Dr. Joshua Sterling

Okay.

So yeah, I will kind of give them, I'll be a little stronger than just Cephezolin in the operating room if they have a history of cultures, even if their most recent one was mixed.

So to your expertise, I'm not sure of.

Talking to my kind of oncology colleagues, I know that they're kind of pulling back.

All the guys that do prostatectomies are pulling back from three days around to just kind of one dose at time of Foley catheter removal.

The stone guys, that's a pretty mixed bag.

For somebody who has just a regular calcium oxalate stone, and I don't think they go crazy, but for those patients who have struvite stones or kind of, you know, history of some sort of urosepsis episode, I think they're a little stricter in terms of treating, getting a testic cure, because they're going up there, and with the pressures they're putting in the kidney, there's definitely going to be some translocation of bacteria into them.

into the bloodstream for it.

Yeah, for that, what I started to do for some of my upper tract reconstruction is, you know, without any real evidence, but just thinking, you know, how can I completely decompress the system and still...

have some antibiotic stewardship.

So I have a stent and a Foley in and they have a Foley in for about a week just to kind of let everything drain out.

Think about it for what we do for any sort of abscess, you know, drainage is as good as antibiotics.

And I think kind of in the urinary tract, I'm trying to apply similar principles.

I think really overuse and misuse specifically is definitely the neurogenic bladder patients that I see.

And it's not always the urologist's fault, but I think zooming out and thinking, what can we do to help the patient?

I think we need to be better about educating patients.

for it so that they can advocate for themselves when if they're in a nursing facility or just kind of every time they go to the emergency room with like some sort of catheter problem, somebody is going to draw a culture on it and be like, oh, it grew back and we need to put them on something.

That patient population kind of drove the development of the clinical trial I'm running as you know, what can we do to try to sterilize the bladder for patients that are that have a chronic SP tube?

And so kind of using

Iricept irrigations when they come in for their SP tube changes to see, you know, can we shift what their microbiome is into something that's going to be a little less scary if they go to the emergency room.