Andrology and Prosthetic Urology Fellowship

Directed by Joseph Alukal, MD, Associate Professor of Urology and Director of Men’s Health, the APU Fellowship will be a non-accredited one year training program for an exceptional early career urologist who is genuinely interested in male infertility and sexual dysfunction. The ideal candidate for the APU Fellowship will be a physician-scientist who has completed an ACGME-accredited Urology residency program, conducted novel research in the field and published their studies in peer-reviewed scientific journals. Selection of the fellow will occur outside the match after review of personal statements, letters of recommendation, and an in-person interview at the AUA Annual Meeting. Only highly qualified candidates will be considered.

The APU Fellowship will focus on state-of-the-art training in the diagnosis and treatment of hypogonadism, Peyronie’s disease, erectile dysfunction, ejaculatory dysfunction, urethral stricture disease, genitourinary trauma, urinary fistulae, voiding dysfunction and lower urinary tract symptoms, and post-prostatectomy incontinence. Other topics to be addressed include non-infectious inflammatory diseases of the lower urinary tract. Clinical research will be incorporated into the training year with the expectation of numerous research projects collaborating with the Columbia Urology residents in addition to review articles, book chapters, and multi-institutional collaborations. The fellow will also be involved in didactic teaching sessions within the training program and Journal Club.

The Columbia Urology APU Fellowship will be distinct, in part, given its setting in an academic and large group practice. With plans to open a modernized multidisciplinary men’s health center in the first quarter of 2020 that utilizes telehealth, virtual collaboration, and cutting edge preventive care strategies, the APU Fellow will be afforded a unique opportunity to provide 21st century care to men from the New York City metropolitan area.

Learning Objectives

Upon conclusion of the training program, the APU Fellow is expected to:

1. Have a thorough knowledge of the surgical and functional anatomy of the external genitalia and pelvic floor, including penile/erectile, urinary (including the continence mechanism), colorectal, skeletal, and myofascial elements in normal and pathologic states.
2. Know the factors that influence normal and abnormal erectile and urinary function, including those that relate to neurophysiology, anatomy, pharmacology, and the endocrine system.
3. Understand the pathophysiology of all conditions encountered in the practice of Male Sexual Dysfunction and Prosthetic Urology Surgery, including erectile dysfunction, ejaculatory dysfunction, hypogonadism, urethral stricture disease, genitourinary trauma, urinary fistulae, voiding dysfunction and lower urinary tract symptoms, post-prostatectomy incontinence, and non-infectious inflammatory diseases of the lower urinary tract and genitalia.
4. Know and be able to correctly use all standard terminology and guidelines for the description, diagnosis and treatment of urological conditions (listed above), including those established by the Sexual Medicine Society of North America and the Society of Genitourinary Reconstructive Surgeons.
5. Have the ability to take a comprehensive medical history in addition to a specific urological, colorectal, and neurological history as they relate to the conditions listed above. The Fellow should be able to classify the severity, and determine the causes of the condition and the impact on the patient’s daily living and quality of life.
6. Know how to perform a directed physical and comprehensive urological examination and correlate the findings with patient history and the results of objective testing to formulate a treatment plan for specific conditions.
7. Perform and/or interpret diagnostic testing related to the urological conditions listed above; this includes interpretation of retrograde and voiding cystourethrogram, penile duplex Doppler ultrasound studies, and duplex Doppler ultrasound of the scrotum and testes. The Fellow is expected to interpret radiologic studies such as MRI and CT scan as they relate to urological conditions. In addition, the Fellow must know the indications for such testing.
8. Have a complete knowledge of available conservative/non-surgical treatments (e.g., behavioral therapy, biofeedback, timed voiding, and clean intermittent catheterization) for all conditions listed above. The Fellow is expected to describe the treatments, cite (and critically evaluate) published literature on the outcomes, and know indications, contraindications, complications, and costs of such treatments.
9. Have complete knowledge of pharmacological treatments (e.g., PDE5 inhibitors, testosterone replacement therapy, intracavernosal injection) including therapeutic dose ranges for all conditions listed above. The Fellow is expected to know the indications, contraindications, side effects and cost of all drugs. In addition the Fellow is expected to cite (and critically evaluate) the published literature on pharmacological treatments.
10. Know and understand the indications and contraindications and costs for the surgical treatments of urological conditions described above (#3). The Fellow is expected to describe the techniques, cite (and critically evaluate) published literature on the outcomes of procedures, and know the intraoperative, short-term and long-term complications of the procedures, as well as the management of complications.
11. Have expertise in the performance of minimally invasive and surgical procedures to treat urological conditions. Specific procedures where expertise is expected are:
    1. Surgery for erectile dysfunction and male sexual dysfunction:
       1. Penile prosthesis insertion (3-piece inflatable, 2-piece inflatable, malleable)
       2. Penile plication; plaque excision and grafting
       3. Penile artery revascularization bypass
    2. Surgery for male infertility/microsurgery:
       1. microsurgical varicocelectomy
       2. laparoscopic varicocelectomy
       3. vaso-vasostomy, vaso-epididymostomy
       4. testicular sperm extraction, microdissection testicular sperm extraction, and microsurgical epididymal sperm aspiration
    3. Surgery for post-prostatectomy incontinence:
       1. Male urethral sling
       2. Insertion of artificial urinary sphincter

    4. The Fellow should be familiar with the performance of the following procedures. In addition, The Fellow should know the indications for and expected outcomes and complications of such procedures:

       1. Division of penile dorsal vein and suspensory ligament

       2. Radial forearm free flap and creation of neophallus

       3. Urethrolysis, urethroplasty

       4. Bladder neck closure

       5. Augmentation cystoplasty

       6. Urinary diversion (continent and incontinent)

       7. Creation of Martius and other vascular pedical flaps

       8. Ureteral repair and reimplantation

12. Have an understanding of the literature as it relates to all aspects of Male Infertility, including complete knowledge of pharmacological treatments and other conservative/non-surgical treatments. The Fellow is expected to describe the techniques, cite (and critically evaluate) published literature on the outcomes of procedures, and know the intraoperative, short-term and long-term complications of the procedures, as well as the management of complications.

13. Write scientific manuscripts related to clinical and/or laboratory research that the fellow has conducted. This includes review of all relevant literature, expression of study design and interpretation of results. The Fellow should be able to search and objectively interpret relevant literature relating to all aspects of urological disorders.