Dr. Benjamin N. Breyer

pretty much do all the stuff that he did dabble in the abdomen do mostly kind of perineal surgeries do a lot of cancer survivorship surgeries prosthetics do a ton of buried penis in a lot of ways the practice and what we do is similar but in a lot of ways it's really evolved and and changed i think we do far fewer anastomotic erythroplasties i think we're doing

probably a fewer buccal urethroplasties than I did, say, 10 years ago in favor of non-transsecting urethroplasties.

Yeah, I think that's accurate.

I think for me, other evolutions in my practice have been around radiated patients.

I'm definitely less aggressive with radiated strictures than I had been when I first, you know, in those first five years.

I still do urethroplasties, those membranous intraprosthetic strictures that we find after radiation.

But I tread, I think, more lightly, probably more aggressive in younger patients that have them.

But just with high recurrence rates and I think sometimes less than satisfactory outcomes, tread lightly with those.

Sometimes favored in the right patient doing a DVIU and having them dilate.

But sometimes that's not an option.

You have to, you know, do plan B.

The other, I mean, I think FOSTA strictures, Dmitry Nikolovsky's transurethral buckle procedure is just really awesome surgery that is for any reconstructive person, very easy to learn and perform.

That's a great surgery.

The outcomes tend to be quite good and you can actually do pretty long strictures with it.

I think LS is another disease process that my viewpoint on it has changed over, you know, the last 15 years in practice.

One where I tend to favor if the patient's up for it, you know, opening them up, then having them self-dilate with a steroid as opposed to doing a big urethroplasty.

Now there's, there's roles for big urethroplasties in those patients and

Many of them need a meatoplasty at least, but those inflammatory structures are just so prone to reforming.

My use of the sort of triple, quadruple buckle, both sides of the mouth, fixing the whole thing.

I still do those cases, but I think a little more sparingly.