Curriculum and Clinical Experiences

Goals & Objectives

The residency program is designed to provide a maximal educational experience in operative, procedural, and office urology. In addition, residents receive training in basic laboratory and clinical research. Over four years, each resident will participate in a variety of clinical and laboratory projects.

The first two years of the residency are spent with the department of general surgery. From their first day as interns, residents have a great exposure to the operating room and act as primary surgeons on a large number of cases. Interns are not relegated to the wards, instead they are expected to assist with all of the surgical team’s operative cases. This hands-on approach well prepares the pre-urology resident for urology. Overnight call frequency is about one in seven nights and short call about one in seven evenings. Residents give the general surgery experience uniformly high praise as a friendly and educational experience.

There are educational conferences in the form of clinical presentations, lectures, reviews of recent literature, discussions of research projects, and pathology reviews. Patient rounds are made daily, and grand rounds are held weekly during which resident and attending physicians are free from all clinical duties. There is a basic science conference weekly, and a pathology conference with a genitourinary pathologist monthly. Visiting professors are scheduled on a regular basis, and residents are strongly encouraged to attend outside meetings and conferences. The department of urology hosts an annual symposium which attracts participants from around the world.

 

Clinical Experiences & Rotations

The first year of urology is spent entirely at the Los Angeles Medical Center (LAMC). Junior residents work closely with the chief residents and spend time on the oncology and general urology services. Call frequency is about one in three, and all call is taken from home. Second year urology residents have six months of protected research time, free from clinical duties and call. The remaining six months is spent on the pediatric urology service at LAMC. Third year urology residents rotate at UCLA for transplant surgery, and Bellflower and West Los Angeles Kaiser Hospitals. During the entire third year of urology, the residents are acting chiefs. These rotations are remarkable for their high operative volume and extensive exposure to laparoscopic surgery. The fourth and final year of residency is spent entirely at the Los Angeles Medical Center. The chief residents split their time among the general urology and oncology services and directly supervise the junior urology residents.

Oncology/Minimally Invasive Uro-oncology

While on the Urologic Oncology Service, residents work closely with Dr. Kaswick, Dr. Williams, and Dr. Chien. The service manages a large volume of routine and complex urologic oncology cases, including radical prostatectomy, robotic assisted radical prostatectomy, radical cystectomy with various types of urinary diversion, and surgery for renal tumors. A wide variety of renal tumors are managed by the service, including nephron-sparing surgery, radical nephrectomy, and radical nephrectomy with IVC thrombus extraction. These are performed in an open or laparoscopic fashion. Chief residents participate in a combined urology/radiation oncology clinic. Residents on the Urologic Oncology Service are expected to learn various surgical techniques and become involved in other treatment modalities, including radiation therapy and chemotherapy. The service is a rich field for clinical research, and many residents choose to be involved with databases on various diseases and collecting data for clinical publications.

Endourology/General Urology

The Stone/Endourology Service is a high-volume rotation that receives many complex referrals. The residents work intimately with Dr. Murphy and Dr. Chien, the regional stone specialists. The residents have exposure to many cases requiring ESWL, PCN, and rigid and flexible ureteroscopy. Residents perform a large number of laparoscopic surgeries, including prostatectomy, adrenalectomy, nephrectomy, pyeloplasty, and renal cyst excision. Residents become proficient in the use of various stone baskets as well as the Candela and holmium lasers. Residents learn the indications for surgical intervention for stone disease, the various endoscopic techniques, and the metabolic studies needed to determine the etiology of urolithiasis. Residents on the Endourology Service will learn the pathophysiology and diagnosis of urolithiasis and urinary obstruction, and will learn to manage patients medically to prevent stone formation.
As part of the General Urology Service residents learn to diagnose and treat common urologic conditions such as BPH, carcinoma of the bladder and prostate, and scrotal conditions. The residents also learn the techniques of transrectal ultrasound with biopsy of the prostate as well as renal ultrasound. In the cystoscopy suite, residents learn Transurethral incision of the prostate (TUIP), transurethral resection of the prostate (TURP), laser TURP, and transurethral destruction of prostate tissue by radiofrequency thermotherapy (TUNA). In the open OR, residents learn radical and suprapubic prostatectomy, and treatment of scrotal conditions such as hydroceles.

Neurourology and Reconstructive Surgery

Junior and chief residents work intimately with Dr. Aboseif on the Neurourology and Reconstructive Service at the LAMC. Residents learn the most advanced techniques for the diagnosis of urinary incontinence, voiding dysfunction, chronic pelvic pain, and male sexual dysfunction. In addition, the service has special expertise in managing patients with chronic neurologic disorders such as multiple sclerosis, spinal cord injuries, and myelomeningocele. Dr. Aboseif utilizes cutting edge technology including videourodynamics, ultrasound and flexible endoscopy. Residents assist Dr. Aboseif to perform more than 50 diagnostic studies every month on both men and women. At the end of training, residents are expected to be familiar with urodynamic equipment and can perform and interpret various studies in evaluation of incontinence. A wide variety of surgical procedures for the treatment of urinary incontinence and voiding dysfunction are performed in this service, including abdominal and vaginal suspensions, sling procedures, collagen injection, reconstructive surgery with bowel segments, and prosthetic surgery. Additionally, residents have a generous exposure to the diagnosis, workup, and treatment of male sexual dysfunction. Residents learn penile color Doppler ultrasound, cavernosometry/cavernosography, and pharmacological testing of erectile dysfunction. Microvascular surgery for selected cases of vasculogenic impotence and various types of penile implants are also performed. The service is also the regional referral center for all cases of penile curvature and Peyronie’s disease as well as various types of urethral stricture disease.

Male Infertility and Infectious Disease

Residents work closely with Dr. Shapiro who performs microsurgery for male infertility. Residents learn and perform vasectomy reversal, vasoepidiymostomy, and microscopic varicocele repair. In association with Dr. Shapiro, residents spend time in the urology clinic seeing patients with a wide spectrum of urologic diseases in addition to patients referred specifically for evaluation of possible male factor infertility. Residents learn diagnosis and treatment techniques for these patients and gain operative experience in general open and endoscopic procedures.

Pediatrics

The second-year urology resident spends six continuous months working one on one with Dr. Hurwitz. The Pediatric Urology Service includes a busy clinic practice and an active OR schedule. In the office, we see a large volume of both routine and complex cases, including antenatal hydronephrosis, vesicoureteral reflux, hypospadias, cryptochidism, and voiding dysfunction. Once or twice per month the multidisciplinary myelomeningocele clinic meets in our offices, allowing us to coordinate the orthopedic, urologic, physical medicine, pediatric, urologic, nutritional, and social service needs of these children with multiple problems. In the operating room, we have a broad experience repairing all the urologic congenital anomalies, and optimal exposure, delicate handling of tissues, and meticulous technique are emphasized. Residents have likened this experience to a “mini-fellowship,” noting that operative experience is equal to some fellowships.