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 clinical and epidemiological research. Over five years, each resident will participate in a variety of research projects.
The first year of the residency is 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 an educational and valuable 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. Visiting professors are scheduled on an annual basis, and residents are strongly encouraged to attend outside meetings and conferences. The Department of Urology hosts the annual Kaiser Permanente National Urology Symposium which attracts experts from around the world.
Clinical Experiences & Rotations
Starting in the PGY-2 year, the residents are fulltime in the Department of Urology at Los Angeles Medical Center (LAMC). Half of the year the residents will be introduced to clinical urology, where they will begin to learn basic urologic procedures. They will also take call with the chief residents. The other half of the year the residents will be introduced to research, while still on clinical duties. They will work early on with our urology faculty and the Research and Evaluation department. The research PGY-2 will also be exposed to operative urology as well as learning to manage emergent urologic consults. 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.
In PGY-4 year, residents have six months of protected research time, free from clinical duties and call. The research resident works 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. The remaining six months of the PGY-4 year is spent on the pediatric urology service at LAMC.
In the PGY-5 year, urology residents will rotate at UCLA for transplant surgery, and Downey 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 minimally invasive surgery.
The final year of residency 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 the junior urology residents and medical students.
Urologic Oncology Service
While on the Urologic Oncology Service, residents work closely with Dr. Kaswick, Dr. Finley, and Dr. Chien. The service manages a large volume of routine and complex urologic oncology cases, including radical retropubic prostatectomy, robotic assisted radical prostatectomy, radical cystectomy with various types of urinary diversion (ileal conduit, continent cutaneous neobladder and orthotopic neobladder), 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 robotic, or laparoscopic fashion. Chief residents will also participate in a combined urology/radiation oncology clinic, which meets weekly and functions as a tumor board for complex prostate and bladder cancer cases referred in from around the region. 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/Minimally Invasive Urology and General Urology Service
The Stone/Endourology Service is a high-volume rotation that receives many complex referrals. The residents work with Dr. Carter, Dr. Lassoff 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 laser lithotripsy. 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 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. In the cystoscopy suite, residents learn Transurethral incision of the prostate (TUIP), transurethral resection of the prostate (TURP), laser TURP. In the open OR, residents learn open simple prostatectomy, and treatment of scrotal conditions such as hydrocele and varicocele repair.
Neurourology and Female Urology Service
Junior and chief residents work with Dr. Reyblat and Dr. Tenggardjaja on the Neurourology and Female Urology Service 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 myelomeningocele.. 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. 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 infectious 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.
The PGY-4 urology resident spends six continuous months working one on one with Dr. Metzdorf and Dr. Huang. The Pediatric Urology Service includes a busy clinic practice and an active OR schedule. In the office, the resident will 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 to coordinate the orthopedic, urologic, physical medicine, pediatric, urologic, nutritional, and social service needs of these children with multiple problems. In the operating room, there is 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.