FNB Andrology: Check out NBE released Curriculum

The National Board of Examinations (NBE) has released the curriculum for FNB Andrology.

I. INTRODUCTION:

The modern management of male reproductive and sexual health requires an in-depth knowledge of the anatomy, physiology, endocrinology and pathology of the male genital system, of specific investigations and various imaging techniques, of surgical procedures for therapy and reconstruction, and some understanding of the biological sciences and laboratory procedures, including Assisted Reproductive Techniques (ART).

The aim of this course is to create an expert level of proficiency in Andrology and related aspects of Men’s Health with Post Graduate knowledge to understand and manage male infertility, male sexual dysfunction, hypogonadism and related aspects pertaining to male ageing.

The Fellowship is intended for a qualified urologist, either M.Ch. or DNB Urology, who wishes to subspecialize in the field of andrology.

II. GOALS & OBJECTIVES

The Andrology fellowship will enable the candidate to acquire an advanced body of knowledge and a high level of skill required for the management of male reproductive problems, male sexual dysfunction, male endocrine problems, and late onset hypogonadism. At the completion of the course the trainee should be able to provide comprehensive care for all these problems, offer appropriate counseling, diagnosis and treatment, and establish an Andrology Centre or provide comprehensive andrology services to an assisted reproduction centre.

1. Learning Outcomes:

i. Acquisition of current, latest, scientific and evidence-based knowledge necessary for attaining programme outcomes

ii. Skill to undertake independent clinical practice thereby delivering the highest standard of andrology care to the community

iii. Correct attitude of responsibility, accountability and caring

iv. Foundation of ethical values in the practice of Andrology

v. Competency to communicate effectively with patients, peers, colleagues, and the community in the discharge of his/her clinical role vi. Skill in academic and research aspects of Andrology

vii. Skill to be an effective teacher and communicator in Andrology

2. Specific Objectives:

i. Comprehensive knowledge related to male reproductive and sexual medicine.

ii. Understanding of male reproductive endocrinology

iii. Develop high level of surgical skill in andrological procedures, including use of operating microscope for various andrological procedures.

iv. Competence in andrological and ART-related laboratory techniques

v. Basic counselling skills related to infertility and psycho-sexual counseling.

3. In addition, individuals completing this training program will be able to:

i. Evaluate the clinical literature on erectile dysfunction and reproductive health in a critical fashion and make contributions to the field

ii. Teach the specialty of Andrology

iii. Organize a multidisciplinary team to manage erectile dysfunction and male infertility.

III. TEACHING AND TRAINING ACTIVITIES

The fundamental components of the teaching programme should include:

1. Case presentations & discussion- once a week

2. Seminar – Once a week

3. Journal club- Once a week

4. Grand round presentation (by rotation departments and subspecialties)- once a week

5. Faculty lecture teaching- once a month

6. Clinical Audit ( Mortality and Morbidity review)-Once a Month

7. A poster and have one oral presentation at least once during their training period in a recognized conference.

The rounds should include bedside sessions, file rounds & documentation of case history and examination, progress notes, round discussions, investigations and management plan) interesting and difficult case unit discussions. The training program would focus on knowledge, skills and attitudes (behavior), all essential components of education. It is being divided into theoretical, clinical and practical in all aspects of the delivery of the rehabilitative care, including methodology of research and teaching.

IV. SYLLABUS

1. Knowledge:

The candidate will become proficient in the etiology, pathophysiology, diagnosis and management of all andrological problems related to male infertility and sexual dysfunction. The following topics will be covered through lectures, and practical training in the clinic.

i. Male Infertility

a. Basic anatomy and physiology of male reproductive system

b. Assessment of male fertility potential

 Semen Analysis: Methodology, Interpretation

 Other Considerations In Predicting Fertility

c. Evaluation of an infertile male

 History: General: Specific; Sexual

 Examination

d. Investigation

 Role Of Hormone Analysis

 Sperm Function Tests: Which? When? Implications?

 Role Of Ultrasonography – Scrotal, Transrectal, Duplex Doppler

 Immunological Tests

 Genetic Testing

 Role Of Testicular Biopsy

e. Management of oligoasthenozoospermia

 Principles Of Management

 Specific Treatment

 Empirical Treatment

 Role Of Varicocele Surgery

 Seminal Infection: Diagnosis; Treatment

 Immunological Infertility

f. Management of Azoospermia

 Diagnostic Algorithms

 Role Of Medical Therapy

 Reconstructive Microsurgery For Obstruction In Vas Or Epididymis

 Trans Rectal Resection For Ejaculatory Duct Block

 Surgical Sperm Retrieval Techniques

 Laboratory Aspects Of Sample Processing After Sperm Retrieval

 Cryopreservation Of Sperm

g. Anejaculation / Aspermia/ Retrograde ejaculation

 Etiology; Diagnosis; Management

 Penile Vibrostimulation And Electroejaculation

h. Hypogonadotropic hypogonadism

 Etiology; Diagnosis; Management

i. Hematospermia

j. Chronic orchalgia

k. Chronic prostatitis and pelvic pain

l. Management of undescended testes

m. Introduction to ART – principles, practice, laboratory

n. Future modalities for evaluation and therapy – genomics, proteonomics, stem-cell based therapy, in vitro culture, etc.

ii. Male sexual dysfunction

a. Anatomy and physiology of the male sexual response

b. Types of male sexual dysfunction

c. Evaluation of erectile dysfunction

 History: Specific Points To Be Covered Investigation: Various Tests Available – Technique, Utility And Limitations, Indications And Contra-Indications.

d. Therapy of erectile dysfunction

 Psycho-Sexual Counseling

 Oral Medication

 Intra-Penile Self Injection

 Vacuum Erection Devices

 Penile Implants: Types; Surgical Technique; Complications

 Newer Experimental Modalities

e. Premature ejaculation

 Definition And Etiology Treatment Options

f. Management of Priapism

 Ischemic; High Flow; Stuttering

g. Peyronie’s disease

 Etiology; Conservative Therapy; Surgical Procedures

h. STIs and their management

i. Neophallus reconstruction & Transgender surgery

j. Ageing male

 Late Onset Hypogonadism

 Screening For Prostate Cancer

 General Andrological Care

k. Medico-legal aspects

l. Setting up an andrology clinic

2. Skills:

The candidate will attain expertise in:

i. Microsurgical techniques of reanastomosis of the vas deferens, vaso epididymal anastomosis and varicocele ligation

ii. Sperm retrieval techniques including percutaneous epididymal sperm aspiration, microsurgical epididymal sperm aspiration, percutaneous testicular sperm extraction, testicular mapping and microdissection TESE.

iii. Trans urethral resection for ejaculatory duct obstruction

iv. Surgery for male sexual problems including penile prosthetic surgery (fresh and complicated revision cases), correction of congenital penile curvature, reconstruction for Peyronie’s disease, penile revascularization.

v. Ultrasonography of penis, testes, scrotum and ejaculatory ducts

Basic proficiency in andrological and embryological laboratory procedures

V. COMPETENCIES

The department will hold half yearly in-house exams to see the progress of the student. Appearance in these examinations is mandatory. The final examination will be held at the end of 2-academic years

On completion of the course, the candidates will be capable of the following:

i. Methodical investigation of problems leading to infertility, aging and erectile function in men, including female sexual dysfunction.

ii. Categorizing them according to clinical condition.

iii. Conducting necessary investigations and diagnostic procedures.

iv. Trans rectal / Doppler ultrasound examination for study of testis, prostate and seminal vesicles for evaluation of the pathophysiological processes of testicular, seminal, ejaculatory dysfunction.

v. Bio Chemical assays of reproductive hormones in serum.

vi. Display detailed knowledge and understanding of human Gamete Biology and Molecular perspective.

vii. Critical evaluation of new advances in Biotechnology.

viii. Acquire ability to establish and IVF Centre.

ix. Conductive Quality Control procedures that are essential to the reliable operations of an IVF clinic.

x. To familiarize oneself with the technique or handling male and female Gametes use in IVF / ICSI etc.

xi. Competence in In Vitro Culture techniques used for Gametes and Embryos.

xii. To be capable of Andrology laboratory procedures – semen analysis, sperm processing, donor semen banking, motility enhancers for sperm, cryopreservation of Gametes, Embryos and Tissues for later use in human infertility treatment.

xiii. Reasonably predict the viability of an Embryo prior to its transfer in IVF.

xiv. Achieve/demonstrate skills for Micromanipulation Procedures as in Intra Cytoplasmic Sperm Injection required for clinical ART.

xv. Display some knowledge about the techniques used for Karyotyping (e.g. Lymphocyte cultures, amniotic fluid, cell culture etc.,)

xvi. Understand the ethical implications of ART and Cloning

xvii. Develop adequate skills in report writing, oral and visual presentations.

xviii. Basic use of computers, data analysis and record maintenance.

VI. LOG BOOK

Assessment and Logbook:

1. During the Course

i. Logbook will be maintained and signed by the Course Supervisor

ii. Regular evaluation on a 4 weekly basis will be done by viva-voce and review of the logbook by the Section Head.

iii. Training period will be divided into 4 semesters and an internal assessment test will be given after each semester and trainee assessed.

iv. The tests will be both written & oral

a. MCQ’s

b. Essay Type and

c. Viva Voce

2. For Certification

i. Logbook

ii. MCQ’s Written

iii. Essay Type – Written

iv. Viva- Voce

v. Lab Practical

vi. Lab – Viva voce

3. Log Book Requirement

Record of cases observed, assisted, and performed independently as per syllabus together with details of complications, if any, and their management. This will be reviewed regularly. Completed logbook is to be submitted before the practical examination and will be reviewed by the external examiners.

Keys:

O – Washed up and observe

A – Assist a more Senior Surgeon

PA – Perform procedure under the direction of a Senior Specialist.

PI – Perform Independently

4. Allied Subjects to be covered:

i. Bio chemistry of endocrine glands like thyroid, adrenal glands, ovarian, testicular glands, pancreatic glands (insulin secretion),

ii. Study of Diabetes / obesity and its relation to infertility, erection, ejaculation and aging etc.,

iii. Sexual Counseling theory & practice / Sexual aspects of psychosexual therapy in men & women

iv. Psycho-social aspects of self/social identity & counseling

v. Lifestyle, sexual practice, depression & self-concept

vi. Counseling of the ED patient / Counseling the Aging Male

vii. Health promotion, men & alcohol abuse

viii. Exercise & healthy living for age prevention

VII. RECOMMENDED TEXTBOOKS AND JOURNALS:

Textbooks

1. Male Sexual Function a Guide to Clinical Management by John J. Mulcahy

2. Textbook of Erectile dysfunction by Culley C Carson

3. Male Sexual Dysfunction by Suks Minhas and John Mulhall

4. Andrology lab manual by Ashok Agarwal

5. Infertility in male by Lipshultz and Niederberger

6. Surgical and medical management of male infertility by Goldstein and Schlegel

7. WHO Manual of Male infertility 6th edition

Journals

1. Asian J Androlgy

2. World J Men’s Health

3. Sexual Medicine Journal