Change of Pelvic Floor Tonicity in Ketamine-induced Cystitis
Yi-Hsuan Wu1,2,3, Mei-Yu Jang3, Kuang-Shun Cheuh4, Jian-He Lu1,6, Shu-Mien Chuang1,6, Yung-Chin Lee1,3, Paul Ming-Chen Shih,5 Yung-Shun, Juan1,2,4,6
1Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; 2Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; 3Department of Urology, Kaohsiung Municipal Hsia-Kang Hospital, Kaohsiung, Taiwan; 4Department of Urology, Kaohsiung Municipal Da-Tung Hospital, Kaohsiung, Taiwan; 5Department of Medical Imaging, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; 6 Department of Urology, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
Purpose We aimed to investigate the tonicity of the pelvic musculature in ketamine-induced cystitis (KIC) by using magnetic resonance imaging (MRI).
Method MRI examinations were performed in 14 female patients diagnosed as having KIC between 2015 and 2016. We also recruited age-matched controls who had undergone pelvic MRI. Patients with previous pelvic trauma or surgery were excluded. We retrospectively reviewed baseline characteristics, including chronic pelvic pain and comorbidities. Two experienced radiologists, blinded to the clinical presentation, measured the pelvic musculature parameters of MRI, including the H line, M line, pubococcygeal line, urethral distance to pubococcygeal line, width and length of the puborectalis muscle, posterior puborectalis angle and urethral area.
Results Both groups showed similar baseline characteristics. However, more patients with KIC displayed chronic pelvic pain and psychiatric problems than the control group. Regarding pelvic floor musculature parameters on MRI, the M line and pubococcygeal line were noticeably reduced in the KIC group compared with the control group (P＜0.01). The H line showed a decreasing tendency without statistical significance in the KIC group. Moreover, urethral area increased in the KIC group compared with the control group (P＜0.05). No significant differences were observed in puborectalis width, puborectalis length and posterior puborectalis angle between the two groups.
Conclusions According to the present study, MRI suggested hypertonicity of the pelvic musculature in patients with KIC. For those with severe pelvic pain and lower urinary tract symptoms of KIC, therapies aimed at pelvic floor relaxation might be helpful. Clinical applications of these MRI findings are worth further investigations.