膀胱內灌注玻尿酸改善Ｋ他命膀胱炎患者下泌尿道症狀之初步結果
蒙恩、吳勝堂、曹智惟、唐守宏、查岱龍、于大雄、孫光煥、張聖原
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.
Purpose:
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.
Results:
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.
Conclusion:
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.