Beth Israel Urology
The strength of Beth Israel's urology program lies in the diversity of
our faculty's interests, the large variety of clinical opportunities,
and the availability of the most sophisticated technologies currently
utilized by the urologic community. Residents train side-by-side with
attending urologists who have expertise in general urologic care, as well
as in highly specialized areas, such as infertility, microsurgery, sexual
dysfunction, calculus disease, benign prostatic hypertrophy, urologic
oncology, urodynamics, incontinence and pediatric urology.
Presently, the department has five full-time faculty in addition to a
large active voluntary staff who employ all technologies currently utilized
by the urologic community. These include laser therapy, extracorporeal
shock wave lithotripsy (ESWL), laparoscopy and microsurgery. The department
is a leader in microsurgical reconstruction and laparoscopic procedures.
Its physicians perform a wide array of laparoscopic surgery, including
adrenalectomy, an exciting advancement for the treatment of adrenal tumors,
including biochemically functional tumors such as pheochromocytomas, aldosteronomas
and Cushing's adenomas.
Benign and Malignant Prostate Problems
The urology residency experience is reinforced
with rotations at two affiliated hospitals. The resident's First year
is spent entirely at Mount Sinai Beth Israel, during which basic endoscopic
and operative urologic skills are obtained. Second-year residents spend
two months at Schneider Children's Hospital on Long Island on the pediatric
urology service. This rotation supplements Mount Sinai Beth Israel's
pediatric urology experience. The second-year residents also spend nine
months performing office and operative urology with the full-time staff.
One month is spent on the transplant service.
PGY-1 – Preliminary Year –
Urology residents are required to spend the Pre-Urology years at Mount Sinai Beth Israel. The Departments of Urology and General Surgery work together to assure that the teaching goals of each department are fulfilled. Each of the PGY-1 urology residents spends 1 month on the Urology Service as the surgical rotator. During this rotation, the resident begins to learn the basics of managing the urology patient. History taking, physical examination, and differential diagnosis are emphasized. The resident participates in the weekly clinic and conferences and is an integral member of the urology team. Two (2) months are spent in the Surgical Intensive Care Unit. Here the resident learns to manage the more seriously ill surgical patient. Under the supervision of the Attending Intensivist, physiology and multi-system treatments are stressed. During this year residents must demonstrate competence in fundamental surgical skills, understand the physiology as it relates to surgery, the response to surgery and healing. Residents must demonstrate competence in history taking, physical examination and the appropriate utilization of adjunctive laboratory tests.
PGY-2 – Urology year 1 –
The emphasis of this year is the development of the infrastructure necessary
to become an excellent urologist. The didactic schedule emphasizes basic
urology anatomy, physiology and the pathophysiology of disease processes.
The urology resident will gain expertise in urology history taking, physical
examination endoscopy and transrectal ultrasonography. Residents are taught
basic principles of microsurgery and urodynamics. By the end of the first
year residents are expected to demonstrate competence in: an understanding
of the physiologic basis for urologic disease, basic endoscopic skills
and basic operative skills to advance their urology training. The resident
is required to attend the Basic Science Urology course sponsored by the
University of Virginia at the completion of the Urology year 1.
PGY-3 – Urology year 2 –
The second urology year will emphasize ambulatory urology care and enable the urology residents to participate in the evaluation and management of urologic diseases in the ambulatory care setting. During this “tutorial” experience, residents will be have the opportunity to participate in the initial evaluation and management of patients, by spending an average of 8 weeks with each faculty member in the department of Urology. Residents will continue to participate in the care of these patients when surgery or hospitalization is necessary. When patients return to the ambulatory setting, the resident will be there to complete the educational cycle – evaluation, treatment and follow-up. The opportunity to participate in this process with the direct supervision of faculty members will enable the resident to develop a mastery of ambulatory urology during training and fully appreciate the significance of their interventions. Additionally, during this year residents will perform extracorporeal lithotripsy (ESWL) at an outpatient affiliated freestanding stone center.
Residents will gain confidence and skill and demonstrate competence in all office based urologic procedures including, cystoscopy, vasectomy, transrectal ultrasound (with and without biopsy), urodynamics, percutaneous sperm acquisition techniques and extracorporeal shock wave lithotripsy.
PGY-4 – Urology year 3 -
During the third urology year, residents will have their formal exposure to pediatric urology. By staffing the pediatric urology clinic under the supervision of the pediatric urology attending, they will broaden the experience and confidence in the management of pediatric urology. The resident will also manage the adult and pediatric consultative services, enabling further development of the skills necessary to assess urologic maladies and outline the course of management and treatment. By the end of this pediatric urology experience the resident will demonstrate competence in the management and or evaluation of pediatric urologic diseases. The PGY-4 will participate in the surgical management of all patients seen by the resident in the teaching practice and consultative service.
The resident will gain his/her first formal exposure to pediatric urology during PGY-3 during a two-month rotation to Schneider Children’s Hospital of the Long Island Jewish Medical Center.
Two months will be spent at Memorial Sloan Kettering Cancer Center. This allows the resident to participate in the management of the most complex cases of urologic malignancy. This will supplement the excellent and growing uro-oncologic experience gained at Mount Sinai Beth Israel.
The resident will participate in formal Quality Improvement activities by participating as the resident member of the Departmental QI committee on the last Thursday of each month and will be expected to oversee a QI project .
PGY-5 – Urology year 4 –
During the Chief year the resident gains greater surgical skill and clinical acumen. Additionally, the chief resident is responsible for orchestrating the educational program and fulfills administrative responsibilities. In addition, he is an integral part of the Curriculum Committee, highlighting areas of concern and those of benefit in the education of the residents. Each of these activities prepares the resident to enter the profession of Urology. The resident will demonstrate competence in the management of all urologic entities including: infertility, impotence, incontinence, voiding dysfunction, calculus disease and oncology. Surgical competence in open, laparoscopic and endoscopic surgery will be demonstrated.
& SELF EDUCATION
House officers are encouraged to attend national, regional and local
meetings. During the first year, the chief resident attends the annual
basic science urology conference at the University of Virginia, and attends
the annual national meeting of the American Urological Association (AUA).
Residents also routinely attend special programs of the New York Section
of the AUA and the New York Academy of Medicine. They are encouraged to
present research papers at national meetings and are supported and funded
for their activities.
Michael A. Palese, MD
Dr. Michael A. Palese is the Chairman of Urology at Mount Sinai Beth Israel. He is also the Director of Minimally Invasive Surgery of the Mount Sinai Health System and specializes in robotic, laparoscopic and endoscopic surgery.
He is a leading authority in the research and treatment of kidney disease specifically kidney cancer and kidney stones. He is one of a handful of surgeons in the United States who is trained in open, laparoscopic and robotic surgery. To date he has performed over 3000 open, laparoscopic and robotic kidney procedures.
Dr. Palese is a world recognized surgeon and scholar who is also a leader in the development of new treatments and technologies. He performed the first robotic radical nephrectomy, robotic partial nephrectomy, robotic donor nephrectomy, robotic nephron-ureterectomy, robotic adrenalectomy, and robotic ureteral reimplant & reconstruction at The Mount Sinai Medical Center in New York City. He holds several patents for the design of novel surgical devices.
He is a course director and faculty member for several national and international educational courses to teach urologists and other physicians. He is actively involved in resident and medical student teaching and training.
Dr. Nagler's internationally recognized expertise in sexual dysfunction and infertility provide a unique training opportunity at Mount Sinai Beth Israel. Residents participate in Dr. Nagler's clinics, as well as in-patient and ambulatory major and microsurgical procedures. As a result of the tertiary referral nature of his practice, residents become sophisticated in the work-up and management of complex infertility cases, varicocele repair, microsurgical vasectomy reversal, sperm extraction and fertilization, prosthetics, and reconstruction. Previous residents have been able to generate hypotheses and become first authors in peer-reviewed journals under Dr. Nagler's direction
Dr Shah offers comprehensive management of overactive bladder including the use of Sacral Neuromodulation for advanced cases.
He has an interest in urologic prosthetics for male incontinence and erectile dysfunction including, the artificial urinary sphincter, male slings, and penile prosthesis.
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