George Koch

So I go and I get the ID textbook, like they're, they're Campbell Walsh.

And I find out that each bacteria, like each subspecies of bacteria in this book,

has its own chapter.

Like that's how they broke it down.

And I was like, oh, this is not a disease process thing.

This is a bacteria thing.

And I am never going to, I had to like abandon the idea because it was just, it was preposterous, I think, of me to think that we could just like, oh no, I know we get ID consults, but let me just like cover this in a lecture real quick.

And it was the first time that I, you know, similarly started thinking about we are in a little bit of a data free zone and then going into recon, you know, it was it was more of a data free zone.

But we deal, you know, unlike maybe andrology and infertility, although they have implant infections or, you know, stones and urosepsis from endoscopic procedures.

I feel like every single one of my patients has a tube and it's not like some patients who I treat.

have to make these decisions on it's every single little patient has a tube of some form or fashion so i think in recon it's really the thoughts that i think you were having and that that i have are like pervasive we just maybe don't always talk about it and all it takes is is one patient where your entire repair breaks down and you're like what else could i have done how could i have prevented this and and suddenly you know you're spiraling i know in medicine in general we try to be you

Yeah.

And you and like those patients when they happen, like you remember them and all you can think about is like, you know, this person wouldn't have had, you know, pilo after their ureteral stricture or a raging UTI or a fluid collection that got infected.

You know, maybe the urethroplasty would have healed.

You know, they like definitely stick with you.

Yeah, absolutely.

So so what does antibiotic use look like in reconstructive urology?

What's like the current landscape?

Yeah.

And it's tough to you don't see the MDROs that you're forming.