Friday, February 21, 2014

Classic Manuscripts in Urology: McGuire, 1981

Dr. Edward McGuire continues to have a long and distinguished career in urology, spanning several decades.  He is a decorated veteran of the Vietnam War.  He trained at Yale and has been faculty at Yale University; the University of Michigan, serving as Head of the Section of Urology and Neurourology and Pelvic Reconstructive Surgery; and the University of Texas Health Science Center in Houston, as Director of the Division of Urology.  Dr. McGuire has made a number of important contributions to urology including the principle of the leak point pressure, understanding surgical corrections of lower urinary tract dysfunction and pioneered the collaborative joint fellowship programs in urology and gynecology. Here we review one of his most important manuscripts and its lasting effect on urology.

McGuire EJ, Woodside JR, Borden TA, Weiss RM. Prognostic value of urodynamic testing in myelodysplastic patients. The Journal of  Urology. 1981 Aug;126(2):205-9.  

In this paper, Dr. McGuire and colleagues evaluated 42 myelodysplastic patients with urodynamics over an average of 7 years.  They carefully defined the urodynamic characteristics of these patients:

  • 86% had an open bladder neck and non-functional proximal urethra
  • Only 9% had coordinated micturation while 83% had areflexic detrusor activity
  • 71% had poor compliance (increased bladder pressure with increasing volume)

Most importantly, this manuscript demonstrated that 85% of patients with a detrusor leak point pressure >40cm H20 had hydronephrosis or vesicoureteral reflux (VUR) [Table 3].  Conversely, no patient in the low-pressure (<40cm H20) had VUR and only 2 had hydronephrosis.

Take Home: This manuscript is a landmark paper as it defined deleterious effects of high detrusor leak point pressures on the upper urinary tracts and defined the cutpoint at 40cm H20, widely used by urologists around the world for patients with a variety of urological issues.  

Classic Manuscripts in Urology will be posted on this blog on regular basis.  These articles are meant to highlight the achievements of our predecessors, recognize the work from which we build our careers and stimulate new conversations and discussion on a variety of urological topics.  Please feel free to comment on this manuscript, help point out its strengths and weaknesses, or suggest a new manuscript and topic. 


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