Urology Los Angeles Medical Center - Curriculum
The first year of the residency is spent rotating 9 months on general surgery and 3 months on urology. The Urology service and the General Surgery service have a collaborative working relationship. From their first day as interns, residents have 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 the surgical team’s operative cases. 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 an educational and valuable experience.
Starting in the PGY-2 year, the residents are full-time in the Department of Urology. Half of the year the residents will be introduced to clinical urology, where they will cover a variety of surgical cases, will begin covering consult service, and take call with a chief resident. Three of these months are spent as the primary resident covering pediatric urology, spending time in clinic as well as the operating room where they will cover complex pediatric cases, learning delicate tissue handling, becoming comfortable operating with loupes, and familiarizing themselves with complex pediatric urologic conditions. The other three clinical months will be on the general urology service with a focus on Female Pelvic Medicine and Reconstruction. There is dedicated time in clinic learning work up and evaluation for these patients, as well as gaining experience with in-clinic procedures including prostate biopsies, cystoscopies, vasectomies, and Urodynamics. The other half of the year the residents will be introduced to research, while still on some clinical duties. They will work early on with our urology faculty and the Research and Evaluation department. They will also rotate for one month on the USC LA County Hospital trauma service.
In PGY-3 year the residents are given more autonomy as they are increasingly given the role of the primary surgeon in the operating room, and they spend time on each of the Urology sub-specialty services. Call frequency is about one in four, and all call is taken from home. The year is split as primary resident for the Endourology service for 6 months, and as the junior resident dedicated to the Oncology service for the other 6 months. The PGY3 takes on more responsibility this year and begins to feel comfortable with all aspects of the service and patient management. The residents are given their own clinic during their PGY3 year, with their own panel of patients. They function as the primary urologist for these patients which is a unique and unparalleled opportunity for learning clinical urology, office management, as well as allowing for continuity of care for their pre op, post op, and consult patients.
In PGY-4 year, residents have six months of protected research time, free from clinical duties and call. The research residents work closely with the urology faculty and with the Department of Research and Evaluation, focusing on large-scale epidemiologic research. Much of this research will be continuation of what was started in their PGY-2 year. Three months of the PGY-4 year is spent back on the pediatric urology service. The remaining three months are with the main Urology service, with a focus on Andrology and Male genitourinary reconstruction. The 4th year residents are also encouraged to spend time exploring all aspects of the field and developing an idea of what type of fellowship or Urologic career they may be interested in pursuing.
In the PGY-5 year, urology residents will rotate at UCLA for transplant surgery, and Downey and West Los Angeles Medical Centers. During the entire PGY-5 year, the residents are acting chiefs of their service. These rotations are remarkable for their high operative volume and extensive exposure to robotic, open, and minimally invasive surgery. This allows the residents to “spread their wings,” to gain exposure to different patient populations, and to learn from our community of fantastic Urologic surgeons in Southern California,
The PGY-6 year is spent entirely at the Los Angeles Medical Center as Chief resident. The chief residents split their time among the sub-specialty services and directly supervise and teach the junior urology residents and medical students.
Clinical Experiences & Rotations
Urologic Oncology Service
Urology is the second busiest surgical service at LAMC and, with two dual console robots, Urology is the busiest robotics division within the hospital. The service, led by Dr. Chien, Dr. Finley, and Dr. Alemozaffar, manages a large volume of routine and complex cancer cases. On an annual basis, we perform an average of 260 robotic cases within our department consisting of weekly robotic cystectomy, prostatectomy, partial and radical nephrectomy with and without caval thrombus, RPLND, and ureteral/adrenal/inguinal cancer cases. Residents are given repetitive exposure to open, lap and robotic surgical techniques. A focused and dedicated robotics curriculum is in place starting intern year that follows the residents through each rotation allowing for graduated responsibility culminating as a chief resident. In addition, other treatment modalities are covered including radiation therapy and MRI fusion focal/ salvage cryoablation. Residents will also participate in a combined urology/radiation oncology clinic, which meets weekly and functions as a tumor board for complex cases referred in from around the region. The service is rife with clinical research opportunities.
Endourology/Minimally Invasive Urology and General Urology Service
The Stone/Endourology Service is a high-volume rotation that manages many complex stone referrals from the region. The residents work with regional stone specialists Dr. Carter and Dr. Lassoff throughout the residency but are on the service for a dedicated 6 months during the PGY3 year. The residents will gain extensive experience in Ureteroscopy, ESWL and PCNL and become proficient in gaining their own access for PCNLs. This service also provides vast experience in the diagnosis and management of upper tract malignancies and masses. Additionally, the service works closely with our urologic oncologists and manages complex uretero-intestinal anastamotic strictures in all types of lower tract reconstruction. Residents will learn the pathophysiology and diagnosis of urolithiasis and urinary obstruction and become proficient in the proper work up and management of metabolic stone disease.
As part of the General Urology Service residents learn to diagnose and treat common urologic conditions such as lower urinary tract symptoms, erectile dysfunction, and scrotal conditions. The residents also learn the techniques of transrectal ultrasound with biopsy of the prostate and flexible cystoscopy and vasectomy. In the cystoscopy suite, residents learn numerous MIST techniques including transurethral water vapor therapy (REZUM) and prostatic urethral lift (urolift), transurethral incision of the prostate (TUIP), bipolar transurethral resection of the prostate (TURP), laser TURP and HoLEP. Residents learn open and robotic simple prostatectomy, and treatment of scrotal conditions such as hydrocele and varicocele repair.
Neurourology and Female Pelvic Medicine & Reconstructive Surgery
Junior and chief residents work with Dr. Reyblat and Dr. Tenggardjaja on the Neurourology and Female Pelvic Medicine & Reconstructive Surgery rotation at 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 transitional care with spina bifida / myelomeningocele. Residents gain exposure in the surgical treatment of pelvic organ prolapse, as well. 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, treatment of mesh complications, bulking and botulinum injections, sacral neuromodulation, urethral stricture, reconstructive surgery with bowel segments, and prosthetic surgery.
Residents also have the opportunity to learn gender affirming surgeries and spend time at the West LA Medical Center operating with Dr. Chi, Dr. Reyblat and plastic surgery teams that take on these major reconstructive operations.
Andrology and Male Genitourinary Reconstruction
For three months in their PGY4 year, residents work closely with Dr. Abdelsayed both in the office and in the operating room on their Andrology and male sexual medicine rotation. Residents have a generous exposure to the diagnosis, workup, and treatment of male factor infertility, Peyronie’s Disease, erectile dysfunction, and urethral stricture disease. Residents will learn and perform vasectomy reversals, microscopic varicocele repair, penile plications, plaque excision and grafting and complex penile prostheses. Working alongside Dr. Abdelsayed, residents spend time in the office evaluating patients and learning the proper diagnosis and treatment techniques for these specialized conditions. Residents will also spend time in vasectomy clinic and become very comfortable performing this procedure independently.
Residents spend three months as a PGY-2 and three months as a PGY-4 working with Dr. Metzdorf and Dr. Huang on the pediatric urology service. The resident is the sole trainee on service, which typically consists of three to four days a week in the operating room and one to two days a week in the clinic. A multidisciplinary spina bifida clinic convenes once a month. A large volume of bread-and-butter operative cases offers the resident an opportunity to master pediatric surgical exposure, delicate handling of tissues, and meticulous surgical technique, through repetition. Because Los Angeles Medical Center serves as a tertiary hospital for the Southern California Kaiser Permanente region, the resident will participate in the care and management of complex pediatric urologic reconstructive, oncologic, and robotic cases referred from throughout the region. The goal for residents rotating through this service is to be comfortable and proficient in delivering general pediatric urology care.
The research rotation is designed to enrich the resident’s future urologic career. Residents work closely with our urology faculty and biostatisticians during their PGY-2 and PGY-4 years to learn the basics of clinical research, including principles of designing, preparing, and publishing a manuscript on a research topic of their choosing. Throughout the process, residents gain experience critically assessing and evaluating journal articles and scientific studies. Moreover, residents will also have the unique opportunity to enroll in leadership courses, various urology subspecialty courses and attend regional, national and international meetings to present their research.