George Koch

And then, and this, you know, this isn't quite our purview, but how does reconstructive urology compare to other subspecialties as far as, you know, like, you know, people giving antibiotics before, TURBTs and stone procedures?

What's the landscape?

Yeah.

Those, those kidneys done patients are the ones that make me worry sometime about like upper tract, ureteral strictures, transplant ureteral strictures are the ones that always worry me and they're immunocompromised.

They've got a solitary kidney and, and for like a majority of the procedure, either it's draining, you know, the kidneys draining the abdomen or, you know, if you've got your

if you put a scope in there during your reconstruction or you cap on a frostbite tube, anything like that, I always really worry about those guys.

And it's those kidney stone patients, you know, from call and from residency that get really sick and end up in the ICU that make me so worried about some of these upper tract guys.

Yeah, the stop it trial in general surgery came out either when I was just beginning residency or maybe just before it.

But I don't know if you're familiar with it.

It's a general surgery.

It was like a New England Journal of Medicine article.

It was a general surgery paper that essentially said for intra-abdominal infectious processes after source control, you only need antibiotics for four days and there was no increase in, you know, reinfections or complications after that.

And I always try to remind myself of that, you know, when I'm thinking about antibiotics stewardship for us, you know, if we're talking about like someone getting X-lapped for

you know for an intra-abdominal infection or a drain for intra-abdominal infection if they can get by with just four days of antibiotics then a lot of things i agree with you like reliable drainage should should do it for us too what are some common scenarios in in recon where you see antibiotic overuse and misuse specifically

Can you, I don't know what kind of data you guys have yet.

Tell us a little bit about the trial and kind of where you are in it.

Yeah.

And I love the idea of shifting the microbiome as opposed to, you know, I think that sterilizing the urine kind of is the classic, the classic goal for us for these procedures.

And, you know, maybe it's just shifting the microbiome, the less pathogenic.

bacteria.