Andrology Fellowship

 

Fellowship Overview:

The UNC Men’s Health Fellowship provides a comprehensive men’s health and andrology training program focused in male reproductive medicine and surgery, with a truly unique and highly sought after combination of advanced skills in urologic surgery from a dual distinguished faculty with backgrounds in male infertility, male sexual medicine, and reconstructive urology.

 

Fellowship Primary Objectives:

  • Evaluate and treat male factor infertility
  • Learn and develop the principles of urologic microsurgery
  • Evaluate and treat erectile dysfunction, Peyronie’s disease, and male sexual dysfunction
  • Manage complicated and difficult urologic prosthesis cases
  • Evaluate and treat patients with urethral strictures, urinary fistulae, genital skin deficiency, and benign disorders of the scrotum and perineum
  • Become expert of the advanced comprehensive men’s health evaluation

 

Fellowship Program Director:

Dr. Matt Coward is the UNC Men’s Health Fellowship Director.  Dr. Coward trained under Dr. Culley Carson during his residency at UNC Urology prior to a fellowship in Male Reproductive Medicine and Surgery at Baylor College of Medicine with Dr. Larry Lipshultz.  While Dr. Coward’s practice focuses on male reproductive medicine and surgery, he spends his clinical time split between UNC Urology and UNC Fertility.

 

Fellowship Faculty:

The primary clinical faculty for the fellowship are Dr. Matt Coward and Dr. Brad Figler.  The fellow will spend approximately equal time clinically with both Dr. Coward and Dr. Figler, depending on the fellow’s desired training experience.  The program faculty may consider that the fellow spend optional time with other UNC Urology faculty in order to augment the training experience at the fellow’s request.  Dr. Culley Carson, chair emeritus of UNC Urology, international leader in the field of erectile dysfunction and prosthetic urology, and past president of the Sexual Medicine Society of North America, will remain on the fellowship faculty in a mentor capacity.

 

Clinical/Research Breakdown and Program Weighting:

The fellowship is one year in duration, comprised by 90% clinical and 10% research activities. Program weighting is approximately 50% Reproductive medicine / 50% Sexual medicine, but can be tailored to the fellow’s clinical and career interests and goals.

 

Fellowship Location:

The fellowship will be based at UNC Department of Urology at UNC Healthcare in Chapel Hill, NC.  Dr. Coward and Dr. Figler both see clinic patients at UNC Hospitals and at a shared nearby off-site UNC facility in Chapel Hill called Carolina Pointe.  Surgical procedures occur at UNC Hospitals or the UNC Ambulatory Surgery Center.  One to two days per week will be spent at UNC Fertility in Raleigh, NC with Dr. Coward.

 

UNC Fertility:

In 2013, UNC Fertility opened its brand new, state-of-the-art facility in an off-site campus location in Raleigh, NC.  Dr. Coward sees male infertility patients at UNC Fertility and is performing full diagnostic and treatment services which include surgical sperm extraction under anesthesia in the on-site procedural suite.  UNC Fertility is one of the only IVF clinics in the region that offers complete evaluation and treatment of the male in the office.  The on-site services offered include advanced semen studies performed in UNC Fertility’s Andrology lab, sperm cryopreservation, hormone and genetic laboratory evaluations, transrectal and scrotal ultrasound, and a full array of sperm extraction procedures.

 

Weekly Clinical Scheduling Framework:

  • On average, the fellow will spend 1.5 days per week in the OR, 3 days per week in clinic, and 0.5 days per week in research
  • One day per week, typically on Friday, the fellow will have his or her own clinic

 

Clinical Skills and Operative Experience Goals:

Reproductive Medicine

Male Infertility - Complete evaluation and treatment

Microsurgery - vasectomy reversals, varicocele repair, micro-TESE

Sperm retrieval - All methods of sperm retrieval will be learned, with emphasis on the more common office-based TESE and MESA procedures.

Advanced Ultrasound - scrotal, penile duplex, transrectal, bladder, and renal

Andrology - Interpretation of the semen analysis and other advanced andrology tests

IVF/ICSI - Join the UNC Fertility REI faculty and fellows for a hands-on and in depth understanding of the comprehensive evaluation of the infertile couple.  Participate in weekly IVF conference.  It is a truly unique experience for a training reproductive urologist to work within an IVF clinic and participate in the management of IVF/ICSI alongside REI faculty.

No-scalpel no-needle vasectomy

 

Sexual Medicine 

Erectile dysfunction - penile prosthesis implantation via both penoscrotal and infrapubic approaches (AMS and Coloplast), including complex revision procedures

Peyronie’s disease- penile prosthesis, plication, incision and grafting, complex penile reconstruction, Xiaflex injections

Surgical Management of male incontinence

Benign scrotal disorders - hydrocele, spermatocele, lymphedema, testicular prosthesis insertion

Hypogonadism - Become proficient in all forms of management of hypogonadism, including Testopel insertion

Genital skin deficiency – Surgical management of patients with genital skin deficiency (e.g., resulting from necrotizing fasciitis, lymphedema, cancer resection) including the use of skin grafts and local tissue transfer

Urethral strictures – Surgical management of anterior and posterior urethral strictures, including patients with a history of prior urethroplasty, lichen sclerosus and buried penis.

 

 

Estimated Annual Case Load:

300 new patient consults for male infertility

300 new patient consults for male sexual dysfunction

25 vasectomy reversals

30 varicocele repairs

40 sperm retrievals

60 penile prosthesis (~50% revision)

25 AUS/Male Sling

25 Peyronie’s reconstruction (plication, incision/graft)

40 urethroplasties

25 Genital reconstruction (STSG to penis/scrotum)

 

Hospital Privileges:

The fellow will obtain a full unrestricted North Carolina state medical license 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.

 

Call obligations:

The fellow will take attending adult and pediatric call at UNC Hospitals. The call schedule is shared among the entire UNC Urology faculty, and is approximately 4 weeks per year.  Call begins on Friday morning and lasts one week at a time.  A call team will always include a urology intern, a urology resident, a urology chief resident, and an attending or fellow.

 

Research Expectations:

  • Submit one or more abstracts to a national meeting.  The fellow will accompany the program faculty to one or more national meetings during the fellowship.
  • Submit one original research paper in addition to one or two review papers or book chapters.

 

Teaching Expectations:

  • Serve as teaching faculty to the UNC Urology residents
  • Attend weekly urology grand rounds
  • Attend weekly IVF conference at UNC Fertility
  • Give a grand rounds presentation on an infertility or men’s health topic
  • Lead a resident teaching session on male infertility prior to the in-service

 

Evaluation:

Periodic evaluation by the program faculty will be performed to ensure the fellow’s successful completion of the program.

 

Program Prerequisites:

In order to be eligible for our fellowship program, an applicant must:

 

  • Be a graduate of a Liaison Committee on Medical Education (LCME)-accredited medical school in the US and Canada or international medical graduates of equivalent international medical schools
  • Have completed United States Medical Licensing Examination Steps I, II, and III
  • Have completed or anticipate completion of an ACGME-accredited Urology residency program
  • Meet requirements and obtain an unrestricted full North Carolina medical license prior to commencing the program
  • Be a United States citizen or Visa eligible and able to provide proof of identity and United States Employment Eligibility (I-9)
  • If selected as a potential candidate for the Fellowship, the applicant will be required to fulfill conditions for UNC Faculty Appointment (Instructor Level), including Health Record Clearance, including drug screening (See UNC Drug Testing Policy) and successful completion of the UNC Application for Appointment (requires 3 reference forms, criminal background check, databank check, and signature on confidentiality agreement)

 

Application and Selection Process

A cover letter, personal statement, curriculum vitae, and three letters of recommendation (including one from the residency program director) must be received by April 1.  On-site interviews will be scheduled throughout the year on a mutually acceptable date.  The UNC Men’s Health Fellowship participates in the AUA Andrology Specialty Match occurring every year in June.   Electronic copies of the application are preferred and should be sent to:

 

Dr. Matt Coward, Fellowship Program Director
c/o Fellowship Program Coordinator
2113 Physicians Office Bldg, CB#7235
Chapel Hill, NC 27599-7235

(P) 919-843-9014, (F) 919-966-0098