Clinical Experience

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 (MSK). Fellows undergo comprehensive, hands-on training in all aspects of the open, endoscopic, and minimally invasive (laparoscopic and robotic) surgical management of urologic malignancies. The fellows also interact extensively with medical and radiation oncologists during weekly multidisciplinary conferences and didactic lectures, as well as through dedicated rotations with international leaders in genitourinary medical oncology. 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 MSK’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.

MSK’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.

Fellows are also trained in the use of minimally invasive — robotic, laparoscopic, and image-guided — approaches to urologic procedures, including prostatectomies, nephrectomies, and cystectomies. MSK has 11 of the latest-generation da Vinci® Xi 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. Educational activities also include a combination of surgical simulation for open and minimally invasive surgery, as well as wet and dry laboratories 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 advanced practice providers (APPs, including nurse practitioners and/or 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 or fourth weekend.

The clinical program is designed to provide the fellow with a practical knowledge of the most up-to-date methods of diagnosing and treating urologic cancers. Clinical care responsibilities are shared by the faculty, fellows, residents, medical students and APPs. We currently have more than 60 dedicated APPs to augment our clinical practice, which includes inpatient and overnight coverage and on-call responsibilities (APP distribution: 13 inpatient; 17, outpatient Kimmel Center; 10, regional sites; 9, main operating room; and 13, Josie Robertson Surgery Center). Fellows are directly involved in the management of patients with urologic malignancies or patients with urologic problems arising from or coincident with the treatment of neoplasms outside the urinary tract. 

Josie Robertson Surgery Center

Urologic oncology fellows will have an unparalleled experience at the outpatient cancer surgery center at MSK. The Josie Robertson Surgery Center sets a new standard for outpatient oncology surgery with operating rooms and care areas specifically designed for specialty procedures including robotic-assisted radical prostatectomy and minimally-invasive kidney procedures. The center is equipped with four of the latest-generation da Vinci® Xi dual-console surgical systems. Every case is staffed with dedicated bedside physician assistants to enable fellows to gain first-hand experience at the console with the attending surgeon. In addition, the center has computer workstations and meeting space for fellows and staff. The center also is dedicated to novel health outcomes research by tracking closely patients’ hospital course and post-operative experience.