Urology Fellowships

Based at: Newcastle upon Tyne Hospitals NHS Foundation Trust

Surgical Specialty Association approving: BAUS

Approval period: Initially approved March 2023 – February 2026

Supervisor / Lead Consultant: Mr Alistair Rogers, Consultant Urological Surgeon

Fellowship duration: 12 months

Stated learning outcomes:

• Achieve level 4 competency in endourology procedures including; PCNL (including siting own tracks trained by interventional radiology), flexible ureterorenoscopy, and Endourological management in patients with reconstructed urinary tracts and urinary stricture disease.
• The above is a complex cohort of patients including those with neuropathic issues.
• Training in bladder outflow procedures and laparoscopic nephrectomy to level 3 depending on fellows learning agreement. Possible to achieve level 4 in HOLEP and urolift if the trainee has the commitment to achieve.
• Acute management of urinary tract stone disease sequalae e.g. ureteric colic, pyonephrosis, including management on critical care/ITU.
• Managing patients in an outpatient stone clinic setting, both acute and chronic. Involvement with nephrology colleagues in managing patients with metabolic problems causing kidney stones.
• Performing and advising on ESWL
• Performing audit, research and quality improvement/service development activity with subsequent presentation of work at regional/national and international meetings.
• At least one peer-reviewed publication within the 12 month fellowship.
• Development of leadership skills within the theatre and ward environment and also outside clinical practice e.g. running the new North East Stone Forum (due 29.4.2022)
• Develop teaching skills by the provision of undergraduate and post-graduate teaching sessions in clinical and non-clinical environments.
• Non-clinical administrative skills and management e.g. admin work, theatre list planning, patient complaints etc

Clinical competencies to be achieved:

• Level 4 Flexible and semi-rigid ureterorenoscopy
• Level 4 laser lithotripsy of renal tract stones
• Level 4 PCNL (with Interventional Radiology assistance), Level 3 PCNL if solo.
• Level 4 Endoluminal treatment of ureteric stricture disease.
• Level 3 HOLEP (possibly level 4 depending on starting experience)
• Level 4 in ESWL provision

     Outpatient

• Independence in managing new patients with kidney stone problems
• Part of the stone team proving MDT input to complex cases
• Competency in endourology techniques demonstrated by running courses for theatre nurses and organising North East Stone Forum.

Emergency

• Able to manage acute urological emergencies, with particular emphasis on endourological problems, independently
• Help in the management of acute stone patients on theatre waiting lists e.g. involvement in ureteroscopy allocation meetings, redeveloping patient pathways, increased liaison with A+E

Number of main operations the fellow could expect to be involved in:

• PCNL: 50-70 per year
• URETEROSTOMY: 120-150 per year
• HOLEP: 20-40 per year
• OTHER ENDOUROLOGY PROCEDURES: 70-100 per year
• ESWL: 100-120 per year

Fellows will be required to complete mandatory Interim and Final Feedback as per RCS monitoring protocol.

Based at: Newcastle-upon-Tyne Hospitals NHS Foundation Trust

Surgical Specialty Association approving: BAUS

Approval period: Initially approved July 2016; reapproved December 2019 - February 2023

Supervisor / Lead Consultant: Mr Christopher Harding, Consultant Urological Surgeon, with Miss Victoria Lavin, Consultant Urological Surgeon

Fellowship duration: 6-12 months

Stated learning outcomes:

• Outpatient management of complex tertiary referrals.
• Independently perform botulinum toxin injections into the bladder.
• Independently perform female stress incontinence surgery.
• Independently perform sacral neuromodulation.
• Wide exposure to surgery for male stress urinary incontinence.
• Independently perform ileal conduit urinary diversion.
• Perform and interpret video cystometry.
• Complete an audit.
• Submission of publication to a peer-reviewed journal.
• Participation in departmental and national research.

Clinical competencies to be achieved:

• Independent operator for female stress incontinence surgery.
• Independent operator for ileal conduit urinary diversion.
• Independent operator for sacral neuromodulation procedures.
• Independent operator for male incontinence surgery.
• Lead operator for advanced reconstructive urological surgery.

Number of main operations the fellow could expect to be involved in:

(Estimates are per 6 month block)

• Video/ Simple Urodynamics – more than 25 cases
• Cystoscopy and Botulinum Toxin – more than 25 cases
• Sacral Nerve Stimulation Procedures – more than 25 cases
• Artificial Urinary Sphincter Insertion – 6-10 cases
• Urethroplasty – 2-6 cases
• Periurethral Bulking Injection – 4-6 cases
• Ileal Conduit Urinary Diversion – 3-6 cases
• Cystectomy – 2-3 cases
• Bladder Augmentation – 1-2 cases
• Orthotopic Bladder Reconstruction – 1-2 cases
• Penile prosthesis insertion – 2-4 cases
• Colposuspension – 4-6 cases
• Mesh removal cases – 3-5 cases
• Urethral Diverticulum excision – 2-4 cases
• Urogenital Fistula Surgery – 1-3 cases
• Autologous Fascial Sling – 1-3 cases
• Penile Reconstruction (Nesbitts procedure) 2-4 cases

Based at: St George's University Hospitals NHS Foundation Trust, London

Surgical Specialty Association approving: BAUS

Approval period: February 2021 - January 2024

Supervisor / Lead Consultant: Mr Roland Morley, Consultant Urologist, with Miss Tina Rashid, Consultant Urologist

Fellowship duration: 12 months

Stated learning outcomes:

• To develop advanced skills in the surgical management of patients and reconstruction of genitalia in patients with gender incongruence/dysphoria
• Outpatient management of complex tertiary referrals in Gender Affirming Surgery and Complications
• Wide exposure to surgery for Gender Affirming feminising surgery and its complications

Feminising surgery:

a. Independently perform vaginoplasty using penile skin lining, with the creation of neoclitoris and labia
b. Assist with surgery using bowel
c. Perform with supervision surgery using penile skin
d. Perform with supervision revisional surgery including revision meatoplasty

• Complete an audit and Quality Improvement Project
• Submission of a publication to a peer-reviewed journal
• Participation in Departmental and National Research

Clinical competencies to be achieved:

• Independent operator for vaginoplasty using penile skin inversion technique
• Independent operator for common complications in feminising genital gender affirmation surgery
• Perform with supervision feminising genital surgery using scrotal or other skin techniques
• Assist in feminising genital surgery using bowel augmentation techniques

Expected number of main operations to be performed by the Fellow:

• Formation of a neovaginal cavity: 50
• Using skin to form a neovaginal lining: 10
• Creation of a neoclitoris, labia minora and majora: 50
• Bowel segment vaginoplasty: 1-5 (trainee would perform part of these as numbers low)
• Treating complications of genital reconstruction in transgender women: 20

Based at: Hertfordshire and South Bedfordshire Urological Cancer Centre

Surgical Specialty Association approving: BAUS

Approval period: Initially approved November 2012; reapproved April 2016; reapproved June 2019 - August 2022; reapproved June 2023 - May 2026

Supervisor / Lead Consultant: Mr J.M. Adshead, Consultant Urological and Robotic Surgeon, with Mr Nikhil Vasdev, Consultant Urological and Robotic Surgeon, and Mr Tim Lane, Consultant Urological and Robotic Surgeon

Fellowship duration: 12 months

Stated learning outcomes:

• Safe understanding of the equipment.
• Safe and independent Robotic surgeon ready for independent consultant practice.
• To be ready to become a national proctor.
• Ready for consultant Robotic urology posts.
• Understood and carried out robotic audit research and hopefully peer reviewed presentation and publication.

Clinical competencies to be achieved:

• Independent surgeon in RALP.
• Experience in Radical Robotic Cystectomy.
• Independent surgeon in Pyeloplasty.
• Independent surgeon in Robotic Nephrectomy.
• Experience in Robotic Partial Nephrectomy.

Number of main operations the fellow could expect to be involved in:

Ralps: 169 total

• Primary operator: 39
• Secondary: 95 with console time
• Assisting approx 40 (some crossover with secondary)

Partials

• 1 x primary (for off clamp AML)
• 11 x console/secondary
• 4 x assist 

Nephrectomy

• 1 x  primary 
• 2 x assist

Pyeloplasty

• 3 cases primary
• 1 cases secondary but with console time
• 3 cases secondary

Open and robotic cystectomy

• 25 over half of the fellowship
• Approximately 10 as secondary (open rather than robotic)

Fellows will be required to complete mandatory interim and final feedback as per RCS monitoring protocol.

Based at: Newcastle-upon-Tyne Hospitals NHS Foundation Trust

Surgical Specialty Association approving: BAUS

Approval period: October 2021 - September 2024

Supervisor / Lead Consultant: Mr Bhavan Rai, Consultant Urological Surgeon

Fellowship duration: 12 months

Stated learning outcomes:

• An understanding of the intuitive Robotic System
• Independent in Robotic Surgeon in Radical Prostatectomy (NHS standard)
• Experience in Robotic Assisted Radical Cystectomy, Robotic Assisted Partial Nephrectomy, Robotic Assisted Pyeloplasty, Robotic Assisted Nephro-ureterectomy
• Academia related to Robotic Surgery or uro-oncology

Clinical competencies to be achieved:

• Complete All Modules of Robotic Assisted Radical Prostatectomy
• Independent in Robotic Assisted Radical Prostatectomy
• Experience in Robotic Assisted Radical Cystectomy, Robotic Assisted Partial Nephrectomy, Robotic Assisted Pyeloplasty, Robotic Assisted Nephro-ureterectomy

Number of main operations the fellow could expect to be involved in:

• Robotic Assisted Radical Prostatectomy-110
• Independent in Robotic Assisted Radical Prostatectomy-20
• Robotic Assisted Radical Cystectomy-15-20
• Robotic Assisted Partial Nephrectomy-15-20
• Robotic Assisted Pyeloplasty-15-20
• Robotic Assisted Nephro-ureterectomy-15-20

Overall Robotic Cases ~ 180. This will be a combination of bedside assisting, observation and console cases. We will discuss with the fellow their individual needs with bedside assisting. We have a dedicated bedside assistant team with an established rota who will engage with fellow for any bedside assisting training needs. We anticipate this to be less than 10% of the time needed.

Over Console Cases ~ 110. This is the total number of cases that we anticipate the fellow will spend on the console

Primary Surgeon ~ 40. This is the number of cases we anticipate the fellow to be the first surgeon has done over 80% of the operation

Based at: St George’s University Hospitals NHS Foundation Trust, London

Surgical Specialty Association approving: BAUS

Approval period: January 2019 - March 2022; reaccredited September 2023 - August 2026

Supervisor / Lead Consultant: Mr Christopher J Anderson, Director of Robotic Urology and Fellowship Training

Fellowship duration: 12 months

Stated learning outcomes:

• Pre-operative, Peri-operative and Post Operative care of Urological Robotic Cancer Cases.
• Competency by Modular training for Robotic Urology Surgery.
• Patient and Cancer outcomes during SURF by AUDIT.
• Trainee opinion on training and trainers to improve quality and trainee satisfaction of training.

Clinical competencies to be achieved:

• Competency in planning Urological Robotic Surgery, including the use of Radiology and Pathology.
• Competency in operative steps as defined by the Urological Robotic Surgery modular steps.

Number of main operations the fellow could expect to be involved in:

Caseload for the fellow in 1 year (46 weeks):

• Prostatectomy (n=50 supervised; 15 independent); Nephrectomy (n=30 supervised; 15 independent).
• Gaining experience in Partial Nephrectomy (n=40), Radical Cystectomy (n=40) and Pyeloplasty (n=15).
• All these competencies will be measured and certified by using validated assessments agreed by the training agreement.

Fellows will be required to complete the mandatory interim and final feedback as per the Royal College of Surgeons of England monitoring process.

Fellows awarded Fellowship Certificate (dates of Fellowship):

• Alarick Picardo (April 20 - April 21)
• Dharmender Aggarwal  (Apr 21 - Oct 22)

Based at: Addenbrooke’s Hospital, Cambridge University Hospitals NHS Trust

Surgical Specialty Association approving: BAUS

Approval period: January 2018 - March 2021; reapproved October 2021 - September 2024

Supervisor / Lead Consultant: Mr Nimish Shah, Consultant Urologist, with Mr Benjamin Lamb, Consultant Urologist

Fellowship duration: 12 months

Clinical competencies to be achieved:

• Independent surgeon in robotic radical prostatectomy.
• Safe and effective preoperative management of patients undergoing robotic radical prostatectomy.
• Appropriate case selection of patients for robotic radical prostatectomy.
• Safe and effective follow-up of patients who have undergone robotic radical prostatectomy including management of complications.

Stated learning outcomes:

• Safe understanding of the equipment.
• Safe and independent robotic prostatectomy surgeon ready for independent consultant practice.
• Active involvement in robotic prostatectomy audit and research, hopefully resulting in peer-reviewed presentation and publication.

Number of main operations the fellow could expect to be involved in:

Supervisor (2017): 'The fellow will attend theatre for 3 days and be involved with 6 robotic prostatectomy cases per week. Over the course of the year, they will be involved with >200 cases.'

Fellows will be required to complete mandatory interim and final feedback as per RCS monitoring protocol.

Based at: Frimley Health NHS Foundation Trust

Surgical Specialty Association approving: BAUS

Approval period: January 2019 - March 2022; reapproved December 2022 - November 2025

Supervisor / Lead Consultant: Mr Neil Barber, Consultant Urologist, Director, Frimley Renal Cancer Centre, with Mr Muddassar Hussain, Consultant Urological and Robotic Surgeon, and Mr Manar Malki, Consultant Urological & Robotic Surgeon

Fellowship duration: 12 months

Stated learning outcomes:

• To formulate appropriate management plans for patients with complex upper tract conditions.
• To independently perform advanced minimally invasive renal surgery.
• To lead and support a multidisciplinary team managing renal cancer.
• To teach junior team members the basics of renal surgery.

Clinical competencies to be achieved:

See operation numbers

Number of main operations the fellow could expect to be involved in:

• To independently perform robotic partial nephrectomy (total: 22-25).
• To independently perform laparoscopic nephrectomy and nephroureterectomy (total: 30).
• To perform robotic pyeloplasty and nephroureterectomy under minimal supervision (total: 10).

Based at: Guy's & St Thomas' NHS Foundation Trust

Surgical Specialty Association approving: BAUS

Approval period: Initially approved August 2015; reapproved March 2019 - May 2022; reapproved December 2022 - November 2025

Supervisor / Lead Consultant: Mr Ramesh Thurairaja, Consultant Urological Surgeon, with Mr Rajesh Nair, Consultant Urological Surgeon

Fellowship duration: 12 months

Stated learning outcomes:

• Comprehensive knowledge of management principles and rational decision making.
• Safe and independent dual accredited Open and Robotic surgeon ready for independent consultant practice.
• To be ready to become a national proctor.
• Ready for consultant bladder cancer urology posts.
• Understood and carried out open/robotic audit research and hopefully peer reviewed presentations and publications.

Clinical competencies to be achieved:

• Independent surgeon in open cystectomy.
• Independent surgeon in robotic cystectomy.
• Independent surgeon in the urinary diversion.
• Experience in the robotic urinary diversion.

Number of main operations the fellow could expect to be involved in:

Supervisor (2018): The fellow will certainly have exposure to approximately 80 cystectomy cases over a 12 month period with 60-70% of these cases being performed robotically (due to involvement with iROC trial reduction in percentage to 50-60%). In addition, there will also be opportunities to be involved with approximately 30 renal cancer cases and 20-25 exenteration cases over the 12 month period. We expect approximately 15-20 done cases independently at Level 4.”

Fellows will be required to complete mandatory interim and final feedback as per RCS monitoring protocol.

Based at: Leeds Teaching Hospitals NHS Trust

Surgical Specialty Association approving: BAUS

Approval period: Initially approved September 2014; reapproved March 2019 - May 2022

Supervisor / Lead Consultant: Mr Sunjay Jain, Consultant Urologist, with Mr Sanjeev Kotwal, Consultant Urological Surgeon

Fellowship duration: 12 months

Stated learning outcomes:

• Able to perform/assist in a minimum of 50 robotic radical prostatectomies, 25 robotic / open cystectomies, 10 nephroureterectomy and 5 retroperitoneal node dissection cases.
• Presentations at national and/or international meetings and peer-reviewed publications.

Clinical competencies to be achieved:

• The fellow should be able to perform open radical cystectomy and robotic radical prostatectomy independently (Level - 4 competence).
• The fellow should be able to provide comprehensive care to uro-oncology patients in a multi-disciplinary setting.

Number of main operations the fellow could expect to be involved in:

Supervisor (2018): These figures are for procedures the trainee will perform independently. They will also perform major parts of other procedures such as Robotic cystectomy, RPLND and open radical nephrectomy:

• Robotic Prostatectomy 25
• Open Cystectomy 15
• Nephroureterectomy 5

Fellows will be required to complete mandatory interim and final feedback as per RCS monitoring protocol.

Based at: Royal Free London NHS Foundation Trust

Surgical Specialty Association approving: BAUS

Approval period: First approved July 2018; reapproved August 2021 - July 2024

Supervisor / Lead Consultant: Mr Faiz Mumtaz, Consultant Urological Surgeon, with Prof Axel Bex, Consultant Urological Surgeon, and Clinical Lead, specialist centre for kidney cancer, Royal Free Hospital

Fellowship duration: 12 months

Stated learning outcomes:

• Comprehensive knowledge of management principles and rational decision making in renal cancer.
• Safe and independent dual accredited Open and Robotic/laparoscopic surgeon ready for independent consultant practice.
• Able to manage all aspects of both benign and malignant disease spectrum relating to the upper urinary tract.
• Able to manage acute renal oncological emergencies.
• Understood and carried out an audit of open/robotic surgery.
• Recognise future directions of research relating to renal cancer.
• Ready for consultant upper urinary tract urology posts.
• Presentations at national and international.
• Publish in peer reviewed journals.
• Exposure to various aspects of very complex upper tract surgery.

Clinical competencies to be achieved:

See operation numbers

Number of main operations the fellow could expect to be involved in:

• Independent surgeon in open (25), laparoscopic (25) and robotic nephrectomy (25)
• Independent surgeon in open (25) and robotic partial nephrectomy (30)
• Independent surgeon in robotic nephroureterectomy (20)
• Independent surgeon in robotic pyeloplasty (15)

Fellows will be required to complete mandatory interim and final feedback as per RCS monitoring protocol.