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Department of Urology 07/21/2020 www.ucsfmedicalcenter.org/medstaffoffice/privilege_form.asp?LINK=995 www.ucsfmedicalcenter.org/medstaffoffice/privilege_form.asp?LINK=995 Department of Urology CAT 1 Basic Privileges: Patient management including H & Ps and diagnostic and therapeutic treatments, procedures and interventions encompassing the areas described below and similar activities Requiring a level of training generally associated with persons who have completed the residency program prescribed by the American Board of Urology, and a level of skill and ability generally associated with persons who are diplomates of that board. A) Diagnosis and treatment of diseases and abnormalities of the female urinary tract and the male urogenital tract, including administration of topical and local anesthesia. Includes minor urologic procedures such as dorsal slit, circumcision, biopsymeatotomy, and vasectomy. CAT 2 Subspecialty Privileges: Patient management at this level encompasses the items marked below, and similar activities Requiring a level of training, skill and ability generally associated with persons who are diplomates of the American Board of Urology and who have had additional training and/or experience in specific patient management problems and specialized expertise and training in order to perform the procedures A) Radical procedures such as radical cystectomy, radical prostatectomy, radical penectomy, radical nephrectomy, lymphadenectomy, extenterations, laparoscopic and percutaneous procedures, laser and renovascular surgery. B) Renal transplantation CAT 3 Special Privileges: Patient management at this level encompasses the items marked below, and similar activities Requiring a level of training, skill and ability generally associated with persons who are diplomates of the American Board of Urology and who have had additional training and/or experience in specific patient management problems. A) General Urologic procedures such as cystoscopy, TURP, orchiectomy, nephrectomy, simple prostatectomy, and ESWL. B) Moderate Sedation (Sedation Module required prior to granting of privilege) C) Videoscopic Surgery 1. Robotic Surgery: Si (Certification of Training required prior to granting of privilege) 2. Robotic Surgery: Xi Surgical System (Certification of Training required prior to granting of privilege) 3. Robotic Surgery: SP Robot – Assisted Surgery i. Initial: Must be board certified or board eligible within their surgical specialty and eligible to be credentialed at UCSF Hospitals in laparoscopic/endoscopic surgery. - AND – 07/21/2020 www.ucsfmedicalcenter.org/medstaffoffice/privilege_form.asp?LINK=995 Completion of a three-hour hands-on robotics system overview plus the web-based Intuitive Robotics course. Must have attended an approved hands-on training practicum in the use of the Da Vinci SP surgical platform (documentation required). ii. Proctoring: Complete 5 proctored patient cases within 12 months of completing the Da Vinci course. If a credentialed surgeon is not available to serve as a proctor, a second surgical attending who has completed the Intuitive Training but has not been proctored on the SP Robot may co-attend a case and may “proctor” each other, and both surgeons may receive credit for a proctored case. iii. Surgeons that completed training outside UCSF Health Care System with the following conditions may be granted initial SP robotic privileges without undergoing proctored cases: 1. Prior training and experience in the use of the SP robotic platform, such as training obtained at another institution, 2. Privileges to perform SP robotic cases at another Joint Commission – accredited facility, 3. Experience with a minimum of 6 robotic SP cases in the prior 12 months iv. Renewal: Performed a minimum of 12 SP robotic procedures within the past two years. (If renewal criteria not met, they will need to complete two proctored patient cases on the da Vinci SP Surgical System). D) Fluoroscopy (Fluoroscopy supervisor certification required) E) Provider Performed Microscopy: (Annual Competency Testing Required) 1. Urine 2. KOH 3. Wet Prep 4. Fern 5. Pinworm 6. Semen Analysis CAT 4 Limited Privileges: A) Nonsurgical Management of Urology Patients Initial Criteria: requires a level of training, skills ability generally associated with practitioners who are diplomats of a primary care ABMS board such as Internal Medicine or Preventative Medicine, Pediatrics, Family and Community Medicine, or other primary care ABMS board. 07/21/2020 www.ucsfmedicalcenter.org/medstaffoffice/privilege_form.asp?LINK=995 Maintenance criteria: Must renew board certification and have seen a minimum of three (3) patients 1. Measuring anogenital distance in newborns and at the one (1) year follow up. 2. Measuring the length of the baby 3. Measuring the weight of the baby ADMSE Admitting Services I expect to admit and care for patients under my own name on the following inpatient services: UR Urology Service PRINT NAME - APPLICANT SIGNATURE DATE PRINT NAME - PROCTOR / SUPERVISING PHYSICIAN SIGNATURE - SUPERVISING PHYSICIAN DATE PRINT NAME - DEPARTMENT CHIEF SIGNATURE - DEPARTMENT CHIEF DATE PRINT NAME - DEPARTMENT CHAIR SIGNATURE - DEPARTMENT CHAIR DATE http://www.ucsfmedicalcenter.org/medstaffoffice/privilege_form.asp?LINK=995 2/2 .
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