Andrology Fellowship Program

 

Program Description

 

A. Program Demographics

Name of Host Institution:  Tulane University School of Medicine

Specialty/Subspecialty:  Urology/ Andrology

Address (Mailing):  1430 Tulane Avenue, #8642, New Orleans, LA 70112

Program Director:  Dr. Wayne J. G. Hellstrom

Program Coordinator:  Demi Robert

Program Coordinator Contact:

 

B.   Introduction

 

History:  The program has been in existence for over ten years.
 

Duration: The training program is a one-year duration with an additional month of patient care continuity transitional period. There is an option to stay an additional year. The second year is at the discretion of the Program Director and is based on the progression and aptitude of the fellow, which includes advanced andrology and sexual medicine training.

Prerequisite Training/Selection Criteria:

  1. Successful completion of medical school.

  2. Successful completion of a surgery internship and urology residency.

  3. Demonstrated proof of United States citizenship or appropriate visa status.

  4. Ability to obtain medical licensure from the Louisiana State Board of Medical Examiners.

  5. Ability to conduct clinical and basic science research which results in a minimum of three major publications within the first year of fellowship training.

Goals and Objectives for Training:  The goals and objectives for the fellow include extensive experience with penile prosthesis surgeries, artificial urinary sphincters, sling procedures, and reconstructive surgeries. In addition, the fellow is expected to undertake both basic and clinical research resulting in presentations and publications. In addition, the fellow is encouraged to become familiar with the clinical and research grant process, develop alliances with the medical industry, and serve on academic committees related to andrology and men’s sexual health. As per our record here at the Andrology section of Tulane University Medical Center, we have demonstrated excellent productivity, with the majority of previous fellows entering academic positions both in the United States and abroad.                                                                

Program Certifications: n/a

C. Resources

  • Teaching Staff:  Dr. Wayne J.G. Hellstrom

  • Facilities: Tulane University School of Medicine; Tulane Medical Center

 

D. Educational Program (Basic Curriculum)

Elements of the training program:

  • Clinical and research components: Case mix is 60% prosthetics and Peyronie's disease/reconstruction; 25% male infertility: microsurgery – vasovasostomy, vasoepididymostomy, microsurgical epididymal sperm aspiration (MESA), testicular sperm extraction (TESE), and varicocele; and 15% urethral stricture disease and general  urology: transurethral resection of the prostate (TURP) and hydrocele, etc. During  the week, the fellow spends about 70% clinical and 30% academic research. The fellow is expected to do academic work (review papers, write and publish manuscripts, perform animal and basic science research (two PhDs in our department), and work with residents, medical students, and other researchers in the medical school.

  • The fellow co-runs three clinics and operates with Dr. Wayne Hellstrom 2 ½ days per week. More specific details will be provided upon request.

 

  • The fellow does 1 in 6 calls with faculty.  The fellow covers Tulane Medical Center, Tulane-Lakeside Hospital, University Medical Center New Orleans (Formerly Charity), & Southeast Louisiana Veterans Health Care System New Orleans.

 

  • Trainee’s supervisory and patient care responsibilities:The fellow participates in all teaching sessions for residents. In addition, the fellow will be responsible for patient care, including clinical and preoperative management of patients under the supervision of the Program Director.

 

  • Clinical procedural requirements: The Tulane Urology Andrology Fellowship Program specializes in training and mentoring academic urologists in the diagnosis and treatment of sexual dysfunction, such as Peyronie's disease, surgical and vascular reconstruction, prosthetic surgery, male infertility (both surgical and medical therapies), BPH, and urethral stricture disease.

 

  • Didactic sessions and teaching methods used to ensure program goals and objectives are met: Patient care and the didactic-related educational experience are the highlights. The fellow is encouraged to actively participate in the resident/fellow didactic conference as well as in the urology teaching and research conference. These conferences are held weekly (with required attendance by the fellow).

 

  • The progression in responsibilities by PGY level, if more than twelve months in duration: The Andrology Fellowship Program is designed to enhance expertise in medical and surgical management of male sexual, endocrine, and reproductive health, particularly in the nonsurgical disciplines. As a department, we strive to train physicians who are not only superior clinical care providers but also active researchers pursuing initiatives to help advance men’s health for the growing and aging male population. By program completion, the fellow will have the expertise needed to provide comprehensive, contemporary subspecialized care as well as to organize a multidisciplinary approach to male sexual dysfunction, endocrine dysfunction, and male infertility care. Our goal is to train physicians who will not only be leaders in the field of andrology but also more broadly in urology.

(PGY-VII)

The first twelve months focus on the development of clinical excellence in all aspects of male fertility management and basic science techniques in andrology. The clinical fellow will spend the majority of their time in the clinic and in the operation room, evaluating and managing patients with infertility problems.

The first twelve months of training will consist of basic diagnostic and therapeutic management of sexual disorders. This management includes:

  • Percutaneous epididymal sperm aspiration (PESA), testicular biopsy, testicular sperm extraction (TESE), transrectal ultrasound (TRUS) of the prostate, seminal vesicle aspiration, vasectomy, duplex Doppler penile ultrasound, testosterone pellet insertion, intracavernosal injections, intralesional injections (collagenase and interferon), penile deformity assessment, dorsal slit, circumcision, excision of tumor/cyst, biopsy, partial amputation and complete penile amputation, insertion of noninflatable, semirigid prosthesis, insertion of inflatable, three-piece prosthesis, insertion of inflatable, triple-unit prosthesis, excision of fibrotic corpora, chordee injury repair, and all aspects of Peyronie's disease.

The thirteenth month is an additional month of patient care continuity transitional period.

(PGY-VIII)

Once the fellow has attained and demonstrated the cognitive and technical skills necessary for the independent practice of sexual medicine, a second year may be offered at the discretion of the Program Director. Upon completion of this program, the fellow will have the expertise needed to investigate and treat all aspects of male infertility and the ability to critically appraise research and literature related to this urologic subspecialty.

The second twelve months of training will consist of advanced diagnostic and therapeutic management of sexual disorders. This management includes:

  • Micro-TESE, microsurgical vasectomy reversal, vasectomy, microsurgical varicocelectomy, transurethral resection of the ejaculatory duct (TURED), orchiectomy, orchiopexy, hydrocelectomy, spermatocelectomy, penile fracture repair, plaque incision/excision and grafting, penile prosthesis insertion, penile plication, and priapism shunting. 

In special circumstances involving a fellow who has achieved post-residency clinical and surgical proficiencies, a modified training program may be designed and customized at the discretion of the Program Director.

E.   Supervision and Evaluation

  • In addition to participating in safe, effective, and compassionate patient care under supervision, the fellow is expected to develop a personal program of self-study and professional growth under the general supervision of appropriately credentialed teaching staff (commensurate with the level of advancement and responsibility). Supervision will be constant throughout the training program.

  • We have a semiannual evaluation process to provide feedback to the fellow in the following categories: Medical Knowledge, Patient Care, Practice-Based Learning and Improvement, Professionalism, and Systems-based Practice. Additionally, evaluations are performed on an “as-needed” basis with prompt feedback.