Bio

Clinical Focus


  • Urology
  • Neuro Urology and Spinal Cord injury
  • Gastroenterology

Academic Appointments


Administrative Appointments


  • Professor Orth.(Courtsey PM&R), Stanford University (1999 - 2010)
  • PVA Professor Spinal Injury Med, Stanford (1981 - 2009)
  • Professor Urology, Stanford University (1991 - 2010)

Honors & Awards


  • Society Medal-The Annual award, International Spinal Cord Society-Annual Meeting Delhi,India (November 1st, 2010)
  • Presidential Roll of Honor, Republican congress and President (2006)
  • Congressional Gold Medal, US Republican congress (2004)
  • Distinguished Physician, Amer. Acad. PM&R (1996)
  • Physician of the year, State of California (1988)

Professional Education


  • Fellowship:Stanford University School of Medicine (1965) CA
  • Board Certification: Physical Medicine and Rehab, American Board of Physical Medicine and Rehab (1977)
  • Internship:Royal College of Surgeons (1961)
  • Residency:Baylor College of Medicine (1973) TX
  • Residency:Hammersmith Hospital (1963) England
  • Medical Education:King Georges Medical College (1957) India
  • Diplomat, American Boards Disab, Disabilty evaluation (2005)
  • MS, Lucknow University, General Surgery (1960)
  • FACS (urology), American College of Surgeons, Urology (1968)
  • FRCS(Eng), College of Surgeons'of England, General Surgery (1961)

Community and International Work


  • Globilization Patient Data Set, Switzerland

    Topic

    Patient Care Data Set

    Partnering Organization(s)

    WHO

    Populations Served

    35 nations

    Location

    International

    Ongoing Project

    Yes

    Opportunities for Student Involvement

    No

Research & Scholarship

Current Research and Scholarly Interests


One of the major areas of interest in our lab has been research related to neurogenic bladder due to neurologic disorders. We have evaluated drugs to improve bladder function, worked on other modalities such as magnetic stimulator and surgical use of lasers to correct voiding disorders. We have developed the role of linear array sonography for the optimal evaluation of bladder neuromuscular disorders. Other focused areas in our lab include studies on hypercoagulation, electroejaculation and bone mineral density.

Teaching

Graduate and Fellowship Programs


Publications

Journal Articles


  • POSTERIOR LEDGE AT THE BLADDER NECK - CRUCIAL DIAGNOSTIC ROLE OF ULTRASONOGRAPHY UROLOGIC RADIOLOGY Perkash, I., Friedland, G. W. 1986; 8 (4): 175-183

    Abstract

    A posterior ledge at the bladder neck was seen in 158 patients (107 of whom were undergoing intermittent catheterization) on a sonographic voiding cystourethrogram. In 117 patients, the ledge was 0.5 cm or longer; 66 patients were on intermittent catheterization, and 51 experienced difficulty with catheterization, including vigorous bleeding in 4. Ledges less than 0.5 cm were discovered in 41 patients, all on intermittent catheterization, none of whom had difficulty with this procedure. The duration of intermittent catheterization and of detrusor-sphincter dyssynergia was shown statistically to be an important factor leading to the formation of the longer obstructing ledges (P less than 0.0005, Mann-Whitney test). Sphincterotomies were performed in 74 patients through the periurethral striated sphincter at 10 and 2 o'clock and extended to the bladder neck. The operation was a success in 73 (98%), all of whom were catheter-free, and in all of whom sonography revealed that the ledge had receded and the catheter was no longer obstructed.

    View details for Web of Science ID A1986F295500001

    View details for PubMedID 3541341

  • Transurethral Sphincterotomy JOURNAL OF UROLOGY Perkash, I. 2009; 181 (4): 1539-1540

    View details for Web of Science ID 000264448200007

    View details for PubMedID 19230921

  • Transurethral sphincterotomy provides significant relief in autonomic dysreflexia in spinal cord injured male patients: long-term followup results JOURNAL OF UROLOGY Perkash, I. 2007; 177 (3): 1026-1029

    Abstract

    An evaluation of the results of transurethral sphincterotomy in spinal cord injured patients for the relief of autonomic dysreflexia is presented.The study describes experience with the treatment of 46 consecutive spinal cord injured males presenting with frequent symptoms of autonomic dysreflexia and inadequate voiding. The selection criteria include patients injured above the thoracic 6 level with subjective symptoms of autonomic dysreflexia who did not want to be catheterized or were unable to perform intermittent catheterization. Patients were studied with complex urodynamics before and at least 3 months after undergoing transurethral sphincterotomy. During cystometrogram the maximum increase in systolic and diastolic blood pressure was recorded. After transurethral sphincterotomy patients were followed for a mean of 5.4+/-3.1 years (range 1 to 12).There was subjective relief in autonomic dysreflexia following transurethral sphincterotomy in all patients, which correlated well with a significant decrease in systolic and diastolic blood pressure (p<0.0001). Mean decrease in maximal systolic and diastolic blood pressure after transurethral sphincterotomy was 55+/-25 and 29+/-17 mm Hg, respectively. Mean post-void residual urine decreased significantly from 233+/-151 to 136+/-0.34 ml after transurethral sphincterotomy. However, there was no significant change in mean maximum voiding pressures.Blood pressure monitoring during cystometrogram provides an objective assessment of the presence of autonomic dysreflexia due to neurogenic bladder dysfunction, enabling better therapeutic management to control autonomic dysreflexia. Persistence of significant autonomic dysreflexia needs urodynamic evaluation if other factors for autonomic dysreflexia have been excluded.

    View details for DOI 10.1016/j.juro.2006.10.066

    View details for Web of Science ID 000244211600056

    View details for PubMedID 17296404

  • Donald Munro Lecture 2003. Neurogenic bladder: past, present, and future. journal of spinal cord medicine Perkash, I. 2004; 27 (4): 383-386

    Abstract

    The foundation of the management of neurogenic bladder can be attributed to a pioneer in spinal cord injury medicine. Dr. Donald Munro, a neurosurgeon, who also had experience in urologic surgery, established the first Spinal Cord Injury Service of 10 beds in the Boston City hospital in the 1930s. He later became adviser to the US Army and the Veterans Administration (VA). On his recommendation, paraplegic centers were created in US army hospitals and later in the VA hospitals from 1943 to 1945. This article reviews the evolution of the management of neurogenic bladder in patients with spinal cord injuries from the past century to the present. The role of urodynamics in defining neurologic lesions is critical to the appropriate management of the voiding dysfunction. Key advances, such as the diagnosis of detrusor sphincter dyssynergia (DSD), recognition of its association with autonomic dysreflexia, and its definitive management, have been emphasized. The role of transrectal linear array sonography using a rectal probe was found useful for defining bladder outlet dysfunction during urodynamics. It also helped to recognize secondary bladder neck obstruction and diagnose false passages in the urethra. Clean technique intermittent catheterization (IC) was evaluated and recommended. In about 28% patients with DSD that led to secondary bladder neck obstruction, a consequence of IC was reported. Transurethral laser sphincterotomy (TURS) was first reported by me in 1991, and later, durable 7-year follow-up results were reported in 78% of the first 99 patients. We reported a surgical technique to lengthen the penis. We also reported the long-term success with semirigid implants in 92% of patients with SCI. This technique helped maintain external condom drainage on a small phallus and improved the sex life of patients, as well as their quality of life. The author's pertinent areas of interest in the past one-half century were aimed at recognizing specific urologic problems associated with neurologic impairment. Management was aimed at preventive care, early recognition, and timely management to reduce secondary complications and enhance quality of life.

    View details for PubMedID 15484669

  • Displacement sequence and elastic properties of anterior prostate/urethral interface during micturition of spinal cord injured men ULTRASOUND IN MEDICINE AND BIOLOGY Constantinou, C. E., Damaser, M. S., Perkash, I. 2002; 28 (9): 1157-1163

    Abstract

    The management of complex micturition problems frequently encountered in patients with spinal cord injury (SCI) may be facilitated by characterization of the elastic properties of the prostate. To this end, we have developed a method of evaluating changes in prostate biomechanics using ultrasound (US) images obtained during routine diagnostic urodynamic evaluations. Ultrasound video sequences of the prostate and urethra during voiding were digitized simultaneously with bladder pressure measurement on 76 patients with spinal cord injury, having a mean age of 47 +/- 16 years. Computer enhancement of the bladder/prostate/urethral interface from sequences of 2-D US images facilitated measurement of midprostatic urethral displacement during micturition. Of 76 patients, 21 were able to initiate voiding. Maximum urethral diameter was 12.0 +/- 1.3 mm, with corresponding maximum voiding pressure of 61.6 +/- 1.9 cmH(2)O. Urethral/prostatic pressure strain elastic modulus (Ep) was 960 +/- 624 N/m(2) and stiffness (beta) calculated as the inverse of compliance was 2.8 +/- 0.1. The diameter of the urethra at P(det50+), during the opening phase, was 0.4 +/- 0.1 mm and, during the closing phase, was 0.7 +/- 0.1 mm. During voiding, the anterior prostate was displaced to a greater extent than the posterior prostate. These observations suggest that distension of the prostate/urethra during micturition is hysteretic and nonuniform and indicates regional differences in compliance within the prostate/urethra interface. These regional differences lend support to the concept that the posterior prostate is implicated in the active process of micturition involving the fibromuscular stroma. Clinical application of this method could include quantification of the biomechanics of micturition consequent to spinal injury, prostatic enlargement, and the impact of targeted evaluation of pharmacological interventions.

    View details for Web of Science ID 000178732200009

    View details for PubMedID 12401386

  • Electrocardiographic findings in patients with chronic spinal cord injury AMERICAN JOURNAL OF PHYSICAL MEDICINE & REHABILITATION PRAKASH, M., Raxwal, V., Froelicher, V. F., Kalisetti, D., Vieira, A., O'Mara, G., Marcus, R., Myers, J., Kiratli, J., Perkash, I. 2002; 81 (8): 601-608

    Abstract

    To demonstrate the prevalence and prognostic value of electrocardiographic abnormalities in patients with chronic spinal cord injury.All electrocardiographs obtained in the Palo Alto Veterans Affairs Medical Center since 1987 have been digitally recorded and stored in a computerized database. For this study, only the first electrocardiograph was considered for analysis. The subjects were divided according to age and level of spinal cord injury. The Social Security Death Index was used to ascertain vital status as of December 1999.Annual mortality was similar in those with chronic spinal cord injury and the able-bodied. However, individuals with a higher level of injury had a significantly higher death rate than those with a lower level of injury. The prognostic characteristics of electrocardiographic abnormalities were similar in both the able-bodied and those with spinal cord injury.In general, electrocardiographic abnormalities had the same prevalence in the spinal cord injury subjects as in the able-bodied ones. The prognostic value of electrocardiographic abnormalities in subjects with spinal cord injury is similar to that observed in able-bodied subjects.

    View details for Web of Science ID 000177047900008

    View details for PubMedID 12172070

  • Early repolarization in patients with spinal cord injury: prevalence and clinical significance. journal of spinal cord medicine Marcus, R. R., Kalisetti, D., Raxwal, V., Kiratli, B. J., Myers, J., Perkash, I., Froelicher, V. F. 2002; 25 (1): 33-38

    Abstract

    The objective was to examine the prevalence of early repolarization in a spinal cord injury (SCI) clinic and the relationship of level of injury to this electrocardiogram (ECG) finding.ST elevation on the resting ECG can be either a normal variant or a sign of acute ischemia, evolving myocardial infarction, or pericarditis. It is frequently seen as a normal variant (early repolarization) in healthy individuals, but has also been reported in individuals with SCI. While the etiology of benign ST elevation (early repolarization) has not been clearly defined, current opinion is that this finding is seen in individuals with high vagal tone.Retrospective analysis was made of 31 5 individuals with SCI at T5 or above (140 with complete injuries), and 1 98 with SCI at T6 or below, and who had ECGs in the computerized database at the Palo Alto VA Medical Center. A comparison cohort of 32,841 able-bodied male controls also was identified in the same ECG database. Patient demographics and computerized ST measurements were analyzed.The prevalence of ST elevation was significantly higher in both the total high-level injury group (19%) and the complete high-injury group (24.5%) than in either the low-injury (6.5%) or control groups (13%), with P < 0.001 for comparisons between both high- and low-injury groups and high injury vs control. The magnitude of ST elevation was also higher in the high-injury groups vs the low-injury and control groups.There is a higher prevalence of early repolarization in individuals with SCI at levels of injury that can disrupt central sympathetic command of the heart. It appears that either enhanced vagal tone or loss of sympathetic tone is responsible for ST elevation.

    View details for PubMedID 11939464

  • Occult maxillary sinusitis as a cause of fever in tetraplegia: 2 case reports ARCHIVES OF PHYSICAL MEDICINE AND REHABILITATION Lew, H. L., Han, J., Robinson, L. R., Britell, C., Perkash, I. 2002; 83 (3): 430-432

    Abstract

    Common causes of fever in tetraplegia include urinary tract infection, respiratory complications, bacteremia, impaired autoregulation, deep vein thrombosis, osteomyelitis, drug fever, and intra-abdominal abscess. We report 2 acute tetraplegic patients who presented with fever of unknown origin. After extensive work-up, they were diagnosed with occult maxillary sinusitis. A search of current literature revealed no reports of sinusitis as a potential source of fever in recently spinal cord--injured patients. Patients with tetraplegia, especially in the acute phase of spinal cord injury, often undergo nasotracheal intubation or nasogastric tube placement, which may result in mucosal irritation and nasal congestion. All of the previously mentioned factors, in combination with poor sinus drainage related to supine position, predispose them to developing maxillary sinusitis. The 2 consecutive cases show the importance of occult sinusitis in the differential diagnosis of fever in patients with tetraplegia.

    View details for DOI 10.1053/apmr.2002.29627

    View details for Web of Science ID 000174277900022

    View details for PubMedID 11887128

  • Bone mineral and geometric changes through the femur with immobilization due to spinal cord injury JOURNAL OF REHABILITATION RESEARCH AND DEVELOPMENT Kiratli, B. J., Smith, A. E., Nauenberg, T., Kallfelz, C. F., Perkash, I. 2000; 37 (2): 225-233

    Abstract

    This cross-sectional study describes bone mineral and geometric properties of the midshaft and distal femur in a control population and examines effects of immobilization due to spinal cord injury (SCI) at these skeletal sites. The subject populations were comprised of 118 ambulatory adults (59 men and 59 women) and 246 individuals with SCI (239 men and 7 women); 30 of these were considered to have acute injury (SCI duration <1 year). Bone mineral density (BMD) was assessed at the femoral neck, and midshaft and distal femur by dual energy absorptiometry. Geometric properties, specifically cortical area, polar moment of inertia, and polar section modulus, were estimated at the midshaft from cortical dimensions obtained by concurrent radiography. Reduction in BMD was noted in all femoral regions (27%, 25%, and 43% for femoral neck, midshaft, and distal femur, respectively) compared with controls. In contrast, although endosteal diameter was enlarged, geometric properties were not significantly reduced in the midshaft attributable to the age-related increase in periosteal diameter. These results suggest that simultaneous assessment of bone mineral and geometric properties may improve clinically relevant evaluation of skeletal status.

    View details for Web of Science ID 000165733400016

    View details for PubMedID 10850829

  • Use of contact laser crystal tip firing Nd : YAG to relieve urinary outflow obstruction in male neurogenic bladder patients JOURNAL OF CLINICAL LASER MEDICINE & SURGERY Perkash, I. 1998; 16 (1): 33-38

    Abstract

    Endoscopic urologic procedures for transurethral prostatectomy (TURP), external sphincterotomy (TURS), bladder neck incision, and incising strictures using diathermy have resulted in excessive bleeding and risk of hyponatremia. This presentation is a review of a methodology developed to evaluate the use of contact laser crystal firing Nd:YAG laser. Details of the technique are presented.A review of 129 patients following laser TURS with 34% of these patients also needing TURP and 29% of patients also requiring TUIP has been done. Following contact laser endoscopic surgery, the catheter was removed in 24 hours. There was minimal to nil haemorrhage perioperatively and secondary haemorrhage was absent.The technique employing contact laser crystal provides an easy TURP, TURS, and stricture ablation. Follow up indicates durable results.

    View details for Web of Science ID 000076079000007

    View details for PubMedID 9728128

  • Limb salvage surgery in spinal cord injury patients ANNALS OF VASCULAR SURGERY Dalman, R. L., Harris, E. J., Walker, M. T., Perkash, I. 1998; 12 (1): 60-64

    Abstract

    Advances in the care and rehabilitation of patients with spinal cord injuries (SCI) have resulted in extended survival following injury. Increasingly, we are faced with difficult chronic lower extremity ischemic complications in SCI patients. Recognizing limitations associated with amputation in these nonambulatory patients, we report the preliminary results of a program of selective limb salvage via arterial reconstructive surgery. Retrospective chart review was performed on the records of the Veterans Affairs Palo Alto Health Care System SCI unit. Since 1989, 15 revascularization procedures were identified in 10 SCI patients. All patients suffered from ischemic ulceration and/or gangrene. Procedures performed included femorotibial bypass (8), aortofemoral bypass (4), femoro-femoral bypass (2), and axillobifemoral bypass (AXF) (1). All patients were men. The mean age was 56 (range 43-73). Follow-up was available on 10 procedures performed in seven patients since 1992. Mean follow-up was 17 months. One patient died 3 months following distal bypass. The AXF occluded within 1 month. One distal bypass occluded in the immediate postoperative period and could not be salvaged. All other grafts remain patent, and all wounds have healed following successful bypass. One patient developed pressure ulceration following AXF grafting due to postoperative upper extremity limitations. No other complications were encountered. Standard arterial reconstructive procedures can be performed safely and successfully in SCI patients, despite diminished limb blood flow due to inactivity, and atrophic arteries, muscle, and fascia. Axillobifemoral bypass grafting may not be suitable in SCI due to requirements for upper extremity-based mobility. Confirmation of benefit of limb salvage versus amputation awaits comparison between patients eligible for either procedure.

    View details for Web of Science ID 000071300900010

    View details for PubMedID 9451998

  • Detrusor-sphincter dyssynergia and vesico urethral reflux: management SPINAL CORD Perkash, I., Linsenmeyer, T. A., Bodner, D. R., Anderson, R. U. 1998; 36 (1): 2-5

    View details for Web of Science ID 000071539600002

    View details for PubMedID 9471129

  • Efficacy and safety of terazosin to improve voiding in spinal cord injury patients. journal of spinal cord medicine Perkash, I. 1995; 18 (4): 236-239

    Abstract

    A total of 28 male spinal cord injury (SCI) patients were enrolled in an open label study to evaluate the efficacy and safety of terazosin to improve voiding. All patients were started on 1 mg daily dose at bedtime. The dosage was gradually increased to 1-2 mg twice daily, depending upon patient tolerance and a minimum acceptable systolic blood pressure of 90 mm Hg. Urodynamic evaluation was done in 24 patients prior to and one week after a maximum tolerated dose was established for at least 48 hours. The maximum dose varied from 1 to 5 mg daily. Subjective improvement in voiding was noticed in 50 percent of patients. Objective assessment with urodynamics showed a mean drop in maximum voiding pressure of 35 cm H2O (range 9-65 cm H2O) in only 42 percent of patients. Subjective improvement in voiding occurred in 14 of 17 patients with absent detrusor sphincter dyssynergia. The drug was discontinued in three patients with side effects of syncope in one patient, lethargy in another and body rash in the third. Because the tolerance dose of terazosin is variable and the therapeutic response is unpredictable, urodynamic monitoring is recommended to accomplish a useful outcome.

    View details for PubMedID 8591069

  • REGISTRATION ERROR QUANTIFICATION OF A SURFACE-BASED MULTIMODALITY IMAGE FUSION SYSTEM MEDICAL PHYSICS Hemler, P. F., Napel, S., Sumanaweera, T. S., PICHUMANI, R., VANDENELSEN, P. A., Martin, D., Drace, J., Adler, J. R., Perkash, I. 1995; 22 (7): 1049-1056

    Abstract

    This paper presents a new reference data set and associated quantification methodology to assess the accuracy of registration of computerized tomography (CT) and magnetic-resonance (MR) images. Also described is a new semiautomatic surface-based system for registering and visualizing CT and MR images. The registration error of the system was determined using a reference data set that was obtained from a cadaver in which rigid fiducial tubes were inserted prior to imaging. Registration error was measured as the distance between an analytic expression for each fiducial tube in one image set and transformed samples of the corresponding tube obtained from the other. Registration was accomplished by first identifying surfaces of similar anatomic structures in each image set. A transformation that best registered these structures was determined using a nonlinear optimization procedure. Even though the root-mean-square (rms) distance at the registered surfaces was similar to that reported by other groups, it was found that rms distances for the tubes were significantly larger than the final rms distances between the registered surfaces. It was also found that minimizing rms distance at the surface did not minimize rms distance for the tubes.

    View details for Web of Science ID A1995RK26900003

    View details for PubMedID 7565379

  • LASER SPHINCTEROTOMY AND ABLATION OF THE PROSTATE USING A SAPPHIRE CHISEL CONTACT TIP FIRING NEODYMIUM-YAG LASER JOURNAL OF UROLOGY Perkash, I. 1994; 152 (6): 2020-2024

    Abstract

    I report a modified technique for use of a contact laser for urological endoscopic surgery in spinal cord injury patients. Instead of the usual technique of passing the laser probe for surface vaporization, subsurface buttonholes were drilled with subsequent incision of the overlying tissue. As a result, creation of an adequate channel was expedited with excellent hemostasis. A total of 40 spinal cord injury patients (mean age 50.1 years, range 28 to 76) underwent transurethral surgery for bladder outlet obstruction using a sapphire contact laser tip. Of the patients 50% had undergone previous transurethral surgery and were not voiding well. Urodynamic studies demonstrated detrusor-sphincter dyssynergia in 37 patients (92.5%). A voiding cystourethrogram was done in 83% of the patients and showed vesicoureteral reflux in 17%. On cystoscopic examination 32.5% of the patients had an associated enlarged prostate, 32% stricture of the bulbous urethra and 20% bladder neck stenosis. Apart from transurethral sphincterotomy in these patients, ablation of the prostate, stricture and eradication of bladder neck stenosis, as indicated, were also done with the contact laser. Blood loss was approximately 25 to 50 ml. per procedure except for 2 initial patients with a blood loss of 100 to 150 ml. Approximately 3,500 to 8,900 joules accumulated energy were used for transurethral sphincterotomy and 11,000 to 37,000 joules for transurethral resection of the prostate. An indwelling Foley catheter was placed postoperatively for a mean of 3 days (range 1 to 8). All patients were followed for 6 to 23 months (mean 13.1). Four patients failed laser transurethral sphincterotomy: 1 due to inadequate initial incision and 3 who initially underwent laser transurethral incisions of the prostate and had persistent detrusor-sphincter dyssynergia (all had relief following laser transurethral sphincterotomy). All subsequent patients are voiding well with a wide open bladder neck and posterior urethra as shown on a voiding cystourethrogram.

    View details for Web of Science ID A1994PR24500027

    View details for PubMedID 7966667

  • LONG-TERM UROLOGIC MANAGEMENT OF THE PATIENT WITH SPINAL-CORD INJURY UROLOGIC CLINICS OF NORTH AMERICA Perkash, I. 1993; 20 (3): 423-434

    Abstract

    The primary goal of bladder management in the patient with a spinal cord injury is to achieve adequate bladder drainage, low-pressure urine storage, and low-pressure voiding. This will help prevent urinary tract infections, bladder wall damage, bladder overdistention, vesicoureteral reflux, and stone disease. Bladder retraining is indicated in all patients with disorders of the spinal cord and the brain. The basic aim is to provide bladder drainage without indwelling catheters and, if possible, without leg bags. Bladder retraining is usually begun with intermittent catheterization, with the use of alpha blockers to improve drainage in patients who are wearing leg bags or with anticholinergic drugs to improve continence. However, bladder retraining may be contraindicated in patients with vesicoureteral reflux or stone disease and in patients with impending renal failure. It is therefore important to evaluate all patients with neurogenic bladder using urodynamics, nuclear scanning, renal ultrasound, and voiding cystourethrography. In patients with stone disease, intravenous urography may also be required. Understanding of the basic neurologic lesion and bladder dysfunction is therefore vital to bladder retraining or transurethral surgery to provide adequate voiding. The regular periodic follow-up of all patients is vital to protect renal function.

    View details for Web of Science ID A1993LT60500006

    View details for PubMedID 8351768

  • CLEAN INTERMITTENT CATHETERIZATION IN SPINAL-CORD INJURY PATIENTS - A FOLLOW-UP-STUDY JOURNAL OF UROLOGY Perkash, I., Giroux, J. 1993; 149 (5): 1068-1071

    Abstract

    A followup study on nonhospitalized spinal cord injury patients using clean intermittent catheterization was conducted to evaluate long-term clean intermittent catheterization for any genitourinary complications, and to institute and evaluate prompt management. A total of 50 patients (36 paraplegics and 14 quadriplegics) was followed for 3 months to 6.5 years (average followup 22 months). All patients had a baseline urodynamic study and renal scan before they were discharged from the hospital. Patients with a reflex bladder and sustained, high intravesical pressures (greater than 40 cm. water) were placed on anticholinergic medication to lower voiding pressures and maintain continence. Those on clean intermittent catheterization and condom drainage were also given alpha-blockers to achieve low pressure voiding and to control autonomic dysreflexia. Of 50 patients 43 (86%) acquired a total of 364 events of significant bacteriuria (10(4) or more colony-forming units per ml.) at a rate of 13.63 infections per 1,000 patient-days on clean intermittent catheterization. Subclinical symptoms for urinary tract infection were noted in 22 of the 43 patients (51%), whereas clinical symptoms for urinary tract infection were recorded in 16 of 43 (37%). These symptoms included fever in 8 patients, chills in 3, hematuria in 3 and flank pain in 2. There were 31 genitourinary complications in 21 patients noted during periodic diagnostic evaluations, with 6 classified as upper tract. Of 50 patients 4 (8%) required rehospitalization for urological problems. One patient died of questionable sepsis. Transurethral sphincterotomy was performed in 15 of the 50 patients (30%) and transurethral prostatectomy was done in 1 for multiple reasons, for example high intravesical voiding pressures, difficult catheterization, repeated symptomatic urinary tract infections or per patient request to discontinue clean intermittent catheterization. Of 7 patients who were catheterized by others 4 elected to discontinue long-term clean intermittent catheterization after an average of 13 months. Overall, 33 patients (66%) discontinued clean intermittent catheterization and 17 are still being followed on a long-term basis. Clean intermittent catheterization is a successful long-term option to drain bladders in spinal cord injury patients who can perform catheterization independently.

    View details for Web of Science ID A1993LA46400031

    View details for PubMedID 8483212

  • USE OF PENILE PROSTHESES TO MAINTAIN EXTERNAL CONDOM CATHETER DRAINAGE IN SPINAL-CORD INJURY PATIENTS PARAPLEGIA Perkash, I., Kabalin, J. N., Lennon, S., Wolfe, V. 1992; 30 (5): 327-332

    Abstract

    This is a retrospective analysis of 79 spinal cord injury patients who have had penile implants from one to 14 years. The primary indication for implants was the loss of condom catheter with a small retractile penis. Mean period after injury to when the implants were placed was 8.24 years (range 1-21 years). Mean total length of time the implants have been followed was 7.08 years (1-14 years). Sixty patients responded to our detailed questionnaire and they have been subjected to further analysis: prior to the implant 46 patients (77%) frequently lost their condoms. Fourteen of the patients (23%) had indwelling catheters, and 3 (5%) had a suprapubic cystostomy since they could not retain an external condom for urinary drainage because of retraction of a small penis. Post implant, 81% of patients had no accidents involving condom loss, while 19% still lost condoms. All indwelling catheters could be removed except for one patient who continued with a suprapubic catheter following transurethral sphincterotomy (TURS) and a penile implant. Sixty-eight percent used the implant for sex and felt their wives were satisfied. Patient satisfaction survey showed a markedly increased self esteem, increased mobility without fear of condom loss, and an improved sex life. Overall, the long term prosthesis failure rate was 8%. The specific infection complication rate was less than 2%. The Flexirod semirigid, hinged prosthesis proved ideal in meeting the requirements for these patients.

    View details for Web of Science ID A1992JV19100003

    View details for PubMedID 1598171

  • BENIGN VERSUS PATHOLOGICAL COMPRESSION FRACTURES OF VERTEBRAL BODIES - ASSESSMENT WITH CONVENTIONAL SPIN-ECHO, CHEMICAL-SHIFT, AND STIR MR IMAGING RADIOLOGY Baker, L. L., Goodman, S. B., Perkash, I., Lane, B., Enzmann, D. R. 1990; 174 (2): 495-502

    Abstract

    Differentiation of benign from pathologic compression fractures of vertebral bodies was evaluated with magnetic resonance imaging in a prospective study of 53 patients. Twenty-six patients had 34 benign posttraumatic compression fractures. Twenty-seven patients had metastatic disease to the vertebral column and seven pathologic fractures. T1- and T2-weighted spin-echo (SE) sequences (1.5 T) were performed in all patients. A presaturation technique was used to obtain "fat" and "water" images to better assess the degree of normal fatty marrow replacement in fractured vertebrae. Short inversion-time inversion-recovery (STIR) images were also obtained. Discrimination between benign and pathologic compression fractures was generally possible with the SE sequences. Chronic benign fractures demonstrated isointense marrow signal intensity (SI), compared with that of normal vertebrae with all sequences. Pathologic fractures showed low SI on T1-weighted images and high SI on T2-weighted images. Fat images revealed complete replacement of normal fatty marrow, shown as absent SI in the involved vertebral body. Water and STIR images showed diffuse high SI in pathologic fractures, with STIR images having the highest contrast between abnormal and normal marrow. Acute benign compression fractures also demonstrated high SI on T2-weighted, water, and STIR images, but the SI was less pronounced and the pattern was generally more inhomogeneous than that of pathologic compressions. In general, fat images showed only partial replacement of normal fatty marrow by low SI, in contrast to the complete absence of marrow SI typical of pathologic fractures.

    View details for Web of Science ID A1990CK84400040

    View details for PubMedID 2296658

  • ELECTROEJACULATION IN SPINAL-CORD INJURY PATIENTS - SIMPLIFIED NEW EQUIPMENT AND TECHNIQUE JOURNAL OF UROLOGY Perkash, I., Martin, D. E., Warner, H., SPECK, V. 1990; 143 (2): 305-307

    Abstract

    A new simplified electrostimulation system for rectal probe electroejaculation has been developed and tested 17 times in 13 patients. Seminal emissions were obtained easily from 13 of 17 studies and partial emissions were obtained in 4. Patients with cauda equina and conus lesions with partial intact sensorium also could achieve successful ejaculation by longer stimulation from 2 to 5 minutes with lower currents that could be maintained easily and were tolerated by the patient--a feature unique to our new computerized equipment. The simplicity of operation reduces the number of trained personnel for an electrostimulation procedure, which can be done even in an outpatient setting.

    View details for Web of Science ID A1990CL50400021

    View details for PubMedID 2299721

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