George Koch

that I was curious about kind of thinking about this talk was we've talked about the outdwelling tubes, right?

The nephrostomy tubes, the catheters.

There was a trial or a retrospective paper, excuse me, out of Memorial Sloan Kettering, maybe last year or the year before about stentless urinary diversions.

And they, you know, they didn't see any increase in the rate of ureterontary constricture,

But they did see a decrease in the rate of urinary tract infections around the time, you know, the theory was that your biofilms build up on the stents.

Then you pull the stents and it causes, you know, pile out.

What are your thoughts on it?

Or have you switched to stentless urinary diversion?

Yeah, I haven't switched yet.

My one of my partners here in Patel, he switched and gives me a lot of flack for not switching, especially because I like talk about this paper all the time.

Anytime ever anyone gets a post stent pull urinary tract infection.

But I just, you know, my my training was always to to use stents, you know, you finish the anastomosis over a stent.

And at some point, I think about it a lot.

At some point, I'll switch.

I had one recently, one patient recently where I left your order was particularly short and not not all that healthy looking.

So we reflect, you know, we took a big conduit, we reflected the conduit to the left instead of the ureter to the right.

And I couldn't get, you know, there was not a clamp.

He was a particularly portly gentleman.

And there was not a clamp that could get...

all the way down to his belly and make the turn for me to be able to grab the stent and pull it back up through.