Dr. Joshua Sterling

and i think part of it is we just i think we need a better understanding of what the bacteria that are always going to be in the urine actually do you know are there some bacteria where if you would just give them 24 hours and sterilize it it's fine or you know are there some bacteria that are going to be a bit more resistant and really live in the tissue and i think

We have the technology now to go past just a basic culture.

And, you know, we really as a field should start thinking about doing that and really understanding the difference between some of the benign and the more pathologic bacteria that live within the urinary system.

It's surprisingly sparse in terms of showing that there's a benefit to prolonged antibiotic use, even in the implant literature.

In urethroplasties, we've seen over the last 15 years a decrease in terms of number of antibiotics.

It was people being on full treatment doses for three weeks or however long it was until the catheter came out.

And now more common is just a couple of days around the catheter pull.

In the implant world, I know they've kind of done all sorts of tests and trials about postoperative antibiotic.

And as far as I know, not one has concluded that it has definitely led to less infections or less explanting and revisions of either a penile prosthesis or an AUS for doing it.

The upper tract literature is a bit more mixed.

There really isn't anything there.

You're leaving a stent.

People are kind of a bit more mixed about that, especially with the nephrostomy tube being in there.

Kind of the summary of all of it is that I don't think it helps much.

I think if somebody actually did a number needed to treat analysis, we'd be surprised about the number of patients we're putting on antibiotics to prevent maybe one wound infection.

It really did cause me to rethink and change my practice and start to really pull back on the antibiotics I'm prescribing.

And it's gotten a little hard recently because I had a rash of pseudomonas infections afterwards.

And I was like, honestly, because we're not doing something, I need to do something different.

But so far, all the patients have done well.

So it's kind of treating the infections as they come instead of trying to get ahead and treating the ones that are never going to be there.