How to cite: Terlecki RP. Session 6 Panel Discussion. Grand Rounds in Urology. October 2025. Accessed Jan 2026. https://grandroundsinurology.com/session-6-panel-discussion/
Summary
This panel discussion brings together experts from across urology, medical oncology, pediatric urology, and sexual health to explore how clinicians navigate complex decision-making, communication, and practice realities in contemporary urologic care. Moderated by Ryan P. Terlecki, MD, FACS, Professor and Vice Chair of Urology, Atrium Health Wake Forest Baptist Medical Center, Winston-Salem, North Carolina, the session emphasizes patient-centered care across diverse clinical scenarios rather than disease-specific protocols.
The discussion opens with practice innovation and entrepreneurship, highlighting integrated care models, mobile imaging, and the operational challenges of telehealth in the current reimbursement environment. Panelists describe how professional networking, conferences, and peer learning shape practice development more than formal business training.
Shared decision-making in cancer care is a central theme. Dr. Rush discusses how medical oncologists communicate trade-offs between survival benefit and toxicity in neoadjuvant chemotherapy, emphasizing education, trust-building, and framing decisions around patient values rather than percentages. The role of circulating tumor DNA is discussed as a tool that may support postoperative risk discussions, while social and logistical barriers to treatment are acknowledged as real constraints in care delivery.
Pediatric urology topics focus on rare but high-stakes emergencies, including priapism in children with sickle cell disease. Dr. Colaco reviews how adult guidelines are sometimes adapted in the absence of pediatric-specific data and discusses workforce trends contributing to declining interest in pediatric urology fellowships.
Sexual health and couples counseling are explored through practical questions about billing, documentation, pornography, and culturally sensitive care. Physician Assistant Fosnight outlines how clinicians can address intimacy concerns within standard evaluation and management visits, when to refer to sex therapists, and how to approach sensitive topics in patients with strong religious or cultural beliefs.
The panel underscores the importance of communication, expectation setting, interdisciplinary collaboration, and humility in clinical practice. Across specialties, panelists emphasize that meaningful patient care depends on trust, context, and thoughtful conversation as much as technical expertise.
About The 12th Urology Today Conference:
Presented by chair Ryan P. Terlecki, MD, FACS, the 12th Urology Today conference was designed to keep urologists, urologic oncologists, and other healthcare providers educated on the most pertinent issues in urology practices. Areas of focus included urologic oncology, men’s health and reconstruction, female urology, pediatric urology, kidney stones and related conditions, and methods of providing the best care amidst the required logistics of the business side of medicine.
For further educational activities from this conference, visit our collection page.
ABOUT THE AUTHOR
Rahul D. Mehan, MD, is Founder and CEO of East Valley Urology Center in Mesa, Arizona. Dr. Mehan is a nationally-recognized expert in minimally invasive surgery, hormone optimization, and longevity medicine. His skillset spans robotic surgeries for kidney and prostate cancer, focal therapies such as HIFU, NanoKnife and TULSA-PRO, and comprehensive men’s health services including testosterone optimization and vasectomy. Dr. Mehan also specializes in women’s urology—offering advanced treatment for recurrent UTIs, urinary incontinence, and pelvic floor restoration.
Dr. Mehan earned his medical degree from Wright State University Boonshoft in Dayton, Ohio. He then completed his residency in Urology at Indiana University in Indianapolis. Dr. Mehan is an expert in surgical therapies for benign prostatic hyperplasia (BPH), including GreenLight laser vaporization, Rezum, Urolift, iTInd, and Aquablation. He holds a Center of Excellence Certification for GreenLight, Rezum, and Urolift. Dr. Mehan has been invited to teach surgery throughout the U.S. and led several workshops at the most recent American Urological Association (AUA) national meeting. He was the first to offer Aquablation in the Southwest and has performed one of the largest series of cases in the U.S. Dr. Mehan is the founder of Snip City and has become the go-to surgeon for a vasectomy in the Phoenix area. He has been featured on several TV segments for men’s health and strives to be an influencer on social media.
Benjamin W. Rush, MD, is a Clinical Assistant Professor of Hematology and Oncology and an Assistant Professor of Cancer Medicine at Wake Forest University in Winston-Salem, North Carolina. Dr. Rush has extensive experience in prostate cancer, renal neoplasms, and resection.
Dr. Rush earned his medical degree from the University of South Carolina in Columbia. He then completed a residency in Internal Medicine and a fellowship in Hematology/Oncology at Wake Forest University.
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).
Marc Colaco, MD, MBA, is Assistant Professor of Pediatric Urology and Assistant Professor of Urology at Wake Forest University in Winston-Salem, North Carolina. Dr. Colaco has research interest in quality improvement and pediatric complex care, neurogenic bladder, and Spina Bifida. His clinic specialties include bedwetting, bladder exstrophy, buried penis, circumcision, cloacal anomaly, and encopresis.
Dr. Calico earned his medical degree from Robert Wood Johnson University in New Brunswick, New Jersey. He then completed a residency in Urology from Wake Forest University. Dr. Colaco earned his MBA from Rutgers Business School in Newark, New Jersey.
Aleece R. Fosnight, MSPAS, PA-C, CSC, CSE, MSCP, IF, HAES, is the founder, owner, and director of the Fosnight Center for Sexual Health. Ms. Fosnight is a nationally certified sex counselor/supervisor and educator through the American Association of Sexuality Educators, Counselors, and Therapists (AASECT). Her expertise includes pelvic floor dysfunction, urinary incontinence, pelvic organ prolapse, pelvic pain, low libido in men and women, interstitial cystitis, menopause transition, effects of cancer and cancer treatments on sexuality, pregnancy/postpartum sexuality, female sexual health, transgender medicine, low testosterone, Peyronie’s disease, and erectile difficulties, including erectile dysfunction, premature ejaculation, and delayed ejaculation.
