國泰綜合醫院 外科部 泌尿外科
Surgical treatment of ketamine-associated ulcerative cystitis:
8-year experience at Cathay General Hospital and review of series
Chu-Hsuan Hung, Chih-Ming Lin
Division of Urology, Department of Surgery, Cathay General Hospital
Purpose: To review clinical outcomes of bladder augmentation with ileocystoplasty for ketamine-associated ulcerative cystitis secondary to long-term ketamine abuse.
Materials and Methods: We performed bladder augmentation with ileocystoplasty for 8 patients with refractory symptoms of ketamine cystitis (severe bladder pain, micturition pain, urgency, frequency, and/or urinary tract damage such as hydronephrosis, and contracted bladder). Every patient had been treated conservatively with medication at OPD or referred from other hospital. Intravenous pyelography and/or cystoscopy were obtained before they had received surgical intervention. Their history of ketamine consumption, symptoms, history of treatment, surgical information and post-operative condition was obtained from medical records and then summarized.
Results: Between 2007 and 2015, eight patients (seven males and one female), aged 26-48 years (mean 32.7 years) underwent this procedure as indicated. The duration of ketamine abuse ranged from 2-15 years (mean 6.8 years). Contracted bladder was noted in all patients, hydronephrosis in 2 and hydroureter in 1 under intravenous pyelography examination. Post-operative hospitalization ranged from 12-47 days (mean 22.4 days). One patient had ileus post colono-enteric bypass post-operative within 90 days. One had impaired renal function before surgery and received intermittent hemodialysis 5 years after surgery. Most of patients followed up at OPD within 1 year and loss follow-up after. All patients reported marked improvement in micturition pain and urinary frequency, which greatly enhance their quality of life.
This study demonstrated that bladder augmentation is effective in relieving refractory symptoms of ketamine-associated ulcerative cystitis. Cessation of ketamine is the most important way to prevent recurrence of above symptoms. This is not only a medical issue, but timely intervention of social workers and psychological support are also essential