國防醫學院 三軍總醫院 外科部 泌尿外科1
Intravesical hyaluronic acid treatment may improve lower urinary tract symptoms caused by ketamine-associated cystitis: preliminary result
En Meng, Sheng-Tang Wu, Chih-Wei Tsao, Shou-Hung Tang, Tai-Lung Cha, Guang-Huan Sun, Dah-Shyong Yu, and Sun-Yran Chang
Division of Urology, Department of Surgery1, Department of Pathology2, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, R.O.C.
Long term ketamine abuse may cause variable lower urinary tract symptoms (LUTS) and severe cystitis. The clinical features of ketamine associated cystitis (KC) are very similar to bladder pain syndrome/interstitial cystitis (BPS/IC). Intravesical administration of hyaluronic acid (HA) is one of the regimens for treating BPS/IC. In this study, we aim to investigate whet her intravesical HA therapy may improve the LUTS of patients with KC.
Materials and Methods:
4 female and 1 male patients with KC who failed oral medications were enrolled in this study. Hyaluronic acid (Cystistat®) at a dose of 40 mg in a volume of 50 ml of phosphate-buffered saline was injected into the bladder on a weekly basis for 6 weeks and then monthly for a further 3 months. Response to therapy was evaluated by Visual Analogue Scale for pain (VAS), International Prostate Symptom Score (IPSS), Overactive Bladder Symptom Score (OABSS), O'leary-Sant Interstitial Cystitis Symptom Index (ICSI) and Problem Index (ICPI). Treatment efficacy was assessed by comparing the pre- and post-treatment mean scores of the five questionnaires using paired t test.
The mean age of the patients was 22.4. The mean duration of ketamine abuse was 57 ± 20 months. After intravesical HA therapy for 4 weeks, statistically significant mean decreases in VAS (from 7 to 4.4, p= 0.03), IPSS voiding subscore (from 16.2 to 11.6, p= 0.017) and ICSI (from 16.4 to 13.6; p = 0.016) questionnaire scores were seen. However, only ICSI constantly reduced after 4 weeks of treatment.
Intravesical HA therapy may have sort-term benefit for improving bladder pain and voiding symptoms in patients with KC. Intravesical instillation of HA on a monthly basis may not be as effective as on a weekly basis.