Urologic Trauma and Reconstruction Fellowships

Fellowships in urologic trauma and reconstruction emphasize management of acute injuries as well as surgical reconstruction of complex anatomic problems which may or may not be injury-related. While typical acute surgical cases include cystorrhaphies, renorrhaphies, nephrectomies, ureteral repairs, pus surgery, there is also a large amount of non-urgent reconstruction such as urethroplasties, fistula repairs, peyronies surgery, urethral sphincters, and penile prostheses. General urologic cases such as stone surgery and some cancer surgery may comprise a portion of the surgical load as well. These fellowships are at major trauma centers where there is a tremendous amount of ER volume. There is often an emphasis on the multidisciplinary/team approach to trauma management, typically including general surgery, orthopedics, plastic surgery, intensivists, etc. . . Additionally, there may be a significant general urology component with an under-served patient base and there may be some training in spinal cord injury patient care. The design of these fellowships is the apprentice model: i.e. McAninch, Santucci, Wessells, Jordan. Fellows are likely to have a large amount of responsibility in patient management and resident education.

Why do a trauma and reconstruction fellowship?
Trauma is interesting and exciting. Clinical decisions happen fast and surgical decisions may have to be made even faster. Developing a comfort level for dealing with urologic emergencies is a significant skill. Additionally, many of the reconstruction techniques taught in these fellowships are highly specialized. For example, not many community urologists are fully capable of performing one-stage urethroplasties with buccal mucosal grafts. While the intent of the trauma fellowship is to train urologists who will be practicing at major trauma centers, in reality, these skills are easily transferable to a general urology practice with an emphasis on reconstruction.

Why not?
Many people go into urology with the idea of eventually having relatively regular hours and few emergencies. For those people, trauma clearly does not fit the bill. Trauma fellows may be responsible for a significant amount of night and weekend trauma call. Additionally, for those who don't see themselves practicing in a major trauma center, you need to think about why you would do this fellowship. A career focused on urologic reconstruction will likely need to be at a big center with a large referral base in order to generate enough cases.