In this episode of Pearls & Perspectives, host Amy Pearlman, MD, sits down with Sijo J. Parekattil, MD, a fellowship-trained urologist and engineer-turned-innovator who is the medical director of Avant Concierge Urology in Winter Garden, Florida. Together, they explore the intersection of clinical innovation, independent practice, and cutting-edge therapies for chronic pelvic and testicular pain. Parekattil shares his unconventional journey—from working as a VLSI electrical engineer to building a globally recognized practice focused on male infertility, pelvic pain, and microsurgical innovation. Frustrated by the limitations of large institutions, he describes how a series of hospital acquisitions pushed him to open his own fully customized surgical center—designed for comfort, efficiency, and patient-centered care. His message: Direct care and autonomy are not only possible but essential for meaningful progress in men’s health. Pearlman and Parekattil dig deep into novel surgical and non-surgical approaches to chronic orchialgia and pelvic pain. Parekattil details the development of his targeted denervation procedure—an office-based, 20-minute microsurgery that avoids the spermatic artery and offers lasting relief to patients once told to “just live with it.” He breaks down how techniques like cryoablation, onabotulinumtoxinA injection, low-intensity shock wave therapy, and even paclitaxel bladder washes have become core components of his evidence-backed protocol for complex pain syndromes. They also discuss patient work-up strategy, the shifting role of diagnostic cord blocks, and the importance of cost-effective, office-based treatment models. Parekattil explains how real-world constraints—like managing overhead and transparency in billing—have led to smarter, more patient-friendly solutions. His practice offers fixed pricing, concierge-style staffing, and a surgical suite equipped with state-of-the-art imaging and customizable patient experiences—all designed to restore trust and satisfaction in the clinical environment. Later, the conversation turns to innovation in prostate care. Parekattil shares his early work using echo laser ablation to treat chronic prostatitis and outlines a compelling vision for how office-based laser techniques could revolutionize prostate cancer management—making screening and treatment more accessible, less invasive, and free from the traditional complications of erectile dysfunction or incontinence. With humility and passion, Parekattil makes a case for independent urology as a source of innovation, agility, and patient-first care. His closing advice to young clinicians: get a few years of experience, define what brings you joy, then invest in yourself—and build a practice that lets you do your best work. Chapters 0:00 Introducing Sijo J. Parekattil, MD 4:50 "Once an engineer, always an engineer" 8:49 Transitioning to private practice 19:53 Creating Avant Concierge Urology 27:29 Treating male pelvic pain 38:08 Work-up to determine whether to perform selective cord denervation 44:00 Innovative therapies 47:20 Targeting the external inguinal ring 54:33 Achieving your dream practice

Ask this episode

“What did the council decide on item 42?” — answered with the speaker and the moment.

Transcript

Related