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Urology Residency

 

Tulane Urology’s residency program is designed for five years of intensive experiences to provide a solid foundation for a life's work in either clinical or academic urology.

While our areas of concentration are necessarily complex, the program's focus is clear: to work, to learn, and to grow in an environment of excellence.

Our Mission

Tulane Urology's Residency Mission Statement
  1. To provide state-of-the-art training to all our residents in the art and science of urology. Our foremost intention is to recruit intelligent, diverse qualified individuals and to train them into excellent urologic surgeons (open surgical and endoscopic).

  2. To provide an environment that is stimulating to academic excellence. Our goal is to stimulate at least 10-15% of our resident pool to pursue a career in academia and pursue further fellowship training. 

  3. To Provide a milieu that encourages both basic and clinical urologic research. This enhances the academic process and productivity of the faculty and residents.

  4. To provide adequate supervision of the residents during their entire training process. With the rapid proliferation of technological innovations within urology, such supervision is critical to the growth of the residents.

  5. To have top-notch faculty who are sub-specialized in each urologic sub-specialty. With technological procedural advances rapidly dominating the urologic landscape, sub-specialized faculty must be available for teaching, research, and academic achievement.

  6. To provide state-of-the-art technology for patient management. This directly results in increased patient referrals, which directly benefits our teaching and clinical research programs.

  7. To work in unison with community urologists in the two-state area of Louisiana and Mississippi to further enhance our department as a Center of Excellence for urological referrals. This, once again, brings in difficult cases for management, further enhancing our status and resident experience.

  8. To stay current with the changing healthcare environment to be proactive in patient management, outcome analyses, and thus be ready to deal directly with managed care products.

Program Overview

At Tulane, residents work closely with faculty members in areas of subspecialization, including pediatric urology, renal transplantation, fertility, oncology, endourology, laparoscopic and robotic surgery, sexual dysfunction, urodynamics, infectious diseases, and microsurgical techniques. Throughout the program, breadth of interest is matched by depths of inquiry. The full-time faculty is augmented by a diverse and active clinical faculty, and several outstanding visiting professors each year.

Teaching rounds—along with daily, weekly, and monthly conferences—enable residents to acquire necessary clinical skills reinforced by a practical frame of reference for academic study. To produce a training regimen that is demanding yet rewarding, the program emphasizes direct involvement in a wide variety of cases encountered in this major urban healthcare center.

Residents attend at least one major AUA seminar. The program also includes the annual Specialty Review in Urology course for chief residents. Any resident who has an abstract accepted by a regional or national meeting may attend at the expense of the Department. Every effort is made to provide time, lab space, and faculty mentorship as needed to fulfill our Departmental mission to foster basic and clinical research.

PGY-1

The FIRST YEAR (intern) of the residency program covers basic surgery with a six month urology rotation.

This year introduces the incoming class to the basics of urology, urologic diagnostics, urologic instrumentation, and basic urologic surgical techniques. A solid foundation promises the PGY-1s to fulfill their endoscopic and surgical skills needed as they progress in their residency training.

PGY-2

The SECOND YEAR of the residency program covers basic clinical urology:

The resident is expected to master basic urologic information including anatomy, physiology, pharmacology, basic diagnostic algorithms, including pertinent history, physical, laboratory and diagnostic imaging, techniques, findings and methods of interpretations.  Residents will evaluate patients with common urologic complaints and presenting signs.  The resident will manage the care of the pre and post-operative urologic patient, as well as gain experience and competence in the outpatient management of common urologic patient problems such as lower urinary tract symptoms in men secondary to bladder outlet obstruction. These objectives are achieved by clinical rotation to the Tulane University Hospital and Clinics, University Medical Center and Southeast Louisiana Veterans Health Care System

PGY-3

The THIRD YEAR is focused on Pediatric Urology and further maturation in endoscopic and open surgical skills:

The resident is provided with sufficient exposure to didactic lectures and basic research in order to understand the evaluation of current information and formulate questions that are answerable by experiment. The principles of study design, the methodology of basic science, and clinical investigation analysis and reporting are taught. The resident participates in clinical trials, evaluates new technology and the implications clinical utility. The resident manages pediatric patients at Children’s Hospital, gaining a sophisticated level of understanding of pediatric urology congenital abnormalities and diseases. The resident refines the skills needed for initial evaluation and consultation of pediatric urology patients, and manages laboratory and diagnostic imaging techniques, as well as pre and post-operative care.

PGY-4

The FOURTH YEAR focuses on advanced clinical urology:

In the fourth year, there are two major educational objectives.  The first is to coordinate and implement longitudinal evaluation and management of urological adult patients through ambulatory and inpatient settings. The goal is to master urologic procedures essential to office-based practice, including cystoscopy, vasectomy, ultrasonography (transrectal, as well as abdominal, pelvic and scrotal) and shock wave lithotripsy, as well as the interpretation of uroflow and urodynamics.  The second educational objective is to master the necessary skills of consultative services, including evaluation and management of inpatients and outpatients, and also to effectively communicate with medical colleagues.

PGY-5

The FIFTH YEAR is spent as a chief resident, with access to major surgical procedures. Research time is available and expected to be part of each resident's curriculum:

During the Chief Residency year, the resident supervises and teaches Junior residents, and masters the most advanced and sophisticated urologic procedures.  During this year, the resident gains the organizational skills needed to be an effective leader and administrator.  At the conclusion of the year, the resident is well versed in the responsibilities of clinical practice, both inpatient and outpatient services, and will have the competence to succeed in his or her future endeavors.  Under faculty supervision, residents will run the inpatient urology service and the weekly outpatient clinic.  They will gain responsibility in complex open, laparoscopic and robotic urologic procedures.  By the completion of urology training, our residents should be prepared to take the Board examination and to assume his or her place as a member of the urology profession.

Rotations and Facilities

Andrology, Infertility, and Urologic Prosthetics (for ED)

Led by Dr. Wayne JG Hellstrom and Dr. Omer Raheem. Tulane Urology holds a strong presence in these areas. Residents get an unparalleled experience in Men's sexual health and in basic and complex urologic prosthetic surgery when rotating through this section.

Endourology, Laparoscopy, and Robotic Surgery

Led by Dr. Raju Thomas. Tulane Urology has a long history of cutting-edge minimally invasive urologic surgery, and boasts a large series of percutaneous lithotripsy procedures, and rigid and flexible ureteroscopy, including endopyelotomy. We have the most experience in urologic robotic surgery and urologic laparoscopy in the entire Gulf South. At the present time, Tulane Urology offers outstanding training in robotic radical prostatectomy, partial nephrectomy, nephrectomy, and radical cystectomies. We have one of the largest series of robotic reconstructive cases. Sim labs and robotic sim procedures are part of the curriculum.

Urologic Oncology

Led by Dr. L. Spencer Krane. Tulane Urology offers a robust and full range of clinical experience for the resident in this section. Residents train to be well-versed in advanced robotic, laparoscopic, and open surgical techniques. A wide array of research opportunities, advanced imaging, and clinical trails are also available.

Pediatric Urology

Presently, this is exclusively delivered through Children’s Hospital under Program Director Dr. Joseph Ortenberg and three other pediatric urologists. Children's Hospital is a premier pediatric facility and provides a full spectrum of pediatric urology, including robotic surgery.

Urodynamics and Incontinence

This section gives the residents a complete training in matters related to urodynamics and incontinence, and associated surgical procedures including use if the robot as well. Rotations are under the guidance of faculty: Drs. Margie Kahn, Pablo Labadie, Wesley Bryan, Ryan Glass, and Cooper Benson.

Reconstructive Urology

This unique sub-specialty, led by Dr. Cooper Benson, teaches our residents the principles and techniques for lower urinary tract reconstruction, focusing on uretheral stricture, GU trauma, trans-gender surgery, genital reconstruction, and skin grafting.

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Procedures

By the completion of urology training, our residents are capable of performing the procedures listed below.

Phallus: dorsal slit; circumcision; clitorectomy; excision of tumor/cyst; biopsy; partial amputation; complete amputation; insert non-inflatable, semi-rigid prosthesis; insert non-inflatable, rigid prosthesis; insertion of inflatable, single-unit prosthesis; insertion of inflatable, triple-unit prosthesis; excision of fibrosis corpora; chordelysis; repair injury; and Peyronie's disease.

Urethra: biopsy; meatotomy; excision of caruncle; repair injury; drainage of urinary extravasation; hypospadias repair; macrosurgical closure of fistula; microsurgical closure of fistula; partial excision; urethrectomy; diverticulectomy - male; diverticulectomy - female; urethrolithotomy; excision condyloma; extract foreign body; external urethrotomy; internal urethrotomy; urethroplasty; repair urethro-vaginal fistula; repair transpubic injury; repair suprapubic injury; and repair perineal injury.

Prostate: trans-rectal ultrasound of prostate with needle biopsy; open biopsy; endoscopic incision and drainage of abscess; perineal incision and drainage of abscess; repair of recto-urethral fistula; prostatolithotomy; prostatolithotomy  - perineal; prostatolithotomy - suprapubic; prostatolithotomy - endoscopic; prostatectomy - transurethral; prostatectomy - cryosurgical; prostatectomy - retropubic, simple; prostatectomy - retropubic, radical, laparoscopic radical prostatectomy; prostatectomy - simple perineal; prostatectomy - radical perineal; prostatectomy - simple parasarcal; prostatectomy - radical parasarcal; prostatectomy - suprapubic; prostatectomy – perineal, transvesico-capsular; (Robotic radical prostatectomy) urologic laparoscopy (all procedures)

Bladder: punch cystostomy; open cystostomy; cystolithotomy; litholapaxy; electrohydraulic lithotripsy; repair of rupture; cystostomy for tumor excision; cystostomy for electrocoagulation; bladder tumor resection, endoscopic; bladder tumor biopsy, endoscopic; cystectomy, partial; cystectomy, radical; cystectomy, complete laparoscopic cystectomy; diverticulectomy; cystoplasty ileum; cystoplasty sigmoid; cystoplasty cecum; cystoplasty ileocecal; cystoplasty vesicostomy; cystoplasty repair of exstrophy; cystoplasty repair of fistula - vesico cutaneous; cystoplasty repair of fistula - vesico sigmoid; cystoplasty repair of fistula - vesico rectal; cystoplasty repair of fistula - vesico vaginal; bladder neck revision - endoscopic; bladder neck revision - open; insert artificial sphincter for incontinence; Marshall Marchetti; anterior vaginal repair; pereyra procedure; sling procedure; Leadbetter procedure; ileal conduit; neo-bladder and  Indiana pouch urinary reservoir.

Ureter: biopsy, endoscopic; open biopsy; repair ureterocele; meatotomy, endoscopic; open repair, ureterocele; ureterolithotomy; ureteral repair - lysis; ureteral repair - excision of ovarian lesion; ureteral repair - rectrocaval ureter; ureteral repair - ureteroneocystostomy, simple; ureteral repair - ureteroneocystostomy, ureteroplasty; ureteral repair - excision and anastomosis; ureteral repair - ureteroplasty; ureteral repair - uretero-ureterostomy; ureteral repair - uretero-calyceal anastomosis; ureteral repair - close uretero vaginal fistula; ureteral repair - close uretero intestinal fistula; ureterotomy for tumor; ureterotomy - partial; ureterotomy - complete; ureterostomy - in situ; ureterostomy cutaneous; uretero-enterostomy: ileal conduit; uretero-enterostomy: colon conduit;uretero-enterostomy: ureterosigmoidostomy; uretero-enterostomy: rectal bladder and sigmoid pull through; uretero-enterostomy: ileocecal pouch; uretero-enterostomy: ileocecal conduit; uretero-enterostomy: Koch pouch; uretero-enterostomy:Camay procedures; ureteroscopic tumor biopsy; ureteroscopic tumor removal; ureteroscopic stone extraction; ureteroscopic lithotripsy; cystourethroscopy ureteral calculus manipulation; and cystourethroscopy ureteral calculus extraction.  Laparoscopic procedures on ureters.

Kidney: exploration; repair of trauma; needle biopsy; open biopsy; drainage of perineal abscess; drainage of renal abscess; nephrostomy; pyelostomy; nephropexy; denervation of pedicle; closure of renal fistula; close reno-intestinal fistula; nephrolithotomy; abdominal transperitoneal nephrectomy; extra peritoneal nephrectomy; lumbar nephrectomy; thoraco-abdominal nephrectomy; partial nephrectomy; calycectomy; nephro-ureterectomy; nephroureterectomy with partial cystectomy; infundibuloplasty; excision or decortication of cyst (laparoscopic approach to these procedures); symphsiotomy; pyeloureteroplasty; renal vascular surgery; renal bench surgery; percutaneous nephroscopy; percutaneous nephroscopy - calculus extraction; and percutaneous nephroscopic lithotripsy.  All kidney laparoscopic procedures.

Scrotal Contents: incision and drainage of abscess; excision of lesion of cord; hydrocele; excision of lesion of tumor; vas ligation; epidiymotomy; epididymectomy; microscopic ligation spermatic veins; macroscopic ligation spermatic veins; microscopic vaso-vasotomy; macroscopic vaso-vasotomy; hydrocelectomy; spermatocelectomy; reduction, torsion testicle; excision, torsion hydatid; excision, lesion of tunica vaginalis; excision lesion of testis; orchiectomy, simple; orchiectomy, radical; orchiotomy; repair injury to testis; testis biopsy; insert testicular prosthesis; and excision of skin lesion.

Miscellaneous: hernia repair-inguinal; hernia repair-lumbar; hernia repair-ventral; exploratory laparotomy; pelvic exenteration, anterior; pelvic exenteration, complete; biopsy retroperitoneal tumor; excision of retroperitoneal tumor; retroperitoneal node dissection; colostomy; closure of evisceration; inguinal lymphadenectomy, superficial; inguinal lymphadenectomy, deep; pelvic lymphadenectomy; and gastrostomy tube placement.

Diagnostic and Endoscopic Procedures: urethroscopy; cystoscopy; ureteroscopy; nephroscopy; ureteral catheterization; ureteral catheterization with pyelogram; ureteral catheterization - differential function; pyelogram, intravenous; pyelogram, percutaneous; nephrostogram; nephromogram; percutaneous nephrostomy placement; loop-o-gram; cine-pyelogram; urethrogram - retrograde; cystogram; cystourethrogram; cystometrogram; ureteral pressure profile; Whittaker test - percutaneous; Whittaker test - open; and cavernosogram, all diagnostic and therapeutic urologic laparoscopic procedures on kidney, ureter, bladder - intra-abdominal; Fluorourodynamics; Whittaker test - percutaneous; Whittaker test - open; and cavernosogram, urologic laparoscopy; percutaneous renal access; and robotic da Vinci procedures (bedside and console).

Adrenal: exploration; excision of cyst; open and laparoscopic adrenalectomy or partial adrenalectomy; adrenalectomy, bilateral; and radical adrenalectomy.