Dr. Benjamin N. Breyer

you're going to want to likely do an anastomotic certainly after p fuds and these kind of things that's what i'm doing anastomotics sometimes if it's a terrible radiated case and there's just a lot of horrible tissue there we'll do an anastomotic we'll also do non-transsecting there and then of course anything in the penis you're you're really using buckle

Yes, I've done that.

And in general, I don't.

know if i love it just because getting the apex of those all the way you know when you're at the bladder neck practically um it's a little painful for me but we've done them and we've had i think reasonable results i think a lot of times you can cut away the tissue and still do a non-transsecting successfully or if there's a bunch of necrotic tissue

probably makes sense.

You could do an augmented roof, but probably just makes sense to cut out the bad stuff and then do an asthmatic.

Those people, of course, will be totally incontinent and will need a sphincter.

And so as much as you can spare the bulbar arteries, you should try to.

Yeah.

I mean, I think part of the wonderful, we are one, training more reconstructive urologists.

We're also, there are other endoscopic techniques that are evolving that are being widely disseminated

And I think as a consequence of that, yeah, some really kind of straightforward stuff.

It's very, very unusual for me to see stuff that's super straightforward.

It's usually, and it's, you know, we get referred these cases that are, I definitely have seen an increasing in complexity over time.

It's just very unusual for us to get a very straightforward case.

Although, you know, we certainly get them, but it used to be more common that we would do, oh, this is a one centimeter bull bar stricture.

Let's do an anastomotic.

yeah well maybe we're fixing all of the easy ones and then it's just the hard ones that have recurred that are left you know i some days i'm just like wow can i get a stricture that's not radiated or has lichen sclerosis like is that possible but yeah you know i think that's part of the fun is just figuring out a game plan evolving over time and in meeting the needs of the patients

I agree.

I agree.