LOGBOOK

Sur Name
First Name
Date of Birth (day/month/year) / / /
MEDICAL DEGREE (MD)
POST-GRADUATE (PG) TRAINING
SURGERY
TRAINING IN UROLOGY / Date obtained (month/year)
Country
Total number years
Date started (month/year)
Total number of years
Date ended
Date started
Total number of years
Present year
To be completed (month/year) / /
/
/
/
/
Name Training Centre
Address
Zip Code / City
Country / /
Signatures certifying data / Programme Director
Hospital Administrator
Date (day/month/year) / //
This Logbook coversthe period*: / From (month/year)
To (month/year) / /
/

* this is a period during training/after accreditation; a minimum period of 2 years preceding the application is required.

INTRODUCTION

This logbook is a record of your urological experience. Do not include postgraduate (PG) training in surgery. For each item, please give number (#) of operations performed as:

S = as Surgeon

A = as Assistant to Senior Surgeon

Calculate total for each category, and grand total in the consolidated report sheet (page 9).

Please use the following classification; when selecting "other", please specify. Most procedures can
be grouped under one heading. If your practice is different, please clarify this at the end of page 9.

I. OPEN SURGERY / 1. kidney2
2. ureter2
3. bladder2
4. prostate2
5. urethra / 6. external genitalia
7. retroperitoneum
nodes2
vascular procedures
8. other
II. RENAL
TRANSPLANTATION1 / 1. transplantation
2. donor nephrectomy
3. transplantectomy / 4. revision
5. vascular access
6. other
III. ENDOSCOPIC
SURGERY / 1. percutaneous upper tract (kidney/ureter)
2. retrograde upper tract (kidney/ureter)
3. bladder
4. prostate
5. urethra
6. laparoscopic
7. other
IV. ESWL / 1. kidney
2. ureter / 3. bladder
4. other
V. DIAGNOSTIC &
MINOR PROCEDURES / 1. endoscopy
2. ultrasound
3. ultrasound transrectal
4. prostate biopsy / 5. interventional uro
radiol. procedures
6. urodynamics
7. other

1Renal transplantation and related procedures are under separate heading; do not include in renal or vascular surgery counts

2Several combined procedures count for two points: ie. node dissections in radical surgery, urinary diversion in total cystectomy.

I. OPEN SURGERY

1. KIDNEY / S / A
1. Nephrectomy:
- non-tumour
- radical, for tumour
Nephroureterectomy:
- non-tumour
- for tumour
2. Partial nephrectomy
3. Pyelolithotomy
Nephrolithotomy
4. Open nephrostomy
Open biopsy
Nephropexy
5. Pyeloplasty
6. Other :
TOTAL OPEN KIDNEY
2. URETER / S / A
1. Ureterotomy
Ureterolysis
Ureterectomy
2. Uretero-neocystostomy (# ureters)
Transuretero-ureterostomy
Megaureter (# ureters)
3. External urinary diversion (all)
idem, continent
Internal urinary diversion (all)
Revision urinary diversion
4. Other:
TOTAL URETER
3. BLADDER / S / A
1. Partial cystectomy
Radical cystectomy
Bladder substitution (replacement)
Augmentation cystoplasty
2. Diverticulectomy
Excision urachal cyst/tumour
Cystotomy/Cystostomy
3. Fistula (all types)
Repair of trauma
Exstrophy
4. Incontinence surgery
Bladder neck plasty
Artificial urinary sphincter
5. Other:
TOTAL OPEN BLADDER
4. PROSTATE / S / A
1. Open "prostatectomy" (ie. adenomectomy)
- retropubic
- perineal
- suprapubic
2. Radical prostatectomy
3. Other:
TOTAL OPEN PROSTATE
5. URETHRA / S / A
1. Urethroplasty (all, except hypospadias)
2. Hypospadias (all types)
Epispadias
3. Urethrectomy
Diverticulectomy
Repair fistula
Repair urethral rupture
4. Other :
TOTAL OPEN URETHRA
6. EXTERNAL GENITALIA / S / A
1. PENIS
circumcision
penectomy (all)
prosthesis
priapism
other:
2. TESTIS
radical orchidectomy (cancer)
inguinal hernia
orchidopexy
biopsy
prosthesis
other:
3. EPIDIDYMIS / SPERMATIC CORD /SCROTUM
vasectomy
vaso-vasostomy
epididymectomy, cysts, biopsy
spermatocele
hydrocele
varicocele
scrotum excision (total/partial)
other:
4. Other:
TOTAL EXTERNAL GENITALIA
7. RETROPERITONEUM / NODES / VASCULAR PROCEDURES / S / A
1. RETROPERITONEUM
adrenal surgery
retroperitoneal tumour
2. NODES
periaortic
retroperitoneal node dissection
pelvic node dissection
inguinal node dissection
other:
3. VASCULAR PROCEDURES
cavotomy for tumour thrombus
for impotence
other:
TOTAL RP / NODES / VASCULAR
8. OTHER / S / A
1. Laparotomy (exploratory)
Appendectomy
Herniorrhaphy
2. Colporrhaphy
3. Other:
TOTAL OTHER OPEN PROCEDURES

II. TRANSPLANTATION

Renal transplantation / S / A
1. Transplantation
2. Donor nephrectomy
3. Transplant nephrectomy
4. Revision
5. Vascular access for dialysis
6. Other:
TOTAL TRANSPLANT

III. ENDOSCOPIC SURGERY

1. PERCUTANEOUS UPPER TRACT : KIDNEY/URETER / S / A
Stone
Tumour / stricture / UPJ obstruction
Other :
2. RETROGRADE UPPER TRACT : KIDNEY/URETER / S / A
Stone
Tumour/stricture (dilation, incision)
Internal stents
Other:
3. BLADDER / S / A
TUR bladder tumour
Stone / foreign body
Other:
4. PROSTATE / BLADDER NECK / S / A
TUR Prostate/Bladder neck
TU Incision prostate/Bladder neck
Other:
5. URETHRA / S / A
Internal urethrotomy
TUR posterior urethral valves
Other:
6. LAPAROSCOPY node dissection / S / A
Testis / varicocele
Kidney
Bladder / other
7. OTHER:
TOTAL ENDOSCOPIC PROCEDURES

IV. ESWL

Extracorporeal shock wave lithotripsy / S / A
1. Kidney
2. Ureter
3. Bladder
4. Other:
TOTAL ESWL SESSIONS

V. DIAGNOSTIC & MINOR PROCEDURES

S / A
1. ENDOSCOPY
urethro/cystoscopy
id + biopsy, coagulation/fulguration
id + ureteral catheterisation
urethral dilation
other:
2. ULTRASOUND STUDIES
all sites, except TRUS-prostate
3. TRANSRECTAL ULTRASOUNDS (TRUS)
4. PROSTATE BIOPSY
all techniques
5. INTERVENTIONAL URO-RADIOL. PROCEDURES
percutaneous nephrostomy, drainage
6. URODYNAMICS
urodynamic studies (except flow)
radio-urodynamic studies
7. OTHER:
TOTAL DIAGNOSTIC & MINOR PROCEDURES

CONSOLIDATED EXPERIENCE : TOTALS

TYPE EXPERIENCE / ORGAN / TOTAL
S / TOTAL
A
I. OPEN SURGERY / 1. Kidney
2. Ureter
3. Bladder
4. Prostate
5. Urethra
6. External genitalia
7. R-p, nodes, vascular
8. Other:
TOTAL OPEN
II. TRANSPLANTATION / 1. Transplantation
2. Donor nephrectomy
3. Transplantectomy
4. Revision
5. Vascular access
6. Other:
TOTAL TRANSPLANTATION
III. ENDOSCOPIC
SURGERY / 1. Percutaneous upper tract
2. Retrograde upper tract
3. Bladder
4. Prostate
5. Urethra
6. Laparoscopic
7. Other:
TOTAL ENDOSCOPIC
IV. ESWL / TOTAL ESWL SESSIONS
V. DIAGNOSTIC &
MINOR
PROCEDURES / 1. Endoscopy
2. Ultrasounds
3. TR-us prostate
4. Prostate biopsy
5. Interventional uro-radiologicprocedures
6. Urodynamic studies
7. Other:
TOTAL DIAGNOSTIC
Comments:

1Signature:______(applicant must sign each page)

UNION EUROPÉENNE DES MÉDECINS SPÉCIALISTES (U.E.M.S.)