Dr. George Koch

But it was not as common a technique as it is now.

So I was wondering if you could talk about, you know, as you talk about your...

philosophy on how you treat strictures, you know, EPA to buckle to non-transsecting for, you know, for short strictures, for example, how you could like think about your case logs versus your fellow's case logs and, and kind of, I'd love to hear you use that as a discussion of how urethroplasty is evolving.

Yeah.

One thought I had while you were kind of listing them off was and you mentioned before you the way that you treat radiation may have changed over time.

Are you doing buckle in some of those radiation structures if you feel like you can feel like you can get to it?

Absolutely.

And as you talk about your kind of propensity to maybe get less aggressive with some of these really complex cases we're talking about from a surgical standpoint, like obviously they're still being managed, but you're maybe doing less invasive surgeries than the ones that have some higher recurrence rates.

I wonder, do you feel like

trainees, residents, and fellows really are seeing kind of more complex urethroplasties than they used to.

and you know it's a it's a fun day those are those are less common yeah i'm glad that your experience in ohio i'm glad to hear you say it because it's certainly it you know it feels like that from my standpoint but you know but dr patel and i and now dr walton eric walton our newest partner

Part of it was also kind of, we wondered, you know, are the, are just the practice patterns and the referral patterns, like not maybe as like manicured as someone who's had a longer practice, you know, cause we're also new.

You know, are we only getting the ones where they're super complex?

Cause that's, those are the patients that are out there that, you know, are now undergoing OptiLooms and maybe they're getting something transurethral first.

versus the new strictures or have we just not like manicured those referral patterns yet so it's at least a little affirming to hear that you're also seeing that because it sure does seem like things are are they're complex they're like not the straightforward two centimeter non-instrumented ball bar urethra posse anymore

Yeah, I mean, to get slightly off topic, I certainly feel that way about about my artificial urinary sphincters.

You know, I was talking to a friend of mine who's in private practice and he was he was talking about, you know,

he wants to do sphincters, but he was deciding whether he was going to do the radiated ones or not.

And I was like, when, when have you seen a non-radiated one?

Like, you know, I feel like they're all like that now.