Urogynecology and Pelvic Reconstructive Surgery Fellowship


This non-ACGME-approved fellowship is a two-year comprehensive clinical program at the Cedars-Sinai Medical Center, one of the largest hospitals in the Los Angeles area. The goal of this program is to teach competent obstetrician-gynecologists to become experts in the management of pelvic organ prolapse and female urinary incontinence. The program will be managed under the auspice of Dr. Cynthia Hall, Director of Urogynecology and Pelvic Reconstructive Surgery and Co-Director of the Center for Women's Continence and Pelvic Health.

The primary teaching responsibilities will be with Dr. Hall who is actively involved with surgical education, resident education, and clinical research. Currently there is no board certification for Urogynecology but it is anticipated that all 2-year comprehensive programs will be grandfathered in to be able to sit for board certification when that occurs, as has been the case with the other subspecialties. Eventually this program will apply for ACGME-approval.

Clinical Training


 

The Urogynecology fellow will spend the bulk of his/her time with Dr. Hall. This consists of three days in the office seeing exclusively women with urogynecologic disorders including prolapse, incontinence, urinary tract infections, interstitial cystitis, and pelvic muscular dysfunction. Approximately 15-20 new patients and 24-40 revisits are seen each week. Diagnostic testing done in the office includes cystoscopy and urodynamics. Patients are offered a wide range of potential therapies ranging from pelvic exercises with or without referral to a local physical therapist (who is also willing to have the fellow come and spend time in the office), to pharmacologic treatment, to pessaries, to surgical repair. We have a wide range of pessaries and the fellows will be taught how and when to use which pessaries for patients appropriately.

Dr. Hall has a full day of operative block time per week. This may include up to four smaller cases or two major reconstructive surgeries. Other cases can be added as needed during non-block time. Surgical cases represent the full breadth of Urogynecologic and Pelvic Reconstructive Surgery.

Cases Including:

  • Midurethral Slings (Transobturator and Retropubic)
  • Vaginal Hysterectomy and Oophorectomy
  • Sacrospinous Ligament Suspension
  • Anterior and Posterior Repair with and without grafts
  • Vaginal Paravaginal Repair
  • Colpocleisis
  • Vesico, Urethro-vaginal and Rectovaginal Fistulas
  • Total Vaginal Mesh kits ("Prolift" or "Apogee/Perigee")
  • Abdomino-sacrocolpopexy and perineopexy
  • Burch colposuspension and paravaginal repair
  • Laparoscopic Sacrocolpopexy
  • Laparoscopic Hysterectomy
  • Sacral Nerve Implantation

As expected, there is significant overlap of these disorders with other pelvic disorders such as pelvic pain, defecatory dysfunction, fecal incontinence, rectal prolapse, and irritable bowel. The Center for Women's Continence includes specialists in Urology, Endourology, Colorectal Surgery, Gastroenterology, Minimally invasive Gynecology, and Physical Therapy to give the fellow a well rounded experience. The fellow is welcome to join the other surgeons on rectal prolapse repairs (open and laparoscopic) and anal sphincterplasties as well as difficult laparoscopic hysterectomies, endometriosis cases, and other prolapse repairs by the female urologists and some total cystectomies/ileal conduits.

The fellow is expected to follow all patients post-operatively with the attending surgeon. He or she might round independently on the weekends but always with attending back-up.

In the anorectal physiology lab, the fellow will learn anorectal manometry, pudendal nerve studies, anorectal biofeedback and anorectal ultrasound. These activities will be performed under the guidance of other Cedars-Sinai Medical Center attendings, all of whom are recognized experts in their field of interest. This experience will also teach how these diagnostic tests are important in the clinical management of patients with defecatory dysfunction and anal incontinence.

One day a week the fellow has free to spend on research pursuits. Currently, Dr. Hall is the Principle Investigator for 6 ongoing IRB-approved clinical trials, including a comprehensive database which is under development. Other Divisions in the Department of Obstetrics and Gynecology conduct quite a bit of basic science research so there is great potential to pursue this as well.

Didactic Training

Clinical conferences, seminars, journal club and one-on-one instruction are important parts of the Cedars-Sinai Urogynecology Fellowship Program. The fellow will actively participate in the following:

  • A monthly urogynecology and female urology didactic conference overseen by either Dr. Hall or Dr. Gary Leach, Co-Director for the Center for Women's Continence. Lectures are given by the residents but discussion is supervised by the fellow and the attending physicians to stimulate critical thinking. Topics include the full breadth of Pelvic Floor pathology.
  • A quarterly Center for Women's Continence and Pelvic Health lecture about state of the art treatment of pelvic floor disorders.
  • A 2-day Bi-annual Conference with the first day CME-approved and geared towards teaching both primary care physicians and specialists in pelvic floor disorders on the nuances of our ever-expanding and changing field. The Fellow is expected to give at least one lecture on the topic of his/her choice. The second day of the conference is community day. Again, the fellow participates as a lecturer and expert in the field.
  • A quarterly regional "Pelvic Surgeons Society" of Urologist and Urogynecologists discussing diagnosis and management of difficult cases.
  • A quarterly regional journal club with the other Urogynecology programs in the greater Los Angeles area.
  • A quarterly journal club for the Cedars-Sinai residents discussing current trends in general gynecology and encouraging a critical review of the literature.
  • A weekly Obstetrics and Gynecology Grand Rounds, often with nationally renowned speakers about a broad range of topics in general Obstetrics and Gynecology.
  • A weekly Morbidity and Mortality conference conducted in the Department of Obstetrics and Gynecology. The fellow will be expected to participate and critique cases presented by the senior residents.

Research Training

The fellow's opportunities in clinical and basic research are excellent. The fellow will be encouraged to pursue a number of research projects and publish at least two research papers during each year. The fellow will be sponsored to attend the yearly American Urogynecology Society meeting and the Society for Gynecologic Surgeons up to an annual minimum of $1500/year. Other national or regional meetings will be sponsored if the fellow has a paper accepted for presentation. Dr. Hall participates in annual medical missions to Niger, West Africa for fistula repairs and the fellow is encouraged to join her.

On-Call Schedule

The first responsibility of the fellow is to become adequately trained in all aspect of Urogynecology. This includes taking phone calls after hours on a rotating basis with Drs Hall and Solnik but only with supervision at all times. It is rarely required to come to the hospital on an emergent basis, though post-operative rounds take place on weekends (again rotating with Drs Hall and Solnik) if there are patients in-house. This is to ensure adequate continuity of care for the patient and for fellow training as well. The fellow will have four weeks of vacation per year in addition to conference time away.

Teaching Staff

Cynthia Hall, MD, Program Director, Urogynecology

Christopher Ng, MD, Endourology and Robotic Surgery

Beth Moore, MD, Colorectal Surgery

M. Jonathon Solnik, MD, Minimally Invasive Gynecology
 

Appointments and Applications

One fellow is chosen every two years for the Cedars-Sinai's Urogynecology and Pelvic Reconstructive Surgery Fellowship Program. Qualified applicants must have completed an Obstetrics and Gynecology residency program at an accredited facility. To apply to the program, please contact Gayana Kisiyan at 310 423 4749 or at gayana.kisiyan@cshs.org. The fax number is (310) 423-0140. To contact Dr. Hall, you can email her at hallc@cshs.org.

Applications must be completed by December 15 and interviews will only be conducted after the application is complete and will take place in Los Angeles from mid-December through mid-January for the following July.

Gayana Kisiyan
Department of Obstetrics and Gynecology
Phone: (310) 423-4749
Fax: (310) 423-0140
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Cynthia Hall, MD
Director, Urogynecology and Pelvic Reconstructive Surgery
Department of Obstetrics and Gynecology
8635 W. Third St., Suite 160W
Los Angeles, CA 90048
Phone: (310) 423-2914
Fax: (310) 423-0140
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