Urologic Andrology Fellowship
The Andrology Fellowship at the University of Virginia aims to provide the Fellow with the depth of knowledge and surgical skill necessary to provide expert specialty care in the field of Andrology (sexual medicine and male infertility) to the patient. Microsurgical techniques and experiences are taught in primarily in a clinical environment with additional opportunities, such as a prosthetics cadaver lab dispersed throughout the year. Office-based assessment for patients with sexual dysfunction or infertility is experienced through a mentorship approach. The Fellow will be expected to continue work as a General Urologist during the Fellowship allowing a maturation of surgical skills and knowledge. This also permits the opportunity for operative and clinic based teaching of residents. Research time is protected to ensure the opportunity to explore clinical questions. Both clinical and bench research opportunities are available. Fellows interested in bench research are guided by a dedicated laboratory staff with a strong background in Andrology research. Upon completion, the Fellow will have the background to become a leader in the field of Andrology through Research and Clinical Practice. Clinical time (two half-day clinics and on average 2.5 OR day/week) represents approximately 90% of the Fellowship experience.
Clinical time will include the Fellow’s own clinic and surgery. The clinic will run parallel with the Fellowship faculty’s clinic to allow discussion and review of Andrology and infertility cases. General urology patients will also be included in the Fellow’s clinical time with the majority of patients being examined for problems with infertility and sexual dysfunction (vasectomy reversal, oligo/azoospermia, Peyronie’s disease, ART evaluations etc). Surgical time will be performed at the outpatient surgery center, clinic procedure rooms and main operating rooms. It is required that the Fellow participate in all Andrology cases. The Fellow is able to schedule and perform general urologic procedures within their ability.
- Evaluate and treat male factor infertility and common disorders of male sexual health
- Learn and develop the core diagnostic and surgical principles of urologic microsurgery, urologic prosthetics and reconstructive urology
- Evaluate and treat erectile and ejaculatory dysfunction, Peyronie’s disease, and male sexual dysfunction
- Manage complicated and difficult urologic prosthesis cases
- Evaluate and treat patients with benign disorders of the penis scrotum
- Develop expertise in the advanced comprehensive men’s health evaluation
In order to be eligible for our Fellowship program, an applicant must:
- Have completed United States Medical Licensing Examination Steps I, II, and III prior to applying for the fellowship
- Have completed or anticipate completion of an ACGME-accredited Urology residency program
- Meet requirements and obtain an unrestricted full Virginia medical license prior to commencing the program
- Be a United States citizen or permanent resident
- If selected as a potential candidate for the Fellowship, the applicant will be required to fulfill conditions for UVA Faculty Appointment (Clinical Instructor Level) as delineated by the University of Virginia and University Physicians Group.
Virtual interviews will be offered and in-person interviews are currently on hold due to COVID precautions, they may become available again in the future. A Letter of Interest, CV and two (2) letters of recommendation should be submitted to the contacts below:
Ryan Smith MD
- Ryan Smith, MD, Reproductive Medicine & Surgery
- Nico Ortiz, MD, Sexual Medicine and Reconstructive Urology
Male Infertility – Complete evaluation and treatment of the infertile male
Microsurgery – vasectomy, vasectomy reversals, varicocele repair, MESA, micro-TESE, microsurgical spermatic cord denervation
Sperm retrieval techniques – All methods of sperm retrieval will be learned including microsurgical approaches to epididymal and testicular sperm extraction. This includes both office and operating room based procedures.
Advanced Diagnostic Ultrasound – scrotal, penile duplex, transrectal ultrasounds that pertain to the fertility and sexual medicine evaluation of the male
Andrology lab experience – Interpretation of the semen analysis and other advanced andrology tests
IVF/ICSI and Female Fact Infertility Evaluation– This is taught jointly with the Andrology laboratory staff and Reproductive Endocrinology group at Virginia Fertility & IVF. The Fellow will participate in and will have the opportunity to learn basic semen analysis evaluation, techniques of sperm cryopreservation, IVF-ICSI and the basics of the female infertility evaluation.
Erectile dysfunction – penile prosthesis implantation via both penoscrotal and infrapubic approaches, including complex revision and replacement procedures
Peyronie’s disease – penile prosthesis implantation, penile plication, incision/excision and grafting, complex penile reconstruction, Xiaflex injections
Surgical Management of male incontinence including artificial urinary sphincter placement and male slings
Benign scrotal disorders – hydrocele, spermatocele, testicular prosthesis insertion
Hypogonadism – Comprehensive evaluation and management of hypogonadism, including Testopel insertion
Ejaculatory dysfunction and orgasm – Management of common disorders of ejaculation including medical treatment and infertility assessment/management including sperm retrieval
Urethral stricture disease – Assessment and surgical management of urethral stricture disease
Buried penis – Assessment and surgical management of buried penis
Priapism/Penile fracture – Evaluation and management of Andrology specific urologic emergencies of priapism and penile fracture
Gender health – Comprehensive evaluation and surgical management of transgender health including orchiectomy, reproductive health and fertility preservation
Fellows are encouraged and expected to participate in the core curriculum established by national sub-specialty societies such as the Sexual Medicine Society of North America which provides online learning modules for core concepts in sexual medicine as well as webinars throughout the year. In addition, the American Society of Reproductive Medicine, Society for Male Reproduction and Urology and the Society for the Study of Male Reproduction have webinars throughout the year for Fellow education. This is in addition to the Andrology curriculum done through scheduled resident/faculty conferences (see below) where the Fellow will participate and instruct residents and medical students in core curriculum materials.
Responsibilities and Expectations
- The Fellow will serve as a Clinical Instructor in the Urology department and will have the same operative and teaching privileges and responsibilities as other Urology Faculty.
- The Fellow is responsible to coordinate their case participation with the residents at least 1 week in advance of scheduled cases. This should be included in the weekly departmental emails delineating resident/Fellow involvement.
- The Fellow is responsible for balancing their operative role with that of residents to ensure a collaborative and balanced experience.
- The Fellow will assist with the management of Andrology faculty Epic in-basket management, patient phone calls and administrative tasks, in particular, when faculty are out of the office.
- The Fellow will assist on-call Andrology faculty with call responsibilities when requested.
- The Fellow will assist with coverage as a proctor for the annual resident in-service exam. The Fellow will take call during the week of the in-service exam and will cover the primary resident pager during the in-service exam.
- The Fellow will serve as a faculty coverage for the Urology resident clinic.
The Fellow will take Urology attending call at UVA Hospital. The call schedule is shared among the entire UVA Urology faculty, and is approximately 4 weeks per year. Call begins on Monday morning and lasts one week at a time. A call team will include a urology resident, a urology chief resident, and an attending or Fellow.
- As a Clinical Instructor, the Andrology Fellow will have the same clinical privileges as urology faculty and will participate in general urology cases and attending call.
- Subspecialty Andrology cases will be observed by the Andrology faculty until the faculty are able to make an entrustment decision. A graded, mentorship approach will be utilized with the Fellow taking on different aspects of these procedures based on faculty entrustment decision-making.
- Moonlighting is permissible if deemed appropriate by the Andrology faculty.
Research time comprises approximately 10% of the Fellowship. Both clinical and bench research opportunities are available. Dr. Rapp is the Clinical Research Director for the department. If desired, bench research is performed under the guidance of Jeffrey Lysiak, PhD. The Fellow may be involved with research already underway. New research topics and opportunities are mandatory for the Fellow to begin their own research. Current bench research is focused on the role of erectile dysfunction in many disease processes, sperm-egg interaction, and the role of engulfment by Sertoli cells. Clinical research pertains to shockwave therapy for erectile dysfunction, prosthetic surgery outcomes and a variety of infertility topics. Both clinical research and bench research are available for study. The Fellow is expected to submit one or more abstracts to a national meeting. The Fellow will accompany the program faculty to subspecialty national meetings during the Fellowship. The Fellow is required to submit one original research paper in addition to submitting one or two review papers, commentaries or book chapters.
The Fellow will serve as teaching faculty to UVA medical students and Urology residents. The Fellow is expected to attend weekly urology conferences including grand rounds. The Fellow will attend IVF conferences if available. They will also participate in formal Andrology didactics throughout the year including resident in-service preparation, scheduled andrology conferences and surgical labs. They are also expected to be present and participate in all Urology department educational conferences on non-andrology topics.
- The Fellow will have clinical privileges at the University of Virginia and participate in clinical activities within UVA Fontaine Outpatient Urology clinic, the Outpatient Surgery Center and Main Operating room.
- The Fellow will participate in male fertility clinics at Virginia Fertility & IVF and will have surgical privileges at this site.
- Other clinical privileges may be obtained depending on UVA Health growth and availability.
- The Fellow will obtain a full unrestricted Virginia state medical license as a licensed independent practitioner and have full independent operative and clinic privileges as an attending. The Fellow will have his/her own clinic and book cases that come out of this clinic. These cases can be booked with either residents assisting or Fellowship faculty assisting, depending upon preference and availability.
- Fellow will coordinate surgical involvement directly with the faculty and residents at least 1 week in advance and include their case involvement with the weekly emailed resident schedule to ensure a balanced and collaborative surgical environment with the resident training experience.
- The Fellow will assist with Andrology instruction in formal resident didactic sessions as well as the clinical setting including the operating room and resident clinic.
- The Fellow will coordinate and participate in formal resident didactics and conferences related to Andrology and non-Andrology topics as well as any supplemental teaching during the year (including a prosthetics cadaver lab).
Departmental conferences are held twice weekly and are required. A Resident-based conference occurs once a week as well and the Fellow will assist with the Infertility and Andrology topics. Several national conferences are important for the Fellow to attend. These usually include the annual AUA meeting, ASRM, and the SMSNA. Other meetings are attended based on funding and presentations. The Fellow is expected to present at least once during a departmental conference during the year.
On average, the Fellow will spend 2.5 days per week in the OR, 2 half-days per week in clinic (either the Fellow’s own clinic, coverage of the Urology clinic or the Andrology faculty clinic, and 0.5 days per week in research/administrative time.
- The Andrology Fellow will receive formal feedback twice annually with the faculty. This will also be done on an intermittent basis throughout the year within the clinical setting and to ensure successful completion of the program.