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GU Reconstructive Surgery Fellowship


The Genitourinary (GU) Reconstructive Surgery Fellowship at the University of Colorado School of Medicine is a one-year clinical fellowship under the directorship of Brian J. Flynn, MD, Professor of Surgery in the Division of Urology. Dr. Flynn started the fellowship in 2008. The fellowship’s focus is both male and female reconstructive Urology. We are one of the few remaining programs that are committed to training fellows in all aspects of GU reconstruction that includes male and female GU reconstruction. This philosophy originates from “old-school” of reconstruction built by Richard Turner-Warwick, George Webster, and Gerald Jordan.

In 2012, GURS started a match in GU Reconstructive Surgery, and we have participated in the match and have received a letter of good standing each year the GURS match has existed. In 2012, Dr. Ty Higuchi joined the CU reconstructive urology program and brought additional expertise in urethral, penile and neurogenic reconstruction as well as adding transitional urology to the program.

The CU Reconstructive Urology fellowship has been committed to meeting the curriculum standards to a GURS-based curriculum. We consistently perform in the top 50% in the majorityof the index cases. Additionally, the GU reconstructive fellowship overlaps partially with what is now known considered FPMRS/SUFU index cases. The fellows do have some flexibility on case selection based on their own individual experience, interest and future job aspirations.

This clinical fellowship includes a graduated experience focusing on GU reconstruction. This includes pre-operative evaluation, intraoperative management and post-operative care. The fellow will be quite familiar with reconstructive surgery of the ureter, bladder, urethra and penis. The fellow will spend 90% of his/her time functioning as a fellow under the directorship of 2-4 faculty members, spending the majority of time with 2 faculty members. The remaining 10% of his/her time will be spent independently. The fellow will have four of his/her own clinics per month and have the ability to schedule minor cases that come from these clinics. The fellow will have 1-2 days per month of research time. This time is flexible based on the fellow’s research interest and productivity. We will support the fellow’s participation at two national meetings per year to present their research activities.



Prerequisites for Admission

The fellowship is open to both “U.S. citizens” and “non-U.S. citizens” who are qualified to obtain a full medical license in the State of Colorado and have completed all 3 steps of USMLE. Additionally, the applicant must have completed an accredited Urology Residency in the United States and be board eligible in Urology. The applicant must have a letter of support from their Program Director attesting to the successful completion of the urology training program and recommending them for the fellowship. Two additional letters of recommendation are required.

One trainee per year will be accepted into the 1-year clinical fellowship-training program.

There maybe opportunity of a 1-year research fellowship or 1-3 month observerships, especially for international fellows. This will usually require extramural funding. To date we have had international scholars visit from Canada, Brazil, Mexico, China, Korea, Italy, Russia and Jordan.

Fellowship training in Genitourinary Reconstructive Surgery is now determined according to a match process through the Society of Genitourinary Reconstructive Surgeons and the American Urological Association. If you are interested in learning more about the match process, please check out the GURS website at https://www.auanet.org/secured/malereconstruction/applicant.cfm.

Please note: Residents/Fellows in University of Colorado training program must be a U.S. citizen, lawful permanent resident, refugee, asylee, or possess the appropriate documentation to allow the resident/fellow to legally train at the University of Colorado School of Medicine.



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

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.



Program 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@UCDenver.edu



Useful websites

http://www.sufuorg.com

http://www.societygurs.org

http://www.augs.org

http://www.auanet.org

http://www.siu-urology.org



Faculty

Brian J. Flynn, MD Professor of Surgery/Urology

Ty Higuchi, MD Assistant Professor of Surgery/Urology

Janine Oliver, MD Assistant Professor of Surgery/Urology



Fellow Roster


Year Name Medical School Residency Post-Fellowship
​2017-2018 ​Michael A. Avallone, MD ​ University of Miami ​Medical College of Wisconsin San Louis Obispo, California
Private Practice
​2016-2017 ​Lisa M. Parrillo, MD ​Eastern Virginia Medical School ​University. of Pennsylvania ​​Meridian, Idaho
Private Practice
​2015-2016 ​Stephen A. Blakely, MD ​Univ. of Maryland ​SUNY Upstate Medical University ​​SUNY Upstate, Assistant Professor
​2014-2015 ​Kirk M. Anderson, MD ​Loma Linda Univ. ​Loma Linda University Sacramento, CA
Sutter Health
2013-2014​ ​Andrew P. Windsperger, MD ​University of Minnesota ​University of Kansas St. Cloud, Minnesota
Private practice
2012-2013 Ketul S. Shah, MD Univ. of Mumbai, Bombay,  India Ohio State University Columbus, OH
Private practice
2011-2012 Dmitriy Nikolavsky, MD Wayne State Univ. Beaumont Hospital
Royal Oak, MI
SUNY Upstate, Assistant Professor
2010-2011 David A. Hadley, MD Loma Linda Univ. University of Utah Twin Falls, ID
Private practice
2009-2010 Christopher R. Knopick, MD Northwestern Univ. Wayne State University San Francisco, CA
Attending – Kaiser
2008-2009 Ryan P. Terlecki, MD Wayne State Univ. Wayne State University Univ. Wake Forest
Associate Professor


To Apply:

Applications for a fellowship position must be submitted through the Genitourinary Reconstructive Surgery Fellowship Match through the AUA. Information on the application process can be found at the GURS website at www.societygurs.org/fellowship​.

In addition to applying on-line, applicants are required to forward a copy of their GURS application and all supporting documentation via e-mail to the Fellowship Coordinator, Noelle Musgrave, at noelle.musgrave@ucdenver.edu.

CU Deadline: December 31 (1.5 years before the potential start date)

Required documentation includes:

  • Copy of GURS application
  • Curriculum Vitae
  • Medical School Transcripts
  • Letter of Recommendation from Residency Program Director
  • Three (3) Additional Letters of Recommendation

Interviews are typically held in February and March. Please feel free to contact Noelle Musgrave via e-mail at noelle.musgrave@ucdenver.edu with questions or to request additional information.​