At the end of our tour Engel muses on the changes in urology he's witnessed in his 30 years of practice. "When I look at all this it reminds me of the fact that when I finished my training I finished at the top program in the country. It was at the cutting edge. And 80 percent of it doesn't apply anymore." Which is good news for anyone who ever faced a perineal fistula reamer.
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