愷他命相關潰瘍性膀胱炎與手術治療-國泰綜合醫院八年經驗與回顧
洪巨軒、林志明
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.
Conclusion: 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