Dr. Joshua Sterling

I still put a stent in for a urethral stricture repair, but any of the kind of diversions I do after a cystectomy, I have switched to stentless.

And I haven't really seen any... It's probably been about a year now since I've done it, and I haven't really seen any problems.

And I know, I'm sure you have the same thing.

It's kind of like...

How many times in training where the intern would go and pull the stent and the next thing you know, there's an overhead code because suddenly the patient was urocepted.

There's some translocation, you pulled off a claw, whatever, brought to give them antibiotics beforehand and didn't did it after.

And then, you know, suddenly they're septic for it.

I think it is a lot easier for patients, especially if you're doing any of the continent diversions where you don't have to worry about how you're going to get those stents out.

And the data kind of is bearing out.

I don't really see a downside in terms of outcomes for it.

We operate in a world where you never know.

You know what happens to the patient, but not what would have happened or could have happened.

And when you know you have to sit down and talk to that patient or go back for it, it is very difficult for it.

In the realm of kind of another way that people are looking to decrease any sort of antibiotic use in diversions is I know that they're running a small pilot study

I think out of Mount Sinai, looking at iris depth irrigations after diversions, you know, again, what can we do to try to sterilize the urine so you don't have that biofilm buildup?

And the reason I know about that is that's the bladder irrigation that I'm using.

So I do use the iris depth chlorhexidine irrigation for the trial that I'm running.

Yeah, mostly the chlorhexidine gluconate kind of disrupts the ionic bonds in the cell walls.

And because of that, you can also start to disrupt the bile cells on it.

Same thing in the plastic literature for breast revisions.