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LEGENDS IN UROLOGY


(16) 5 Oct 2009

John M. Barry, MD Professor of Surgery
Divisions of Urology and Abdominal Organ Transplantation
The Oregon Health & Science University
Portland, Oregon, USA

I was surprised at the request to write about myself as a “Legend in Urology.” I thought one had to be dead to be a legend so I asked my younger, but not obscenely so, second wife, “Am I old enough to be a legend?” She just smiled and said, “I’m afraid so.”

I’ve been fortunate to have had preparation, curiosity, opportunity, and a sense of humor with me for most of my life.

Preparation

From my parents, I got a great genetic package and a safe place to grow up in three small towns in Minnesota. I wanted to be a doctor since grade school. This was based in large part on my encounters as a patient with our family’s general practitioner, Dr. Robert Page. I was intrigued by the smell of alcohol in his small office, the white uniforms of his office staff, and that I recovered from whatever illnesses my parents thought significant enough for me to be seen by him. I remember four significant gifts from my parents: a microscope, a chemistry set, a desk, and a typewriter. My first surgical patients were frogs and fish. I was taught the craft of surgery by an immigrant, Dr. Ali Hakim, at the end of my second year of medical school. He offered to teach me how to operate if I would loan him my hand-written notebooks from my basic science classes so he could study for the Minnesota State Medical Board Examination. I learned how to cut, sew and tie, and he passed the exam. Shortly thereafter, he became Chief of Urology at Ancker Hospital in St. Paul, and, at his invitation, I spent 6 weeks of my junior-senior biennium surgery rotation with him. It was like being a junior urology resident.

When I was a junior medical student, I would walk across the street to University Hospital to a medicine ward, spin the rack of patient charts, and when it stopped, pick out a chart and read it like a novel. One of those evenings, I spotted a familiar name on a chart. I went into that patient’s room, and saw that the patient was a grade school classmate whom I hadn’t seen for years. We used to play together, and I remembered him watching him interrupt play one day to give himself an insulin injection. I asked him that night what was wrong, and he said, “My kidneys are shot, and they’re thinking about doing a kidney transplant.” He died later that year, and he’s buried next to my grandparents at Hillside Cemetery in St. Charles, Minnesota. That was the beginning of my interest in kidney transplantation.

After internship at the State University of New York, Upstate and 3 years in the Air Force, I did my pre-urology and urology training at the University of Oregon Medical School in Portland where Dr. Russ Lawson taught me how to do kidney transplants, and the Chief of Urology, Dr. Clarence Hodges, taught me, by example, how to be quietly effective in my professional life. Why Oregon? I made out a checklist of qualities I wanted in a training program, and Oregon was the only place that had all of them. I applied to that one residency program, wrote to Dr. Hodges and told him that I couldn’t come for an interview because I was stationed on Okinawa, and he took me. I’ve been there ever since,Table 1.

TABLE 1. My life

Year

Event

Historical reference

1940

Born

Battle of Britain

1958

Graduated from high school

First US satellite launched

1965

MD

First space walk (Edward Higgins)

1966

Entered US Air Force

Caesars Palace opens in Las Vegas

1969

Started residency

Neil Armstrong walks on the moon

1973

Joined faculty at Oregon

OPEC oil embargo

1976

Appointed director of transplant program

Viking 1 lands on Mars

1979

Acting Chief of Urology

Saddam Hussein becomes President of Iraq

1980

Chief of Urology

US Olympic hockey team beats Russian team

2008

Step down as Chief of Urology

US economy begins to slump



TABLE 2. Some general urology ideas

Year

Reference

Idea

1976

1

Corpus cavernosum to dorsal vein of penis shunt for priapism

1979

2

Penoscrotal approach for placement of penile prosthesis

1979

*

Nephrostent concept (manufactured 1983)

1980

3

Nocturnal penile tumescence testing with stamps

1981

4

Preoperative determination of inflatable penile prosthesis cylinder length

1981

5

Actuarial method applied to time-related events in urologic surgery

1982

6

Cut-to-the-light for obliterated membranous urethra

1984

7

Prediction of semi-rigid penile prosthesis diameter from saline erection

*Manufactured, not published as manuscript

TABLE 3. Some kidney transplant ideas

Year

Reference

Idea

1973

8

Cadaver kidney transplant ureteroneocystostomy with double ureters

1978,1988, 1995

9, 10, 11

Methods to extend the right renal vein in cadaver kidney transplantation

1982

12

Community urologists and general surgeons to do cadaver kidney retrievals

1982

13

Percutaneous antegrade transluminal ureteroplasty for ureteral stenosis

1982

14

Triangulation method to preserve spermatic cord

1983

15

Human kidney preservation beyond 48 hours with simple cold storage

1983

16

Unstented parallel incision extravesical ureteroneoycystostomy

TABLE 4. Other significant milestones/opportunities

Year

Opportunity/organization

1982

AUA/ABU Joint Examination Committee

1983

Western Urologic Forum

1983

Moderator, Western Section AUA Round Table

1986

ABU Examiner

1989

American Association of Genitourinary Surgeons

1992

Renal Transplantation in Campbell’s Urology

1995

Secretary, Western Section AUA (President 2001-2002)

1996

Trustee, ABU (President 2001-2002)

1998

Clinical Society of Genitourinary Surgeons

2007

Executive Committee, AUA (President 2008-2009)

AUA = American Urological Association; ABU = American Board of Urology

Closure

In March of 2007 I had a successful radical prostatectomy for localized prostate cancer, but that’s another story. In the summer of 2008, I stepped down as Chief of Urology at Oregon and had my compensation cut in half simply because it was time to do so, and because I had significant new responsibilities as President of the AUA.

My career has been more than I dreamed possible. Here are a few principles that I’ve kept in mind along the way. Leadership is simply helping others do their jobs; if you do that, they’ll help you do yours. Perfection isn’t possible, but it must be sought. Do the best you can with what you’ve got. Opportunity is of no value if you are unprepared. Pick something that’s worthwhile that you like to do, do it well, and money will follow you around. Money is important because it frees you to be a professional so that you don’t have to confuse revenue generation with patient care. Public service is a responsibility of citizenship. If you can’t do it, make it possible for others to do so. Life is only two things: problem solving and the pursuit of happiness. If you do those two things without hurting others, you’ll go to heaven; that’s all there is to it.

It’s been a great ride.

John M. Barry, MD

Professor of Surgery

Divisions of Urology and Abdominal Organ Transplantation

The Oregon Health & Science University

Portland, Oregon, USA

References

1. Barry JM. Priapism: treatment with corpus cavernosum-dorsal vein of penis shunts. J Urol 1976;116(6):754-756.

2. Barry JM, Seifert A. Penoscrotal approach for the placement of penile prosthesis. J Urol 1979;122(3):325-326.

3. Barry JM, Blank BH, Boileau M. Nocturnal penile tumescence monitoring with stamps. Urology 1980;15(2):171-172.

4. Barry JM. Preoperative determination of inflatable penile prosthesis cylinder length. Urology 1981;18(1):82-83.

5. Giesy JD, Barry JM, Fuchs EF, Griffith LD. Initial experience with Rosen incontinence device. J Urol 1981;125(6):794-795.

6. Lieberman SF, Barry JM. Retreat from transpubic urethroplasty for obliterated membranous urethral strictures. J Urol 1982;128(2):379-381.

7. Barry JM. Prediction of semi-rigid penile prosthesis diameter from saline erection. J Urol 1984;131(2):281.

8. Barry JM, Pearse HD, Lawson RK, Hodges CV. Ureteroneocystostomy in kidney transplant with ureteral duplication. Arch Surg 1973;106(3):345-346.

9. Barry JM, Fuchs EF. Right renal vein extension in cadaver kidney transplantation. Arch Surg 1978;113(3):300.

10. Barry JM, Hefty TR, Sasaki T. Clamshell technique for right renal vein extension in cadaver kidney transplantation. J Urol 1988;140(6):1479.

11. Barry JM, Lemmers MJ. Patch and flap techniques to repair right renal vein defects caused by cadaver liver retrieval for transplantation. J Urol 1995;153(6):1803.

12. Barry JM, Fischer SM, Craig DH, Fuchs EF, Farnsworth MA. Effect of donor surgeon on first cadaver kidney transplant function. J Urol 1982;127(2):227-229.

13. Lieberman SF, Keller FS, Barry JM, Rosch J. Percutaneous antegrade transluminal ureteroplasty for renal allograft ureteral stenosis. J Urol 1982;128(1):122-124.

14. Barry JM. Spermatic cord preservation in kidney transplantation. J Urol 1982;127(6):1076-1077.

15. Barry JM, Fischer S, Lieberman C, Fuchs EF. Successful human kidney preservation by intracellular electrolyte flush followed by cold storage for more than 48 hours. J Urol 1983;129(3):473-474.

16. Barry JM. Unstented extravesical ureteroneocystostomy in kidney transplantation. J Urol 1983;129(5):918-919.

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© The Canadian Journal of Urology™; 16(5); October 2009

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