This fellowship will provide a broad experience in genitourinary reconstruction. The fellow will have the opportunity to care for reconstructive patients including those with congenital abnormality, acquired injury and sequelae from genitourinary trauma/spinal cord injury, iatrogenic injury, gender dysphoria or complications of gender affirming genital surgery, as well as compromise associated with cancer therapy and aging. In treating these patients, the fellow will have exposure to classical techniques, minimally invasive approaches and new and innovative techniques setting trends in reconstructive urology.
The fellowship will be supported by The State University of New York Upstate Medical University, a large academic institution located in Syracuse, NY and its Department of Urology. This group has over 20 urologists and a large, well-established referral pattern across the New York State region.
Urethral stricture disease
Specific emphasis is on teaching various urethroplasty techniques including anastomotic and augmentation anterior and posterior urethroplasties for patients with all causes of urethral stricture disease, urethral injury or bladder neck stenosis. The fellow will have experience with formulating a plan for reconstruction based on patient’s preferences, comorbidities, disease etiology (radiation, trauma, hypospadias, lichen sclerosus, iatrogenic etc), patient’s prior reconstructive efforts, plans for future operations (i.e. sling/sphincter) and will gain technical skill to perform appropriate reconstruction. Fellow will gain experience on preoperative workup of patients including being able to perform and interpret retrograde urethrograms, voiding cystourethrograms, endoscopy and being able to interpret other appropriate studies.
This part of the practice has become a center for national referrals and a large proportion of practice is dedicated to repair of complications associated with gender affirming genital surgery. The fellow will have training in surgical management of complications after phalloplasty/metoideoplasty and vaginoplasties (including repair of fistulae, strictures and other problems with functional and aesthetic outcomes). Additionally, the fellow will perform primary gender affirming surgeries including metoidioplasty and vaginoplasty in a multidisciplinary surgical team with Urology and Plastic Surgery.
The training will include evaluation and management of male urinary incontinence (such as post-prostatectomy incontinence), various techniques of placement and troubleshooting an artificial urinary sphincter (perineal, bladder neck, transcorporal), male sling and re-operative cases of male stress urinary incontinence.
GU Trauma and Genital reconstruction
All cases of acute urological trauma and management of trauma sequelae will be handled by the fellow. These may include bladder ruptures, renal, urethral and ureteral injuries, and injuries to external genitalia. The fellow will work in collaboration with the trauma team that may include General Surgery, Orthopedics, Plastics, Burns Service, SICU and others as appropriate. Additionally, the fellow will learn management and tissue transfer techniques for concealed phallus, genital lymphedema, paraffinoma and diseases associated with genital skin loss (PTO injury, Fournier’s, genital LS).
Upper Tract Reconstruction, Diversion and Robotics
The fellowship will provide wide exposure to robotic GU reconstruction. Pyeloplasty, ureteral reconstruction (uretero-ureterostomy, BMG ureteroplasty, reimplants, Boari flap, psoas hitch), majority of GU fistula and urinary diversion/bladder augmentation are performed robotically under supervision of Dr. Shapiro, Dr. Blakely, Dr. Ginzburg and Dr. Ferry. Additionally, we frequently utilize robotic approach for bladder neck reconstruction (post anti-BPH or radiation contractures or vesico-urethral anastomotic stenosis), in gender affirmation surgery (i.e. vaginoplasty, revisions) and female pelvic floor reconstruction (i.e. sacrocolpopexy, repairs of mesh complications).
Female Pelvic Reconstruction and Neurourology
The fellowship provides an opportunity for exposure to basic female urology including primary pelvic organ prolapse repair and primary incontinence surgery as well on complex revision cases and management of complications associated with female pelvic floor surgery. The fellow will also manage patients with neurologic conditions effecting the urinary tract including spinal cord injury, multiple sclerosis, and spina bifida. The fellow will have the opportunity to evaluate these patients using urodynamics and videourodynamics and learn the interpretation of these modalities. Medical, procedural and surgical management of these patients will be carried out by the fellow.