Urologic Oncology Fellowship: Clinical Experience

The clinical training of the Urologic Oncology Fellowship Program is supervised by the Faculty of the Urology Service at Memorial Sloan Kettering Cancer Center. Fellows undergo comprehensive, hands-on training in all aspects of the surgical management of urologic malignancies, and they interact extensively with medical and radiation oncologists. By the end of this training, fellows are fully versed in the multidisciplinary management of all types and stages of urologic malignancies.

The Urology Service has a long and distinguished history in the diagnosis and treatment of prostate, bladder, renal, testicular, penile, and adrenal cancers. We provide the highest quality of care for patients by using innovative techniques and the most-advanced treatment modalities. The faculty and staff of the Urology Service are housed in the 50,000-square-foot Sidney Kimmel Center for Prostate and Urologic Cancers, working alongside the faculty of the Genitourinary Oncology Service of the Department of Medicine.

Located across the street from Memorial Sloan Kettering’s inpatient hospital and main campus, the Kimmel Center provides state-of-the-art diagnostic services along with multispecialty consultations in surgery, medicine, and radiation oncology. Close collaboration among all specialists involved in caring for a particular patient allows for development of a comprehensive multimodal treatment plan. By providing clinical, academic, and research resources in the same building, the Kimmel Center fosters a high level of collaborative clinical research that benefits patients and the urologic oncology fellows in training.

Memorial Sloan Kettering’s urologic surgeons are renowned for their expertise in a wide range of surgical techniques, including open, robotic, laparoscopic, and image-guided approaches, as well as in urinary tract and pelvic reconstruction, voiding dysfunction and incontinence, sexual dysfunction, and treatment of benign prostatic hyperplasia.

Our urologic cancer surgeons have refined nerve-sparing procedures that preserve erectile function in many patients. Our bladder cancer surgeons are able to create neobladders for more than half of our patients requiring cystectomy for bladder cancer. Our kidney cancer surgeons are experts in kidney-sparing surgery and have documented its life-expectancy benefits. Our prostate cancer surgeons are experienced in performing technically demanding salvage prostatectomy, the surgical removal of the prostate after other treatments have failed. In addition, the treatment of prostate cancer has expanded from radical whole-gland procedures to image-guided focally ablative therapies. Our testicular cancer treatment team has contributed extensively to the literature on the management of this disease, leading to today's remarkably high cure rates.

Fellows are also trained in the use of minimally invasive — robotic, laparoscopic, and image-guided — approaches to urologic procedures, including prostatectomies, nephrectomies, and cystectomies. Memorial Sloan Kettering has five of the latest-generation da Vinci® SI dual-console surgical systems, which are used for both training and collaborative surgeries. When used for training, the dual-console system allows for control over the instruments to be exchanged quickly between the teaching surgeon and the fellow. Dry laboratories are also available for fellows to augment their surgical training. They include remote-controlled manipulators (da Vinci and other robots), laparoscopic simulators, perfused-organs models, and other instrumentation.

Our high-volume practice receives more than 25,000 patient visits and performs approximately 3,500 inpatient and outpatient procedures each year. In 2012, the Urology Service evaluated nearly 5,500 new patients, the majority of whom were surgical candidates. Our urologic surgeons performed 238 cystectomies, 143 radical and 262 partial nephrectomies, 645 prostatectomies, and 127 retroperitoneal lymph node dissections for testicular cancer, among a total 4,423 major or minor operations. Currently, more than 30 active protocols studying urologic cancers are headed by members of the Urology Service.

Working with the Genitourinary Disease Management Team, which includes experts in medical oncology, radiotherapy, pathology, radiology, and basic science, fellows have an opportunity to participate in the development of multidisciplinary management plans for patients. Fellows lead a team of residents, students, and physician assistants in providing care for inpatients, evaluate and manage pre- and postoperative patients in the outpatient clinics, and participate in the full range of surgical procedures. The call schedule is shared among the fellows. Fellows are responsible for the patients on their service during the week. Fellows are on call every third weekend, with responsibilities for the Urgent Care Center every sixth weekend.

In June 2010, the 40,000-square-foot Center for Image-Guided Intervention opened, offering cancer patients minimally invasive diagnostic and treatment options in a multidisciplinary setting designed to foster rapid innovations in cancer care. Memorial Sloan Kettering now has three combined “angio-CT” suites. Three-dimensional CT, MRI, and PET are also available for guiding interventional procedures. The proximity of the Surgical Day Hospital and a new endoscopy suite allows interventional radiologists, surgeons, and endoscopists to collaborate closely in developing new procedures and treatments.