愷他命膀胱炎與間質性膀胱炎/膀胱疼痛綜合症（IC/ BPS）共病比較
吳惠卿1,2、李明輝1,2、陳韋志1
1行政院衛生署豐原醫院 泌尿科，2中台科技大學
The prevalence of non-bladder comorbidity between patients with
Interstitial Cystitis / Bladder Pain Syndrome (IC/BPS) and
ketamine induced uropathy (KIU)
Huei-Ching Wu1,2, Ming-Huei Lee1,2 , Wei-Chih Chen1
1 Department of Urology, Fong Yuan Hospital, Ministry of Health and welfare, Taiwan,
2Central Taiwan University of Science and Technology
Purpose: Recreational ketamine abuse cause lower urinary tract symptoms including dysuria, urinary frequency, urgency, urge incontinence and hematuria. Several reports showed denuded epithelial inflammation of the bladder and petechial hemorrhage. As with similarly presenting interstitial cystitis, several studies investigated the pathophysiology as purinergic neurotransmission of ketamine induced uropathy. A recent study found that patients with IC/BPS often have other non-bladder conditions such as irritable bowel syndrome (IBS), fibromyalgia (FM), migraine headaches, and depression. The aim of this study is to investigate subjective symptom score, voiding diary parameters he findings of cystoscopic hydrodistension and presence of non-bladder condition compared with IC/BPS patients.
Materials and Methods: This was a retrospective study. Of 24 patients who were admitted due to severe lower urinary tract symptoms with recreational ketamine abuse history more than one year and 173 female patients who were compatible with AUA/SUFU criteria including unpleasant sensation (pain, pressure, discomfort) perceived to be related to bladder with duration >6 weeks were included as control group. All of patients with ketamine induced uropathy and IC/BPS patients were assessed by cystoscopic hydrodistension and all of them have different severity of glomerulations. These patients completed measures of pain severity (Visual Analog Scale) and bladder symptom severity (IC Symptom Index, IC Problem Index, The Pelvic Pain and Urinary/Frequency scale). Three day voiding diary was also collected and all patients completed non-bladder condition as medical history questionnaire including migraine, FM, IBS, and depression. These data were analyzed using point bi-serial correlation for association (ANOVA) and post-hoc analysis.
Results: The ketamine induced uropathy patients with a mean age of 26.58 ± 4.4 years were statistically significant younger than IC/PBS patients with a mean age of 44.26 ± 12.5 years (p<0.001). Patients with ketamine induced uropathy had more severe pain score (p=0.01) and PUF score (p=0.005) than IC/BPS patients. KIU have significant decrease of night-time volume (p=0.02) as well as increased day-time and night-time frequency. Moreover, KIU have significant decrease of anesthetic bladder capacity during cystoscopic hydrodistension than IC/BPS patients (p<0.001). However, there were no differences in non-bladder condition between KIU and IC/BPS patients (Table 1). After adjusted age between IC/BPS and KIU group, there were still no differences in non-bladder condition (Table 2).
Conclusions: Subjective symptom scores, three day voiding diary parameters, and anesthetic bladder capacity in patients with KIC seem more severe compare to those with IC/BPS. Compare to age matched IC/BPS, there were no differences in non-bladder condition between KIU and IC/BPS patients.