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Urology Residency

 

Tulane Urology's residency program is a comprehensive five-year program that provides a solid foundation for a life's work in either clinical or academic urology.

Our Mission/Vision

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.

Goals and Objectives:

  • To provide superior training to all our residents in the art and science of urology. Our foremost intention is to recruit intelligent, qualified individuals and to train them into excellent urologic surgeons (open surgical and endoscopic);

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

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

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

  • To provide advanced and up-to-date technology for patient management. This directly results in increased patient referrals, which directly benefits our teaching and clinical research programs; and

  • To work in unison with a community of urologists in 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 residency program.

Commitment to Diversity, Equity, and Inclusion

The Urology Department, knowing the diversity of our society, is committed to cultivating a workplace environment conducive to diversity, equity, and inclusion (DEI) in relation to faculty, fellows, residents, and staff.

Program Overview

Tulane Urology’s residency program is a comprehensive five-year program that provides a solid foundation for a life’s work in either clinical or academic urology. With an educational focus on diverse medical management and state-of-the-art surgical technology, in addition to offering ample opportunities for clinical and basic research advancement, our residency program is designed around a working relationship between our residents and our diverse, clinically active faculty members who are experts in their areas of specialties and subspecialities including pediatric urology, renal transplantation, fertility, oncology, endourology, laparoscopic and robotic surgery, sexual dysfunction, urodynamics, infectious diseases, and microsurgical techniques. In addition, the full-time faculty is augmented by 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 to fulfill our 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 residents to the basics of urology, urologic diagnostics, urologic instrumentation, and basic urologic surgical techniques. This solid foundation provides PGY-1 residents with the endoscopic and surgical skills needed to progress in their residency training.

PGY-2

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

Residents are expected to master basic urologic information including anatomy, physiology, pharmacology; basic diagnostic algorithms including pertinent history, physical, laboratory, and diagnostic imaging; and methods of interpretations.  Residents will evaluate patients with common urologic complaints and presenting signs; manage the care of the preoperative and postoperative urologic patient; and gain experience and competence in the outpatient management of common urologic 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, the University Medical Center, and the 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.

Residents are 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. Residents participate in clinical trials; evaluate new technology and the implications for clinical utility; and manage pediatric patients at Children’s Hospital New Orleans, gaining a sophisticated level of understanding of children's congenital urologic anomalies and diseases. Residents refine the skills needed for initial evaluation and consultation of pediatric urology patients, managing laboratory and diagnostic imaging techniques as well as preoperative and postoperative care.

PGY-4

The FOURTH YEAR focuses on advanced clinical urology.

In the fourth year, residents master two major educational objectives.  The first educational objective 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), 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 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, residents supervise and teach junior residents, master the most advanced and sophisticated urologic procedures, and gain the organizational skills needed to be an effective leader and administrator.  Under faculty supervision, residents manage the inpatient urology service and the weekly outpatient clinic as well as gain responsibility in complex open, laparoscopic, and robotic urologic procedures. 

By the completion of urology training, residents should be prepared to take the examination for board certification and to assume their place as members of the urology profession.

Rotations and Facilities

Andrology, Infertility, and Urologic Prosthetics (for ED)

Tulane Urology has traditionally had a very strong presence in these areas. Under the guidance of Dr. Wayne J.G. Hellstrom, residents receive 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

Tulane Urology has a long history of being on the cutting edge of minimally invasive urologic surgery, boasting a large series of percutaneous lithotripsy procedures, rigid and flexible ureteroscopy including endopyelotomy.  Under the guidance of Dr. Raju Thomas, residents receive outstanding training in robotic radical prostatectomy, partial nephrectomy, nephrectomy, and radical cystectomies, especially since Tulane Urology has one of the largest series of robotic reconstructive cases. Accordingly, sim labs and robotic sim procedures are an essential component of the curriculum.

Urologic Oncology

Tulane Urology offers a robust and full range of clinical experience in urologic oncology. Under the guidance of Dr. L. Spencer Krane, residents train to be well versed in advanced robotic, laparoscopic, and open surgical techniques. A wide array of research opportunities, advanced imaging, and clinical trials are also available.

Pediatric Urology

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

Urodynamics and Incontinence

This rotation is led by Drs. Pablo Labadie, Wesley Bryan, and Ryan Glass. This RRC-approved rotation gives residents a complete training in matters related to urodynamics and incontinence. The anticipated future expansion of the faculty should further enhance the learning experience of our residents. In addition, Dr. Margie Kahn actively engages residents in urogynecological management of open surgical and robotic procedures, further enhancing their skills for managing urinary incontinence.

Reconstructive Urology

This is a unique subspecialty. Under the guidance of Dr. Wayne Hellstrom, residents receive training regarding the principles and techniques for lower urinary tract reconstruction, with a specific focus on uretheral stricture, GU trauma, transgender surgery, genital reconstruction, and skin grafting. Furthermore, under the guidance of Dr. Raju Thomas and Dr. Erik Castle, residents receive robotic training, specifically the da Vinci robotic platform, for managing a range of procedures such as pyeloplasty, Boari flap, and urinary reconstruction.

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Procedures

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

Phallus: dorsal slit; circumcision; 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; excision of fibrosis corpora; chordelysis; repair injury and manage Peyronie's disease.

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

Prostate: trans-rectal ultrasound of prostate with needle biopsy; open biopsy; endoscopic incision and drainage of abscess; perineal incision and drainage of abscess; prostatolithotomy; prostatectomy - transurethral; prostatectomy - retropubic, simple; prostatectomy - retropubic, radical; prostatectomy - suprapubic; prostatectomy – perineal transvesicocapsular. (robotic prostatectomy, laparoscopic and robotic procedures - depending on the proficiency of the resident).

Bladder: punch cystostomy; open cystostomy; cystolithotomy; cystolithotripsy; repair of rupture; cystostomy for electrocoagulation; bladder tumor resection, endoscopic; bladder tumor biopsy, endoscopic; cystectomy, partial; cystectomy, radical; cystectomy, simple; diverticulectomy; cystoplasty ileum; cystoplasty sigmoid; cystoplasty cecum; cystoplasty ileocecal; cystoplasty vesicostomy; cystoplasty repair of fistula - vesico cutaneous; cystoplasty repair of fistula - vesico sigmoid; cystoplasty, repair of fistula - vesicorectal; cystoplasty repair of fistula - vesicovaginal; bladder neck revision - endoscopic; bladder neck revision - open; Marshall Marchetti; anterior vaginal repair; pereyra procedure; sling procedure; Leadbetter procedure; post-void residual ultrasound; robotic radical cystectomy, depending on proficiency of the resident; and bedside and console surgeon.

Ureter: biopsy, endoscopic; open biopsy; repair ureterocele; meatomy, endoscopic; open repair, ureterocele; ureterolithotomy; ureteral repair - lysis; ureteral repair; 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 ureterovaginal fistula; ureteral repair - close ureterointestinal fistula; ureteroenterostomy: ileal conduit; ureteroenterostomy: colon conduit; ureteroenterostomy: ureterosigmoidostomy; ureteroenterostomy: ileocecal pouch; ureteroenterostomy: ileocecal conduit; ureteroscopic tumor biopsy; *ureteroscopic tumor removal; ureteroscopic stone extraction; ureteroscopic lithotripsy; cystourethroscopy ureteral calculus manipulation and cystourethroscopy ureteral calculus extraction; and endoureterotomy.

Kidney: exploration; repair of trauma; needle biopsy; open biopsy; drainage of peri-renal abscess; drainage of renal abscess; nephrostomy; pyelostomy; nephropexy; denervation of pedicle; closure of renal fistula; nephrolithotomy; abdominal transperitoneal nephrectomy; extra peritoneal nephrectomy; partial nephrectomy; nephroureterectomy; nephroureterectomy with partial cystectomy; excision or decortication of cyst; pyeloureteroplasty; percutaneous nephroscopy; percutaneous nephroscopy - calculus extraction; and percutaneous nephroscopy lithotripsy, and laparoscopy for all renal procedures (includes: robotic partial nephrectomy, robotic pyeloplasty, laparoscopic nephrectomy, and nephroureterectomy, depending on proficiency of the resident).

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 vasovasotomy; vasoepididostomy; macroscopic vasovasotomy; 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: exploratory laparotomy; pelvic exenteration, anterior; pelvic exenteration, complete; biopsy retroperitoneal tumor; 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; percutaneous; nephrostogram; percutaneous nephrostomy placement; loop-o-gram; fluoro-pyelogram; urethrogram - retrograde; cystogram; cystourethrogram; percutaneous renal cystogram; cystometrogram; urethral pressure profile; Fluorourodynamics; Whittaker test - percutaneous; Whittaker test - open; and cavernosogram, urologic laparoscopy; percutaneous renal access; and robotic da Vinci procedures (bedside and console), depending on proficiency of the resident.

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