Program Goals and Content Areas
Learning Objectives
- Management of anterior and posterior urethral stricture disease
- Male incontinence surgery – AUS and male sling
- Bladder reconstruction and continent urinary diversion– Augmentation, Mitrofanoff, bladder neck closure, Indiana Pouch
- Ureteral reconstruction – pyeloplasty, re-implant, psoas hitch, ileal ureter
- Robotic upper and lower urinary tract reconstruction
- Penile reconstruction and prosthetic surgery
- Management of neurogenic bladder and voiding Dysfunction – Botox, Interstim, TURP, PVP
- Recto-urethral fistula surgery
- Neurourology and Urodynamics
- Complex female pelvic medicine – Complications of pelvic surgery vesicovaginal & urethrovaginal fistula surgery, urethral diverticulectomy, surgery for recurrent SUI and POP
Overall Program Goals by Area
At the end of this fellowship in Genitourinary Reconstructive Surgery, the fellow will have obtained knowledge in the core reconstructive urologic procedures. The fellow will be knowledgeable especially in the following areas:
Male Reconstructive Surgery
- Management of urethral stricture disease including urethroplasty and substitution urethroplasty using grafts and flaps (both local flaps as well as extra-genital flaps)
- The management of male stress urinary incontinence and proficiency in artificial urinary sphincter and male sling implantation
- The fellow will be proficient in management of urethro-cutaneous as well as rectal-urethral fistula surgery
Bladder and Ureteral Reconstruction
- The fellow will demonstrate knowledge in ureteral reconstruction and be adept in the full array of reconstructive procedures including ureteral re-implantation, uretero-ureterostomy, transuretero-ureterostomy, ileal uretero substitution, boari flap, and pyeloplasty (both open and laparoscopic)
- Bladder reconstruction including bladder augmentation, creation of catherizable urinary stomas, urinary diversion
Robotic Reconstructive Urology
The fellow will be exposed to robotic surgery and has the opportunity to log 50 - 75 robotic cases in a single year. The fellow case log is more than double the robotic exposure that a fellow would receive at any other GU reconstructive surgery program. Approximately half of the procedures are FPMRS cases (Fistula surgery, RALS, graft removal from the LUT) and the other 50% are upper urinary tract reconstruction (ureteral recon and pyeloplasty) and lower urinary tract reconstruction (bladder augmentation, mitrofanoff, bladder neck closure, cystectomy with urinary diversion). Robotic GU reconstruction is an exciting area of growth in our field. These cases are lengthy, technically demanding procedures. Minimally Invasive Urology and FPMRS are excelling in GU Robotic reconstructive surgery while GURS fellowships are lagging behind. We are committed to training our fellows in bot open and robotic cases.
Complex Female Pelvic Medicine
Complex female pelvic medicine is a term our fellows coined recently and is reflective of the tertiary FPMRS practice we have at the University of Colorado. This includes management of patients with complications from pelvic surgery, fistula, ureteral obstruction, urethral stricture, recurrent stress incontinence and prolapse. Fellows will have exposure to both the clinic procedures as well as minor and major procedures we perform.
Research
The fellow will be involved in all related clinical research activities. The fellow will be able to select three (3) new or ongoing projects. The expectations for these projects will be completion by years end in the form of a manuscript that is prepared for publication in a peer-reviewed journal. Additionally, the research will be presented at a local as well as a national urologic meeting.
Summary
In short, the fellowship is a mix of major abdominal reconstructive surgery as well as male and female reconstruction. Dr. Flynn performs approximately 500 cases per year. The fellow will participate in approximately half of these cases, specifically the cases involving male reconstruction. These cases occur at the University of Colorado Hospital (85%), Denver Health Trauma Center (10%) and Children’s Hospital Colorado (5%). The fellow will have attending privileges and will have their own clinic (4 clinics per month) and cases of his/her own where he/she will function as the staff (approximately 4-8 cases per month). As the year progresses he/she will function as the staff on some combined cases. We do a number on large reconstructive cases especially in the 2nd half of the year (3-5 per month).
Brian J. Flynn, M.D.
Co-Director of UCH Women’s Pelvic Health and Surgery Clinic
Fellowship Director of Genitourinary Reconstructive Surgery
Professor of Surgery/Urology
University of Colorado Denver, Division of Urology
Academic Office One Bldg.
12631 East 17th Ave., Box C319, room L15-5602
Aurora, CO 80045
Academic Office: (303) 724-2712
Fax: (303) 724-2818
E-mail: Brian.Flynn@cuanschutz.edu