Sub-Specialty Training

Andrology and genito-urethral reconstruction includes the medical and surgical management of penile malignancy, urethral stricture disease, erectile dysfunction, Peyronie's disease & male infertility. It also includes a number of other rarer disorders (e.g. buried penis, gender reassignment surgery). Due to its relatively small number of cases, compared with other urological sub-specialties, the practice and management of these conditions tends to be confined to regional centres. As such, it’s often difficult for trainees to gain adequate exposure to this subspecialty.

The BAUS conference has a large amount of andrology content. These sessions are a great way to meet people in the field and to learn more about the sub-specialty as a whole.

One major talking point in 2019 has been the proposed centralisation of penile prosthesis to just four centres nationally. Although centralisation can improve overall service delivery, we at BSoT felt the reduction to just four centres nationally was too drastic. This could potentially lead to many patients declining possible treatment due the large distances many would be required to travel. We were part of a campaign suggesting prostheses be offered in ten existing high level tertiary centres. We await the final outcome of the NHS commissioning review bnut the delivery of high quality andrology services to the population remains a challenge for the future.

This year has seen the introduction of several exciting new courses in andrology. This includes the cadaveric penile implant and artificial urinary sphincter course, and the hands-on microsurgical course, excellent for those wishing to pursue a practice in the ever expanding field of male fertility. Both these courses were run as part of the KCL Simulate Programme. In 2019, a new male infertility training day was introduced, run by UCLH in October,  which is likely to become a yearly event.

There is also the AGOUR course run by Boston Scientific which provides an overview of andrology, useful for those preparing for the FRCS Urol viva ...

Urinary tract stone disease is an important and prevalent condition associated with major lifetime morbidity. It therefore comes as no surprise that the majority of UK urologists are exposed to stone disease in their practice, and many of them consider endourology to be a sub-specialist interest. With a wide array of procedures including both rigid and flexible ureteroscopy, percutaneous nephrolithotomy, shockwave lithotripsy and laparoscopic upper tract procedures, the Section of Endourology is often at the forefront of technological advancements within urology, and continues to develop actively as a speciality.

 How to get involved in the section 

There are many ways to become more involved in the endourology section of BAUS as a trainee. The section has always been very inclusive of trainees, with paper and poster sessions and a trainee prize at the Annual Meeting. Many trainees may also be given opportunities to chair or co-chair sessions at BAUS or at the section meeting (which is often co-ordinated by BSoT).  The endourology section representative position, which involves regular meetings with the executive committee to plan the BAUS Annual Meeting, as well as the annual section meeting, is another opportunity for involvement in the section.

 Courses and Opportunities

The Endourology Section organises an annual Residential Operative Course. This is aimed at trainees in their final year, post FRCS Urol, who wish to be appointed to a Consultant post in endourology and laparoscopy. The course is limited to four delegates and involves each delegate being the primary surgeon, with one-on-one expert Consultant assistance / coaching, to perform a variety of laparoscopic and endourological procedures including flexible ureteroscopy, percutaneous nephrolithotomy and laparoscopic nephrectomy. Click here for further information about this course. 

The World Congress of Endourology (WCE) offers an annual prize in the form of a fellowship opportunity for UK urology trainees. Following a successful application, there is an award of up to £8000 annually to travel for an endourological fellowship. Applications normally open in the Autumn and the successful candidates are notified mid-November each year. Click here for further information about this course ...

The section covers a vast wealth of urological surgery and, for trainees, includes a large proportion of the curriculum topics within urinary incontinence, neuro-urology, urinary tract obstruction, urinary tract trauma and radiology. Conditions managed range from the common, such as stress or urge urinary incontinence and voiding dysfunction, to the rare such as urethral diverticula, female urethral stricture or uretero-, vesico- & urethro-vaginal fistulae, resulting in a wide variety of operative interventions to learn, and a breadth of interesting topics to be covered every year at the BAUS Annual Scientific Meeting. 

 Currently, the FNUU section are working hard to engage trainees in this subspecialty. The section is in the process of initiating BAUS’s first pilot mentoring project which will run for 6 months and, hopefully, be open to more trainees in the future, if successful. This project was set-up to help trainees with an interest in FNUU to develop their training and career portfolio via a process of mentorship with a FNUU Consultant, as it is acknowledged that access to FNUU for trainees can be difficult during training. 

A number of courses are available for trainees to widen their exposure to FNUU including the Emergency Urology Cadaveric Course, Neuro-Urology courses run from Sheffield and Stanmore, & Urodynamics Courses (mainly run out of Bristol and London). In addition, in 2019, there was a joint meeting with AGUS (Andrology and Genitourethral Surgery) and BAGURS (British Association of Genito-Urinary Reconstructive Surgery) which was well attended and there is a yearly FNUU Masterclass at UCLH with live and semi-live surgery, alongside lectures covering the breadth of the curriculum. 

With regards to audit and research, the BAUS FNUU section is involved with the proposed new BAUS snapshot audit projects and audit handbook. The section will also be leading with two, key, FNUU-based audits with which we hope to involve trainees from the outset. There Is also a wealth of high-quality clinical trials and research being carried out in the domain of FNUU with studies including UPSTREAM, FUTURE, AMPLITUDE and ALTAR. 

 So finally ... why do FNUU? This is an exciting and varied specialty with career options for those who want to practise in both a district general hospital setting as well, as for those more interested in working in highly specialised units. The range of procedures performed include diagnostic urodynamics, endoscopic and minor vaginal surgery through to complex vaginal surgery and major abdominal surgery for urinary tract diversion or reconstruction. There are numerous opportunities to be involved in a wide range of extra activities including research, development of guidelines, education and audit.

In short – there is something for everyone and it will definitely never be boring!

Uro-oncology has relevance to all trainees because much of the management of urological cancer is embedded in the practice of core urology. It is a subspecialty which permeates much of our day-to-day emergency and elective work, but is also at the forefront of advancing technology and minimally-invasive techniques. Clinical work incorporates not only the most minor but also the most complex surgery in urology, and the delivery of a high quality uro-oncology service is a unifying objective for both district general hospitals and tertiary referral centres alike.

 A career with an interest in uro-oncology encompasses a huge variety of required surgical skills, with laparoscopic, open, robotic, and endoscopic techniques all having relevance in the management of different cancers. It is a specialty necessitating collaboration not only with surgical peers, but also with each member of the multidisciplinary team, as difficult diagnoses are delivered with clear communication and a holistic approach to patient care.

 The section is committed to the promotion of training, research and development and aims to improve the standards and quality of practice in the sub-specialty of urological cancer. The committee meets regularly, and is instrumental not only in the perpetration of national guidelines but is also influential in steering national audit and research.  As the Surgical Outcomes Audit comes to a close this year, further national projects will employ a "snapshot" technique to answer carefully chosen clinical questions in urology departments across the UK, over a co-ordinated period of time. 

 Another way for trainees to engage with the Section is the annual sub-specialty meeting, with carefully chosen speakers delivering high quality content pertaining to chosen topics within uro-oncology. This is an excellent forum for trainees to present their work, win prizes and explore an interest in the sub-specialty. 

 The position of oncology representative within the section of trainees provides an excellent opportunity for a trainee to participate in oncology section committee meetings, to gain an appreciation of current issues relating to the sub-specialty, whilst contributing to BSoT aims and initiatives and promoting relevant opportunities for trainees ....