Dr. George Koch

to your procedures and then how you've seen them change even over the course of time.

So you feel like less, you know, it seems like it kind of went in anastomotic to buckle back to anastomotic, but without a transection.

Is that kind of what you're describing?

I mean, that was one thing I felt like Dr. Wessels kind of talked about the same progression.

You know, when I was, when I was in, I was in fellowship, maybe five years after Niels Johnson, who's one of my mentors in residency.

And even the strictures that he and I talked about fixing and fellowship were kind of very

very different.

And I think that really reflected Dr. Wessel's, Dr. Volsky leaving the practice and Dr. Wessel's also kind of talking about making some of the shifts in kind of philosophy that you're talking about.

We talked about, whereas I would look at a rug for a guy with LS and see two areas and say, I think we can get a buckle to go across both.

I specifically remember the one that got us talking about this exact

problem.

And he was like, well, you know, maybe we can do a miatoplasty or a Nikolovsky and then dilate the proximal one and kind of see if we can stop the proximal progression if we treat the miatus.

It really was a different way of thinking than I think I expected even to come into, you know, a year earlier when I transitioned from residency to fellowship.

Absolutely.

And I want to get into that a little bit later when we talk about urethroplasty research as well.

But I did want to, before we lose the thought, I did want to ask you, you know, you've, you're describing kind of changes in your, and correct me if I'm wrong, kind of changes in your thought process and your, where you utilize different surgical approaches.

But I did want to ask, are there surgical approaches that you just don't use anymore at all?

You know, are there, are there approaches that you've moved away from?

Totally.

yeah yeah i'm i am a big fan of it as well we and we didn't do any dorsal middle cases in in fellowship so i don't know that i can speak about it with with as much experience but we always talked about that judith hagedorn and i always talked about you know you do a nikolovsky and if you get in trouble then you can kind of like