Genitourinary Surgery
Name:
Date: Month January February March April May June July August September October November December Day 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Year 2008 2009 2010 2011 2012
Level 1
Time spent on Procedure:
Scrub Circulate
Procedure: ____________________ Cystosopy Diagnostic Cystoscopy TUR Circumcision Urethral Dialation/Meatotomy Hydrocelectomy Vasectomy Orchiectomy Orchiopexy Collagen Injection Interstim Pacer
Level 2
Procedure: ____________________ Cystoscopy Stone Extraction Cystoscopy TURP Cystoscopy TURB Cystoscopy Ureteroscopy Suprapublic Catheter Nephroscopy Pyelolithotomy Pubovaginal Sling Male Sling Penile Implant Hypospadias/Epispadias Repair ESWL/Lithotripsy Laparoscopic Biopsy
Level 3
Procedure: ____________________ Cystectomy Ileal Conduit Nephrectomy Radical Prostatectomy
Other:
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