and completed residency in general surgery and urology at Detroit Medical Center. Following his residency, Dr. Terlecki completed two separate fellowships in reconstructive surgery. He completed a fellowship at the University of Colorado’s Denver School of Medicine and at UT Southwestern Medical Center in Dallas, Texas. Dr. Terlecki’s publications cover multiple areas of trauma and reconstruction and his research is focused primarily on models of wound healing and regeneration in the lower genitourinary system. Dr. Terlecki’s areas of expertise include urethral stricture disease, male sexual dysfunction, male incontinence, Peyronie’s disease, chronic testicular pain, hypogonadism, and infertility. He is a member of the Society of Genitourinary Reconstructive Surgeons (GURS), a member of the American Urological Association (AUA), and past president of the North Carolina Urological Association (NCUA).


Dr. Terlecki has the following disclosures:
Consultant with grant support: Boston Scientific
Advisory Board: Boston Scientific

Talks by Ryan P. Terlecki, MD, FACS

Pitfalls in Perineal Surgery

Ryan P. Terlecki, MD, FACS, Vice Chair and Associate Professor of Urology, Director of the Men’s Health Clinic, Director of Medical Student Education, and Fellowship Director for Reconstructive Urology at Wake Forest University School of Medicine in Winston-Salem, North Carolina, discusses perineal surgery and key elements of preoperative planning to optimize the surgeon and patient experience while highlighting some intraoperative technical considerations to facilitate efficiency. He advises practitioners to choose patients commensurate with their own experience, to prioritize risk reduction, to under-promise and over-deliver, and to maintain technical poise. Dr. Terlecki addresses helping patients set expectations, which is dependent upon the patient’s preoperative level of suffering and upon the definition of success. He discusses patient preparation and the importance of doctors investing time to understand their patients as well as his own requirements, such as patients undergoing urine testing and suspending blood thinners preoperatively. He underlines the importance of clearly laying out the process—from start to finish—for the patient. He also warns of the “CURSED” patient—one who is compulsive-obsessive, unrealistic, revision-seeking, surgeon-shopping, entitled, and in denial. Dr. Terlecki then turns to optimizing the operating room through organization and aiming for what he calls “SWEET”; doing things the same way each and every time. He suggests video primers for support staff and an instrument and equipment checklist as well as pre-gaming with anesthesiologists and paying special attention to patient preparation. He addresses antibiotic stewardship before shifting to some technical items, highlighting the challenge of working in tight spaces during perineal surgery and the importance of surgeons freeing their hands and not struggling. Dr. Terlecki discusses the importance of illumination and magnification but advises surgeons to be mindful of ergonomics and equipment weight. Dr. Terlecki discusses considerations when doing artificial urinary sphincter (AUS) surgery, such as challenges when a patient has had a prior sling, before turning to combination cases (sling or AUS with inflatable penile prosthesis [IPP]). Here, he advises surgeons to accomplish the sling part of the operation first, noting that single-incision approaches are problematic and there are implications for the patient, the surgeon, and the hospital. Dr. Terlecki offers several items that allow for more efficient use of the surgeon’s time during urethroplasty. For example, surgeons should know whether the repair is an anastomotic repair or a substitution repair. He prefers scoping before and during the procedure to avoid a suboptimal incision site and addresses instruments that can be helpful throughout surgery. Dr. Terlecki then turns to the principles for urethral surgery, and poses a question for practitioners’ consideration: “If this was going perfectly, what would it look like?” He closes by citing Sir William Osler who advocated for equanimity, meaning the ability to calmly assess a situation, determine the best course of action and correction, and then to move forward. Dr. Terlecki discusses the importance of asking for help when needed, emphasizing that reaching out also helps build relationships and is a sign of excellence, not weakness.

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The Prostate – Most Diseased Organ in the Male Body

Ryan P. Terlecki, MD, Vice Chair and Associate Professor of Urology, as well as Director of the Men’s Health Clinic at Wake Forest University Baptist Medical Center, reviews data on inflammation and the prostate’s microbiome as well as general prostatic anatomy in order to establish a better understanding of the biological factors which are connected to PCa and BPH development. High rates of prostatic disease (64% of men by the age of 70 have PCa) suggest that many of the causes of PCa stem from the anatomy and microbiome of the prostate. Dr. Terlecki notes that data supports the notion that PCa and BPH prevalence rise with age, are hormone-dependent, and are associated with inflammation. He takes a close look at these factors and the inner workings of the prostate to display how over the course of an individual’s life, decreases in hormone production causes gland function impairment, resulting in overall prostatic inefficiencies which lead to a gradually increasing chance of developing PCa or BPH.

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Urinary Health Issues Following Treatment for Prostate Cancer

Ryan P. Terlecki, MD, Vice Chair and Associate Professor of Urology, as well as Director of the Men’s Health Clinic at Wake Forest University Baptist Medical Center, discusses the relative incidence of urinary issues following primary and salvage prostate cancer therapies including radical prostatectomy, radiation therapy, and salvage cryotherapy.  He goes on to describe challenges to urinary health for patients undergoing treatment, proposes language for counseling patients pre and post-operatively, as well as highlighting effective treatment options for various types of urinary issues.

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Conquering Burnout: Where the Rubber Meets the Road to Resilience

Ryan P. Terlecki, MD, FACS, explains the phenomenon of physician burnout as it relates to urologists and outlines the threats it poses to physician wellness. Using his personal experience as a urologist, he discusses practical tips for improving operational efficiency and striving for an improved work/life balance, such as practicing mindfulness, time management, and monotasking. 

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