Available Positions -
Fellowship in Genitourinary Trauma and Reconstructive Surgery

"The establishment of a Fellowship in Trauma and Reconstructive Surgery in 2005, regular involvement of urology residents in the Harborview Injury Prevention Research Center, and an expanding volume of trauma and elective reconstruction make these exciting times at Harborview."
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Overview

The University of Washington School of Medicine and Harborview Medical Center offer a 1-year clinical fellowship focused on acute injury management and the delayed reconstruction of post-traumatic, infectious, and radiation-induced urologic complications.

The clinical fellowship includes mentored graduated experience in acute injury management, year-long participation in complex elective genital and urinary reconstructive surgery, and shared responsibility for the general urology and mission population of Harborview Medical Center. The prospective fellow will have staff privileges at the medical center, have a clinic of his own supported by residents, and have block time assigned to him/her with the ability to book cases and contribute to the care of patients at Harborview Medical Center (average 1-day per week). Extensive research opportunities are available at the Harborview Injury Prevention Research Center as well as other research programs.

Areas of active research include biomechanics of renal injury, genitourinary complications of pelvic fracture, long-term outcomes of genital skin grafting, as well as other ongoing studies related to renal injury management, urethral realignment, and reconstruction of urethral stricture disease.

Faculty

The faculty involved in fellowship training include the program director Hunter Wessells, MD, FACS, Chief of Urology at Harborview Medical Center (HMC) and William J. Ellis, MD, at University of Washington Medical (UWMC).

Essential and Unique Characteristics of a Fellowship Trained Urologic Trauma and Reconstructive Surgeon:

The goal of advanced training in trauma and reconstructive urology is to provide further knowledge and skills beyond the expertise achieved during a urology residency program. The additional expertise should include scholarship, critical analysis of complex clinical problems, and development of advanced technical skills. The fellow should develop good skills in the planning of multidisciplinary approaches to patient care. The trainee should also achieve expertise in clinical scientific research methodologies.

After completing a one-year minimum fellowship in trauma and reconstructive urology, the surgeon should demonstrate the following unique characteristics:

1. Advanced expertise in the multidisciplinary management of patients with urologic trauma;
2. Knowledge and the ability to apply the critical principles of:
   1. Plastic surgery
   2. Microsurgery
   3. Urologic imaging techniques
3. Ability to perform complex urethral and genital surgery with a clear understanding of the benefits and the technical limitations of surgical procedures;
4. Extensive knowledge of and technical experience in lower urinary tract diversion and reconstruction;
5. Knowledge of the biology of injury and wound healing;
6. Comprehension of and facility with scientific methodology, study design, biostatistics, clinical trials, and data analysis;
7. Ability to manage academic or tertiary referral clinical practice, participate in continuing education.
8. Skills for self-education, and collaboration in translational research.

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Eligibility Requirements

1. Admission to a trauma and reconstructive urology program is contingent upon completion of an ACGME accredited urologic training program or an appropriate foreign program.
2. The applicant must have a letter of support from their urology training program director recommending them for the fellowship and attesting to the candidate's successful completion of the urology training program. Additional letters are required.

Duration of Training

1. The clinical portion of the experience must be a minimum of 12 months in duration.
2. Goals, expectations, and requirements should be stipulated at the beginning of the program. The clinical and basic science research available during the fellowship should be clearly defined. Research should be encouraged under the supervision of an appropriate mentor.

Urogenital Trauma Research

• Pelvic Injury Outcomes and Quality of Life Cohort study of urinary and sexual outcomes and quality of life in male and female pelvic fracture patients
• Renal Trauma: Injury Staging and Management Variation: Various ongoing study using the Trauma Registry, National Trauma Data Bank, and Crash Injury Research Engineering Network.
• Fournier’s Gangrene: Urology/ Plastics Reconstructive service and database established comparing meshed and unmeshed penile grafts; outcomes; techniques.
• Urethral reconstruction: primary posterior urethral realignment, dorsal vs. ventral onlay bulbar urethroplasty, 2 stage buccal mucosa grafting of pendulous urethra.

Clinical Volume Indicators

Harborview Urology Service

Average daily census: 3.05
Length of stay: 2.98
Admissions/month: 20

Case Load (year)
Endoscopic: 546
Open: 186
Total: 732

TRAUMA REGISTRY and NUMBER OF ADMISSIONS
Year	Pelvic FX	Renal
2001	433	93
2002	430	72
2003	460	89
2004	471	99
2005	477	115
2006	505	156
Total	2556	624
Mean (per yr)	???	???

OPERATIVE TRAUMA and RECONSTRUCTION (ONE YEAR TOTAL)
Type	Total
Upper tract (Kidney and Ureter)	15
Bladder	30
Urethra	30
Genital	20
Fournier’s	10
Total	105

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Snapshot Of Cases

Cases for Sept-Nov 2005
Chronological order
Hunter Wessells, MD, F.A.C.S.
Harborview Medical Center & University of Washington Medical Center

• Complex 1 stage posterior urethroplasty post traumatic stricture
• Resection/release of glans from BXO, Meshed STSG to the Penis
• Urethrocutaneous fistula resection, first stage urethroplasty, FTSG genitalia
• Inflatable Penile Prosthesis
• Complex 1 stage posterior urethroplasty post traumatic stricture
• Bladder Repair for Grade 4 Bladder laceration
• Resection iliac-ileal fistula, bilateral ureterostomies
• Excision eroded pubovaginal sling
• Excision of Peyronie’s Plaque, Grafting of Penis with Bovine Pericardium and Insertion of Inflatable Penile Prosthesis
• Complex 1 stage posterior urethroplasty for radiation induced stricture
• Inflatable penile prosthesis
• Cysto JJ Stent for post traumatic UPJ obstruction
• 1 stage bulbar ventral onlay buccal urethroplasty; distal urethrectomy and first stage urethroplasty with buccal mucosa FTSG to penis
• DVIU (n = 3)
• Shotgun wound to pelvis – bladder repair, ureteral exploration, scrotal exploration and right orchiectomy
• Trans Urethral Resection of the Prostate
• Pelvic lymph node dissection
• Removal AUS and replacement with Double cuff transcorporal AUS
• Buccal Mucosa Ventral Onlay Free Graft Urethroplasty
• Take Down of Patent Cavernosal Spongiosal shunt
• Deep biopsy of urethral mass (SCCa)
• Complex incision and grafting of Peyronies plaque
• 1 stage ventral onlay buccal mucosa urethroplasty
• Artificial Urinary Sphincter
• 1 stage dorsal onlay buccal mucosa urethroplasty
• Distal urethrectomy and first stage urethroplasty with buccal mucosa FTSG to penis
• Massive ventral hernia repair and buried penis repair
• Penile plication
• 1 stage ventral onlay buccal mucosa urethroplasty
• Inflatable penile prosthesis
• L Partial nephrectomy
• 2nd stage urethroplasty, tunica vaginalis flap
• 1 stage ventral onlay buccal mucosa urethroplasty
• 1 stage dorsal onlay buccal mucosa urethroplasty
• 1 stage ventral and dorsal onlay buccal mucosa urethroplasty
• 1 stage augmented ventral onlay buccal mucosa urethroplasty
• 1 stage posterior urethroplasty for radiation induced stricture

To apply for a position for July 2010, send

• Your CV
• Cover letter
• 3 letters of recommendation

To

Dr. Wessells attn
325 9th Ave
Seattle, WA 98104

OR

Leo Calipusan
leowill@u.washington.edu

Applications will be taken up until December 2008.

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