One Year Fellowship in Endourology
Job Address: Blvd Milienio 130, San Carlos La Roncha, Leon, Guanajuato. Zip Code: 37660, Hospital Regional de Alta Especialidad del Bajío. Leon, Gto. México.
Program Director: Braulio O. Manzo, M.D.
Type/Focus: Endourology, Stone disease, Laparoscopic Renal Skills and Benign prostate disease treatment, like HoLEP and ThuFLEP.
Duration: 1 Year
Starting Date: March 1rst
Applications dates: August – September
Country: MEXICO
City: León
Contac Name: program director MD Braulio O. Manzo.
Phone: +52 3312174796
Region: North America
Contact Email:
Twitter: @urobraulio.
Co – director: MD Hector M. Sanchez
Research Professor and Statistician: Edgar E. Lozada
Fellow Overview
The Hospital Regional de Alta Especialidad del Bajío, and Universidad Nacional Autonoma de Mexico (UNAM), offer a highly specialized and comprehensive fellowship training program in Endourology. This fellowship mainly focused on stone disease and minimally invasive benign prostate treatments like HoLEP and ThuFLEP.
This is a unique program in one of the most highly recognized hospitals in Mexico, where the fellows are exposed to highly complex cases of stone disease, getting experience in ECIRS, MiniECIRS, Standard PCNL, and MiniPCNL, and of course, ureteroscopy and semi-rigid ureteroscopy. In addition, the fellows are taught the simplified 0-90 puncture technique for all PCNL procedures, which has the main characteristic of accuracy and very low radiation exposition, as well as the USG puncture technique. Additionally, the fellows are taught two main treatment options for BPH, HoLEP, and ThuFLEP. As well as laparoscopic skills in renal surgery like simple nephrectomies, pyeloplasties, and renal cysts resection.
The fellowship is a one-year program with integrated clinical and research components. The clinical component will be mainly with professor M.D Braulio O. Manzo with daily activities, including lectures, patient evaluation, and surgeries. The academic and research component will involve professor MD Edgard Lozada, a well-recognized international statistician and researcher.
Fellowship components
Requirements
All the applicants must fulfill the following requirements:
1.- To have finished the urology specialty and be under 35.
2.- To have a minimum score of 8.5 in the university.
3.- Domain of English language.
4.- Full-time availability for one year to live in Leon, Guanajuato.
Former Publications
1.- Manzo BO, Gómez F, Figueroa A, Sánchez HM, Leal M, Emiliani E, Sánchez FJ, Angerri O. A New Simplified Biplanar (0-90°) Fluoroscopic Puncture Technique for Percutaneous Nephrolithotomy. Reducing Fluoroscopy Without Ultrasound. Initial Experience and Outcomes. Urology. 2020 Jun;140:165-170. doi: 10.1016/j.urology.2020.03.002. Epub 2020 Mar 14. PMID: 32184084.
2.-Manzo BO, Alarcon P, Lozada E, Ojeda J, Morales C, Gökce MI, Chew BH, Sepulveda F, Flores E, Morales I, Akpınar Ç, Emiliani E. A Novel Visual Grading for Ureteral Encrusted Stent Classification to Help Decide the Endourologic Treatment. J Endourol. 2021 Sep;35(9):1314-1319. doi: 10.1089/end.2020.1225. Epub 2021 Aug 13. PubMed PMID: 33730863.
3.- Vicentini FC, Mazzucchi E, Gökçe Mİ, Sofer M, Tanidir Y, Sener TE, de Souza Melo PA, Eisner B, Batter TH, Chi T, Armas-Phan M, Scoffone CM, Cracco CM, Perez BOM, Angerri O, Emiliani E, Maugeri O, Stern K, Batagello CA, Monga M. Percutaneous Nephrolithotomy in Horseshoe Kidneys: Results of a Multicentric Study. J Endourol. 2021 Jul;35(7):979-984. doi: 10.1089/end.2020.0128. Epub 2020 Jun 22. PubMed PMID: 32292038.
4.-Manzo BO, Tejeda E, Chew BH, Alarcon P, Flores E, Torres JE. Long-Term Passive Ureteral Dilatation with Double-J Stent: Possibly an Effective Treatment for Recurrent Renal Colic Caused by Papillary Renal Necrosis. J Endourol Case Rep. 2020;6(4):526-529. doi: 10.1089/cren.2020.0141. eCollection 2020. PubMed PMID: 33457720; PubMed Central PMCID: PMC7803271.
5.-Manzo BO, Gómez F, Figueroa A, Emiliani E. Author's Reply to Editorial Comments to the Original Article: A New Simplified Biplanar (0°-90°) Fluoroscopic Puncture Technique for Percutaneous Nephrolithotomy. Reducing Fluoroscopy Without Ultrasound. Initial Experience and Outcomes. Urology. 2020 Nov;145:305-306. doi: 10.1016/j.urology.2020.08.002. Epub 2020 Aug 14. PubMed PMID: 32798515.
6.- Cabrera JD, Manzo BO, Torres JE, Vicentini FC, Sánchez HM, Rojas EA, Lozada E. Mini-percutaneous nephrolithotomy versus retrograde intrarenal surgery for the treatment of 10-20 mm lower pole renal stones: a systematic review and meta-analysis. World J Urol. 2020 Oct;38(10):2621-2628. doi: 10.1007/s00345-019-03043-8. Epub 2019 Dec 7. PubMed PMID: 31813026.
7.-Gómez-Regalado F, Manzo BO, Figueroa-Garcia A, Sanchez-Lopez H, Basulto-Martinez M, Cracco CM, Scoffone CM. Efficacy of the Endoscopic Combined Intrarenal Surgery for the Treatment of a Staghorn Calculus in Crossed Fused Renal Ectopia. J Endourol Case Rep. 2020;6(3):205-208. doi: 10.1089/cren.2019.0181. eCollection 2020. PubMed PMID: 33102728; PubMed Central PMCID: PMC7580624.
8.-Manzo BO, Gómez F, Figueroa A, Sánchez HM, Leal M, Emiliani E, Sánchez FJ, Angerri O. A New Simplified Biplanar (0-90°) Fluoroscopic Puncture Technique for Percutaneous Nephrolithotomy. Reducing Fluoroscopy Without Ultrasound. Initial Experience and Outcomes. Urology. 2020 Jun;140:165-170. doi: 10.1016/j.urology.2020.03.002. Epub 2020 Mar 14. PubMed PMID: 32184084.
9.-Emiliani E, Kanashiro A, Chi T, Pérez-Fentes DA, Manzo BO, Angerri O, Somani BK. Fluoroless Endourological Surgery for Stone Disease: a Review of the Literature-Tips and Tricks. Curr Urol Rep. 2020 May 23;21(7):27. doi: 10.1007/s11934-020-00979-y. Review. PubMed PMID: 32444987.
10.-Manzo BO, Lozada E, Manzo G, Sánchez HM, Gomez F, Figueroa A, Gonzalez A. Radiation-free flexible ureteroscopy for kidney stone treatment. Arab J Urol. 2019;17(3):200-205. doi: 10.1080/2090598X.2019.1606381. eCollection 2019. PubMed PMID: 31489235; PubMed Central PMCID: PMC6711139.
11.-Valdez Vargas AD, Pérez Abarca VM, Maldonado Valadez RE, Badillo Santoyo MA, Sánchez López HM, Manzo Pérez BO. Idiopathic renal arteriovenous fistula, a rare cause of severe hematuria: Case report. Urol Case Rep. 2018 Jul;19:23-24. doi: 10.1016/j.eucr.2018.04.007. eCollection 2018 Jul. PubMed PMID: 29888181; PubMed Central PMCID: PMC5991333.
12.-Manzo BO, Lozada E, Vicentini FC, Sanchez FJ, Manzo G. Differences in the percutaneous nephrolithotomy practice patterns among Latin American urologists with and without endourology training. Int Braz J Urol. 2018 May-Jun;44(3):512-523. doi: 10.1590/s1677-5538.ibju.2017.0599. PubMed PMID: 29522290; PubMed Central PMCID: PMC5996812.
13.-González Maldonado AA, Manzo Pérez G, Vanzzini Guerrero MA, Marte Aracena EM, Manzo Pérez BO, Sánchez López HM. Extrarenal calyces as a cause of non-functional kidney in a child: Case report. Urol Case Rep. 2018 Mar;17:56-58. doi: 10.1016/j.eucr.2017.11.004. eCollection 2018 Mar. PubMed PMID: 29379739; PubMed Central PMCID: PMC5782399.
14.-Manzo BO, Bertacchi M, Lozada E, Rasguido A, Aleman E, Cabrera M, Rodríguez A, Manzo G, Sánchez H, Blasco J. Current practice in Latin America of flexible ureterorenoscopy with laser for treating kidney stones. Actas Urol Esp. 2016 May;40(4):229-36. doi: 10.1016/j.acuro.2015.11.002. Epub 2015 Dec 7. PubMed PMID: 26672677.
Description of Training
The Fellowship Program in Endourology and Metabolic Stone Disease at Duke University Medical Center offers prospective candidates the option to pursue either a one or two year training experience focused on endourology and stone disease. Our goal is to provide trainees with opportunities to develop the clinical, surgical, and research skills needed to be a leader in kidney stone management and research.
Fellows have the opportunity to work with Glenn M. Preminger, MD, Gary J. Faerber, MD, Mike E. Lipkin, MD, Charles D. Scales, MD, Chad M. Gridley, MD, Robert A Medairos, MD and Jodi A. Antonelli, MD in clinical, surgical, and research capacities. The Fellowship is structured to encompass a combination of clinical/surgical (75%) and research (25%) training over either a one or two year period, depending on the nature and degree of research focus. Our clinical volume and research infrastructure enables an applicant to get a comprehensive clinical and research fellowship experience in one year, however, if there is a particular research interest that could be better served with an additional year of research this could be accommodated. Areas of research interest include studying the bioeffects of shock wave lithotripsy and intracorporeal lithotripsy, shock wave and laser physics, advanced imaging technologies, development of novel endourologic devices, medical management of nephrolithiasis, innovative management of BPH, and health services/outcomes research as it pertains to stone disease and endourology.
Clinical/Surgical Training
Fellows work primarily with Drs. Scales, Antonelli, Medairos, Lipkin, and Preminger concentrating on developing the skills to master the clinical and surgical management of nephrolithiasis, including complex metabolic and anatomic cases. From a clinical perspective Fellows learn the fundamentals and nuances of metabolic stone evaluation and management so they are prepared to successfully manage even the most challenging metabolic cases in stone disease. Surgically, there is specific emphasis on developing proficiency with an array of techniques for PCNL including obtaining percutaneous access with fluoroscopic, ultrasound, and endoscopic guidance as well as mini-PCNL. Additionally, there is opportunity to use a wide range of technologies for ureteroscopic management of stones. Finally, for those interested applicants, there is the opportunity for training in the innovative management of BPH including holmium laser enucleation of the prostate (HoLEP) with Dr. Chad Gridley.
The Fellow is also an important part of the Endourologic training program for our residents including assisting in teaching basic and advanced ureteroscopic and percutaneous procedures and contributing to journal clubs and resident teaching conferences. The Fellow will be employed as a junior faculty member and will be responsible for 2 weeks of faculty call per year.
Laboratory Facilities and Research Supervision
Full research facilities are available at the at the Comprehensive Kidney Stone Center at Duke University Medical Center, including basic science bench-space for SWL and intracorporeal lithotripsy bioeffects studies, the Duke Lithotripsy Laboratory in the Department of Engineering, and two dedicated research lithotripters for animal studies. The Duke University Medical Center Vivarium with full veterinary and technical support is located immediately adjacent to the Medical Center and Department of Engineering.
Pei Zhong, Ph.D., will act as the immediate supervisor for performance of the basic physics studies and intracorporeal lithotripsy research. High-speed photographic analysis, acoustic emission equipment and a cavitation detection system will all be available to perform such physics studies. NIH funding is currently in place to cover the cost of performing many of these studies.
Health services research activities in Endourology occur at the Duke Clinical Research Institute (DCRI) under the direction of Charles D Scales, MD. The DCRI houses several large administrative datasets that provide insights into quality of care. NIH and other funding is currently in place to cover many of these studies.
Surgical Volume
|
Procedures |
Volume Year |
|
Percutaneous procedures |
250 |
|
Ureteroscopic procedures |
400 |
|
HoLEP |
50 |
Past Fellows
|
Fellow |
Year Completed Program |
|
|
Assim Durrani |
1995 |
- |
|
Chu Teh |
1996 |
- |
|
Todd Cohen |
1997 |
- |
|
Peter Aslan |
1998 |
|
|
Fernando Delvecchio* |
1999 |
|
|
John Kourambas |
2000 |
|
|
Brian Auge** |
2001 |
|
|
Paul Pietrow |
2002 |
[encode] |
|
Yeh Hong Tan* |
2003 |
|
|
James L’Esperance* |
2004 |
|
|
W. Patrick Springhart* |
2005 |
|
|
Roger Sur* |
2006 |
|
|
George Haleblian |
2007 |
|
|
Sean Pierre |
2008 |
|
|
Michael Ferrandino* |
2009 |
|
|
Dorit Zilberman |
2010 |
|
|
Michael Lipkin* |
2011 |
|
|
Agnes Wang |
2012 |
|
|
Muhammad Iqbal |
2013 |
|
|
Ramy Yaacoub* |
2014 |
|
|
Fernando Cabrera |
2015 |
|
|
Joanne Dale |
2016 |
|
|
Adam Kaplan |
2016 |
|
|
Daniel Wollin |
2018 |
|
|
Brent Whiship |
2019 |
|
|
Patrick Whelan |
2020 |
|
|
Russ Terry |
2021 |
|
| Christian Tabib* | 2022 | |
| Francois Soto-Palou* | 2023 | |
| Robert Medairos* | 2023 |
*In Academic Urology
**AFUD Scholar
Description of Training
The goal of this fellowship is to establish the basis for future thought in the care and robotic treatment of Genito-Urinary cancers. Duke's high-volume surgical practice offers exposure to and proficiency in the treatment of the following conditions using multiple robotic platforms (multiport, SP…) and approaches (intra-, extra-, retro-peritoneal…):
-from basic to advanced robotic urethral, ureteral, bladder/bladder neck reconstruction -the diagnosis and management of cancer arising from the genitourinary tract -the medical and surgical treatment of marked BPH -focal therapy techniques for image-targeted cancer treatment of prostate and kidney cancer -the creation of continent and non-continent urinary diversions
This fellowship provides a heavy emphasis on clinical experience exposing the fellow to routine and complex urologic cancer conditions. This exposure includes education in the multidisciplinary approach including radiation oncology, surgical oncology, and medical oncology. Fellows will participate in multi-disciplinary tumor boards and clinics, which will provide exposure to the disciplines and thought processes of treatment of even the most complex cases. This experience is rounded out by the opportunity to rotate with dedicated uro-oncologists and radiation oncologists during the one-year fellowship. Surgical training during the clinical year will focus very heavily on exposure to advanced robotic surgical procedures. Emphasis is made on the treatment of prostate, kidney, bladder cancers, which are the most common in our field. There also will be a component of training related to the robotic reconstruction of the ureter and bladder. The Fellowship is structured to encompass a combination of clinical/surgical (80%) and research (20%) training over a one-year period. Research opportunities are numerous and include image-guided ablative cancer therapies, advancements in prostate and kidney cancer treatment and AI in education and robotic surgery. Upon successful graduation of the fellowship the fellow receives a certificate from Endourology Society and from Duke University. Our goal is to provide trainees with opportunities to develop the clinical, surgical, and research skills needed to be a leaders in their fields.
Fellows will primarily work with Drs. Polascik, Morgan, and Gahan to gain a broad experience in the minimally invasive treatment of urologic cancer as well as some benign disease with enhanced exposure to upper and lower tract ureteral reconstruction. The fellow will have the opportunity to learn focal therapy techniques for image-targeted cancer treatment in a safe and effective gland-preserving manner. There is a wide array of research opportunities in these arenas as well. The Fellow is also an important part of the Endourologic training program for our residents including assisting in teaching and contributing to journal clubs and resident teaching conferences. The Fellow will be employed as a junior faculty member and will be responsible for 2-4 weeks of faculty call per year.
Note: If a combined two-year MIS Onc and stone pathway is desired, we will happily accept applicants to a two-year track as well.
Laboratory Facilities and Research Supervision
Full research facilities are available at Duke. We have NIH funding to cover the cost of performing studies which focus on prostate cancer imaging, focal therapy of prostate cancer, prostate cancer outcomes, kidney cancer outcomes, and minimally invasive surgery. More, the Duke University Medical Center Vivarium with full veterinary and technical support is located immediately adjacent to the Medical Center.
Research is focused on clinical outcomes and human and animal-based research related to the care of the urologic cancer patient. The research training will provide the Fellow with a valuable educational experience that will result in peer reviewed publications. The Fellow will also have the opportunity to work with one of several individuals engaged in either the basic science or translational research. Research training will include instruction in evidence-based medicine, clinical trial design, biostatistics and grant writing. Per Society requirements, our Fellows must submit and/or publish at least one first-author article in the subject matter of oncology to the Journal of Endourology.
Surgical Volume
Robotic nephrectomy/nephroureterectomy- 30-40/year Robotic partial nephrectomy/nephrolithotomy- 30-40/ year Robotic cystectomy/other-15-20/year Robotic radical prostatectomy- 90-110/year Robotic simple prostatectomy- 60-80/year Ureteral reconstruction (pyeloplasty, reimplant, buccal ureteroplasty, ileal ureter, U-U…)- 30-50/year
Application Process: All applicants should submit a letter of intent, current curriculum vitae, and letters of recommendation as outlined on the Endourology Fellowship website. Applicants selected for a formal interview will be contacted. Interviews will be held either by online meeting or during the American Urological Association Annual Meeting.
Please note that due to current restrictions in North Carolina, we are not able to accept International Medical Graduates who are not US citizens or permanent residents.
DESAI SETHI UROLOGY INSTITUTE, UNIVERSITY OF MIAMI
ENDOUROLOGY FELLLOWSHIP
INTRODUCTION:
The Desai Sethi Institute of Urology at the University of Miami offers a highly specialized and comprehensive fellowship training program in Endourology and Minimally Invasive Urological Surgery to fully trained urologists. Supported by an academic practice in a tertiary care medical center, the fellowship affords high volume clinical training as well as advanced research and educational opportunities with a strong focus on mastering HoLEP, PCNL and complex ureteroscopy for upper tract urothelial cancers and strictures.
GOAL:
The goal of the fellowship is to train urologists in endourologic procedures encompassing all common endourologic procedures so that trainees graduate in a position to manage even the most complex urologic patients with minimally invasive techniques. You will also learn how to independently perform high quality urologic research and apply for grants; ultimately preparing you for a career in academic urology.
SAMPLE SCHEDULE
Monday–Friday: The fellow will have four clinical days per week and one protected research day. Clinical responsibilities include rotating every two months with either Dr. Shah or with Drs. Marcovich and Katz. Typically, the schedule will consist of two operating room days and two clinic days.
Saturdays: Optional HoLEP and PCNL cases with Dr. Shah at the University of Miami Hospital.
PRE-REQUISITE TRAINING/SELECTION CRITERIA:
GOALS AND OBJECTIVES:
Endoscopic Surgical Skills: The fellowship is designed to provide an opportunity for the fellow to learn advanced endoscopic techniques related to the lower and upper urinary tracts. The fellow will be given progressive and graded patient care responsibilities from observation of techniques and assisting in surgery to assuming the primary surgical role and supervising residents under the direction of the fellowship director. The fellow will gain special training in obtaining percutaneous access by both fluoroscopy and ultrasound guidance for renal surgery and in various other modifications including supine and mini PCNL, and Endoscopic combined intrarenal surgery (ECIRS). Additionally, the fellow will have significant exposure to endoscopic enucleation of enlarged prostates and En-bloc laser resection of upper and lower tract urothelial cancers. Once a week, the fellow could participate in robotic surgery including both Xi and Single-Port Systems at the University of Miami hospital.
Nonsurgical Management of the benign urological conditions: Another goal of the fellowship program is to give each fellow the opportunity to develop non-surgical clinical skills. Fellows gain exposure in interpreting urodynamics and management of patients with complex lower urinary tract symptoms. They will also master metabolic stone management for stone prevention.
Knowledge of Imaging Modalities: When the endourology fellow completes the fellowship, he/she will have skill in reading and interpreting imaging modalities. The program provides exposure to state-of-the-art imaging modalities and uro-radiologists committed to teaching urologists the nuances of analyzing MRI, nuclear studies and scans.
Ability to Manage an Academic and Tertiary Referral Practice: The fellow will have the opportunity to develop skills in managing an academic practice at a tertiary referral practice. The fellow will work as a manager and liaison between the endourologists, residents, clinical staff, and the patient.
Communication Skills with Patients, Physicians, Residents and Staff: Through feedback and coaching, the fellowship will aid in the development of interpersonal and communication skills, as well as direct interaction, teaching and supervision of urology residents. Twice during the year, these skills will be assessed formally by the program director.
PROGRAM CERTIFICATIONS:
The fellowship will receive completion credentialing certificates from the Desai-Sethi Urology Institute, Jackson Memorial Hospital , and the Endourology society.
RESOURCES:
TEACHING STAFF:
FACILITIES:
SUPERVISORY RESPONSIBILITIES OF STAFF:
The endourology fellow is supervised by the program director for all the fellow’s clinical responsibilities. For the clinical portion of the fellowship, the fellow operates daily with either the director or the other clinical faculty members.
EDUCATIONAL PROGRAM-BASIC CURRICULUM:
(The surgical skills curriculum is listed under the “Goals and Objectives” section)
The didactic education component of the fellowship program is based in the departmental conference schedule.
EVALUATION OF TRAINEES:
The endourology fellow is evaluated semiannually by the program director. Because of the close association between the fellow and the program director, there is continuous discussion, reappraisal of goals and evaluation.
CONCLUSION
Ultimately, we expect you will find the fellowship education and enjoyable. We hope to foster a dynamic environment with mutual learning, curiosity, feedback, and respect.
