Overview

Our fellowship is organized around genitourinary injury and reconstructive urologic surgery. It is run through the adult division of urology at University of Utah. The Fellowship is directed by Dr. Jeremy Myers, and clinical and research mentors include Drs. James Hotaling and Sara Lenherr.

Mission/Vision statement

To train leaders in reconstructive and academic urology through a fellowship program that is oriented to the diverse and different interests of reconstructive urology fellows.

To create one of the leading fellowships in the country based upon operative experience, teaching excellence, and research opportunities.

Duration

The reconstructive urology fellowship is 2 years in duration. The fellowship transitioned from a 1-year clinical fellowship to a 2-year fellowship in 2021.

Starting date: Variable, most fellows elect to start August 1st

Salary, Benefits, & Other Associated Expenses

The year 1 salary for the reconstructive urology fellow is based upon the current salary for a post-graduate year 6 or 7 resident at the University of Utah (depending upon whether fellows have completed a 5 or 6 year residency). Unlike residency the fellowship includes retirement benefits, up to 27% of salary, which is contributed into retirement accounts separate from any 403 or 457 retirement. The fellow may take 5 weeks of vacation, which would include any time off for interviews. Attendance at academic meetings would not be counted as vacation.

Family leave follows a well-established policy in the department of surgery. 

Meetings

The fellow is expected to attend 1-3 meetings during the course of the year. These meetings may include: the AUA, Sexual Medicine Society of North America, SUFU, American Association for the Surgery of Trauma, and the American College of Surgeons.

AUA attendance is expected, attending other meetings will depend upon the fellow’s research interests and academic productivity. Other meetings will be considered at the discretion of the fellowship director and the fellow’s mentors.

Other Educational Trips

Interested fellows can participate in an international reconstructive urology surgical experience, in conjunction with the International Volunteers in Urology (IVUMed.org) or the Society for Genitourinary Reconstructive Urology (GURS.org). Participation depends upon the fellow’s interest and opportunities in any given year. 

Fellows, also depending upon their interests, may attend the fellows’ course on prosthetics sponsored at different times by industry partners.

Structure of Years 1 & 2

Year 1: In this year, the fellow will have a research emphasis (detailed below). The fellow will also support faculty working in reconstructive urology with an emphasis in gender affirmation surgery. The fellow will likely be active clinically 2 days per week. One of these days will be clinic based, in reconstructive urology and one will be in the operating room. The operating room day will vary between the two faculty active in reconstructive urology.

Year 2: The fellow will transition to a clinical based year, with either 3 or 4 clinical days a week.  These days would consist of one reconstructive urology clinic day and 2 or 3 operating room days. Emphasis in this year will be with Dr. Jeremy Myers, learning urinary diversion, abdominal reconstruction, and the treatment of urethral strictures.

*There is one fellow per year that will matriculate in the program, so there will be a 1st and 2nd year fellow every year.

Clinical Responsibilities: 

The fellow will be expected to obtain a Utah medical license prior to matriculation and will be employed as a clinical instructor. Hospital privileges at the University of Utah and the Salt Lake Veterans Medical Center will be obtained prior to starting the fellowship. The fellow will cover attending call at the University of Utah and the Veterans Medical Center 1 in every 6 weeks (8 weeks total per year). The fellow will act to triage appropriate cases to services within urology, such as oncology and endourology and will supervise the care of trauma / acute care patients and general urology patients. This care will include operative care. There is NO general urology clinic routinely staffed by fellows. The fellow may need to see urology patients in clinic periodically in the course of their duties.  Fellows may staff some surgical days with general urology patients, as well as clinics if their clinical mentor is gone for vacation or academic travel. Generally, we try to split this time between clinical responsibilities and opportunities for increased research or administrative time.

Research Responsibilities

The first year of fellowship will involve structured research development. The fellow will work 2 days clinically and 3 days in research development. During this year, the fellow will develop a research plan, begin to implement this plan in developing impactful research, take seminal course work (e.g. biostatistics, health care leadership, scientific/grant writing, education) and may elect to take course work for a master’s degree.

In the second year of the fellowship research time will consist of 1 or 2 days per week, depending upon the fellow’s goals. If research is of prime interest and the fellow is developing grants or finishing master’s training then 2 days per week will be designated. If the fellow has interest in being more clinical during this year then they would continue their research 1 day per week.

Structure 

The fellowship is structured upon three main pillars: Operative experience, teaching, and research.

Operative Experience 

Fellows will gain experience in reconstructive urology, genitourinary injury, urinary diversion, prosthetics, gender affirmation surgery, some female urology, and robotics.

  • Reconstructive urology
    • Urethroplasty
    • Buried penis / split thickness skin grafting genitalia
    • Ureteral repair
  • Genitourinary injury
    • Acute trauma management: University of Utah is one of two level-1 trauma centers in a huge geographic area and treats close to 2,500 trauma cases per year.
    • Radiation injury: managing the full spectrum of injury from conservative to urinary diversion for complications associated with prostate, colorectal, and gynecologic radiation.
    • Surgical: ureteral, bladder injuries associated with recent surgery
    • Spinal cord injury / disease: University of Utah has a strong collaboration with rehabilitation medicine, which serves as a large tertiary rehabilitation center for SCI patients throughout the intermountain west. Augmentation and surgical revision of neurogenic bladder patients are common
  • Urinary diversion
    • Orthotopic neobladder: In bladder cancer patients treated with radical cystectomy
    • Continent catheterizable pouch in patients after cystectomy for bladder cancer and for complications of benign disease
    • Conduit urinary diversion: for benign disease
    • Revision surgery for common long-term issues, such as ureteral stenosis, hernia, problems with catheterization
  • Prosthetics
    • Male urethral sling
    • Artificial urinary sphincter volumes make University of Utah the leading implant site for the Intermountain west.
  • Female urology (with Dr. Sara Lenherr)
    • Pubovaginal sling
    • Vesico-vaginal fistula
    • Complex mesh excision/revision
  • Robotics
    • Ureteral repair
    • Treatment of ureteropelvic junction obstruction
    • Pelvic reconstruction for bladder neck contracture
    • Revision of vaginoplasty
  • Gender affirming surgery
    • Vaginoplasty / vulvoplasty
    • Phalloplasty, including radial forearm flap and metoidoplasty
    • Complications of gender affirming surgery

Teaching

A major part of fellowship training is learning how to teach surgery effectively. Fellows will have graduated responsibility in the operating room and a major component of this is learning how teach residents. Additional expectations are routine lectures to residents in areas of reconstructive urology. These didactic sessions are focused upon improving the residents’ urologic knowledge base, in order to prepare them for the yearly inservice exam, clinical experiences, and ultimately the urology board exam.

Research

There are many areas of research that the fellow may choose to work within, depending which projects are current, and the fellow’s interest. Some of the current projects underway or are the following:

  • Reconstructive Urology
    • Full availability of the Trauma and Urologic Reconstruction Network of Surgeons database. This data source pools data from > 10 tertiary reconstructive centers in North America and can be used to investigate many aspects of clinical outcomes in urethral stricture and incontinence treatment.
  • Trauma
    • Utah is the primary investigator for two prospective studies through the Multi-institutional Trials Committee of the American Association for the Surgery of Trauma (AAST), which evaluate current management of bladder and renal trauma, as well as the acute management of pelvic fracture urethral injury.  We now have a database of > 1,100 high grade renal trauma cases from 21 level 1 trauma centers across the US with downloaded and de-identified radiology.  This database has generated numerous impactful publications with the Multi-institutional GenitoUrinary Study (MiGUTS).  Our trauma publications are listed in the following link, including studies from MiGUTS: University of Utah Trauma Studies.
    • Utah has access to the National Trauma Databank (NTDB) and the Trauma Quality Improvement Project (TQIP).  These large administrative datasets are maintained by the American College of Surgeons. They have allowed us to analyze the link between nephrectomy and death in two ongoing studies. These databases can be leveraged to understand many aspects of genitourinary trauma care.
  • SCI and Neurogenic bladder
    • PCORI grant – A grant entitled “Bladder Management in Patients with Spinal Cord Injury” started in August 2015. This was a multi-institutional study, for which Utah served as the primary investigative site.  The grant’s goal was to assess current trends in SCI bladder management and patient reported outcomes with different bladder managements. The grant ended in 2018, however, there is large database has been assembled with many areas of potential investigation.
    • DoD grant – A grant entitled “The Effectiveness of Early Sacral Nerve Stimulation in Preserving Bladder Health and Quality of Life After Acute Traumatic Spinal Cord Injury” began September 2016 and will randomize patients after acute spinal cord injury to SNM placement versus usual care. There are multiple opportunities to use data from this project to describe bladder dynamics after SCI.
    • The Neurogenic Bladder Research Group is a group of 10 centers focused upon meaningful studies in neurogenic bladder. A database is under current development and the group is open to ideas for meaningful studies in the years to come.  The current publication list from NBRG is available at the following link: NBRG Studies.
  • Utah Population Database
    • The UPDB houses full medical records and pedigree data on 85% of all Utahns. This database is unique and can be used to conduct powerful population-based studies. The discovery of BRCA-1was through the UPDB. Current areas of investigation in reconstructive urology are management of urethral strictures and familial inheritance, outcomes in pediatric congenital urologic disease, and incidence an impact of radiation injury. The possibilities for meaningful health services research are virtually endless.  The Surgical Population Analysis Research Core (SPARC) is an important collaborator in these studies.
    • AUA data grant - We received and AUA data grant in 2018 for the study of radiation injury after treatment of prostate cancer and are currently creating a database for the study of multiple aspects of this problem.

Advanced Degree Training During Fellowship

Motivated fellows may receive or work towards a master’s degree during fellowship.  Advanced degrees could include a master’s degree in clinical investigation (MSCI), business (MBA), or education. These advanced degrees can help catapult a career in academic or other practice settings.

Sample Fellowship Schedule

The schedule may vary year to year depending upon interests of the fellow and research/clinical goals.

YEAR 1

Monday Tuesday Wednesday Thursday Friday
Week 1 Gender Affirmation Surgery OR Clinic Recon Staff Academic Academic Academic
Week 2 Academic Clinic Recon Staff OR Myers Academic Academic 

YEAR 2

Monday Tuesday Wednesday Thursday Friday
Week 1 Academic Clinic Myers OR Myers OR Myers OR Recon Staff
Week 2 Gender Affirmation Surgery OR Clinic Myers OR Myers Academic OR Recon Staff

YEAR 2 - RESEARCH HEAVY

Monday Tuesday Wednesday Thursday Friday
Week 1 Academic Clinic Myers OR Myers OR Myers Academic
Week 2 Academic Clinic Myers OR Myers Academic OR Recon Staff

Society of Genitourinary Reconstructive Surgeons (GURS) Verification:  The fellowship at University of Utah is one of twenty fellowships verified by GURS.

Fellowship Volumes

In general, reconstructive urology staff perform about 80 urethroplasties a year, > 50 abdominal reconstructive cases including urinary diversion and ureteral repair, and > 50 gender affirmation surgeries.

 case volumes

Program Director

Jeremy B. Myers, MD, FACS


Other Staff

Jim Hotaling, MD, MS, FECSM (Andrology/Men's Health)
Alexander Pastuszak, MD, PhD (Andrology/Men's Health)
Sara Lenherr, MD, MS, FPMRS (Female Pelvic Reconstruction)

Contact Us

For more information, contact the following:

Elizabeth Royall
Urology Fellowship Coordinator 
Phone: 801-585-2616
Email: Elizabeth.Royall@hsc.utah.edu