Dr. Joshua Sterling

We had our standard protocol at SUNY Upstate and never really questioned it.

And then probably the first year I was in practice, I got a culture for a bacteria I'd never heard of before.

They started like subspeciating our different species of Klebsiello and looked into that and realized that

What we think of as, you know, bacteria and then positive urine cultures is probably the tip of the iceberg.

And if there are actual, you know, ribosomal differences and enzyme differences in the bacteria, maybe there are clinical differences as well.

And so kind of really tried to dig into it and realize that there wasn't much there, at least in the urology literature, which is kind of, you know, UA reflects the positive culture.

If

culture there, then treat.

And I realized that there's a wide world where we could really be doing a lot more for patients.

I think that's when I started talking to people about it and getting interested in and realizing that I wasn't the only one having these thoughts.

evidence-based and data-driven, but that personal end of one case is really hard to ignore.

So especially in an area where there is a lack of level one evidence and just a couple of case series and small things, it really is kind of hard to break some of the habits that we pick up over time.

So I think surprisingly, the current landscape is pretty varied.

Looking at and talking to colleagues and looking at the literature, everyone knows that bacterial infections are bad and can definitely affect our repairs.

And past that, there really isn't a lot.

So, you know, I think it's pretty standard across the board to get a pre-op culture regardless of what you're doing.

and then treat that.

But, you know, kind of what is a symptomatic UTI comes into question for patients that are colonized, you know, kind of what are we doing for that comes into question.

And I think the only area that is pretty clear is, okay, if there is, you know, a greater than 100,000 colony form units, we're going to treat that.

Not everyone is going to get a proof of treatment.