1台北市立聯合醫院忠孝院區 外科部 泌尿科
Painful bladder syndrome with secondary bilateral hydronephroureters associated with ketamine abuse
Ken-J Chien-Hsun Huang1,2, Allen W. Chiu1
Division of Urology, Department of Surgery, Taipei City Hospital, Zhongxiao branch, Taiwan1
Department of Urology, School of Medicine, National Yang-Ming University1
Graduate Institute of Medical Sciences, Taipei Medical University2
Introduction: Ketamine is a drug used in human for general anesthesia in pediatric and trauma situations. It is classified as a non-competitive N-methyl-D-aspartate (NMDA) receptor antagonist and induced the dissociative anesthesia as a recreational drug. In Taiwan, it has been abused and increases the cases number in recent years. The ketamine abusers often visited emergency or outpatient department for their lower abdominal pain or urinary tract problems. Herein, we reported a young man who presented the painful bladder syndrome (PBS) with secondary bilateral hydronephroureters within 5+ months latterly and he is a ketamine abuser off & on for more than 5 years.
A young man presented to the outpatient department with the PBS without renal colic initially at his age of 22 y/o. No hydronephrosis was found by the renal sonography. After history taking, he admitted that the recreational drug ketamine was taken in white powder form, smoking or snorted once per day for more than 2 years at that time. He also had been received the emergent operation of splenectomy and left partial nephrectomy due to traumatic injury at his 20 y/o. Intravenous pyelography (IVP) showed no hydronephrosis of bilateral kidneys with decreased upper contour and function of left kidney and normal contour and function of right kidney. Cystoscopy presented erythematous bladder mucosa without superficial ulceration. 1st hydrodilation was also performed. He was discharged 1 week following the operation favorably. 22 months later, he suffered from the PBS again due to keep taken ketamine abuse. Cystometrogram reported detrusor overactivity and severe decreased the maximal bladder capacity to 44 ml. IVP also showed the same pictures as previous study. He was admitted to receive the 2nd cystoscopy hydrodilation at his 24 y/o. Moreover, he had been received the 3rd cystoscopy hydrodilation 14 months latterly and no hydronephrosis was found by IVP. Due to keep taken ketamine abuse, bilateral hydronephrosis were noted by the CT-urography and he was admitted to receive the 4th cystoscopy hydrodilation 7 months latterly at his 26 y/o. Fortunately, after he quitted ketamine abuse for 6+months, the PBS disappeared and the renal sonography showed no more bilateral hydronephrosis at his 27 y/o.