K他命膀胱炎患者行腸道膀胱擴大整形術之臨床結果
李宇坤、郭漢崇
花蓮慈濟醫院 泌尿部
CLINICAL OUTCOME OF AUGMENTATION ENTEROCYSTOPLASTY FOR PATIENTS WITH KETAMINE-INDUCED CYSTITIS
Yu Khun Lee, Hann-Chorng Kuo
Department of Urology, Hualien Tzu Chi Hospital, Huelien, Taiwan
Purpose: To analyze the clinical outcome of patients with KC managed with augmentation enterocystoplasty (AE).
Materials and Methods: We retrospectively collected and analyzed the medical records and video-urodynamic (VUD) test results of 26 patients who underwent AE as treatment for refractory KC during the period 2009-2014. Data from VUD studies performed before AE and 3–6 months after surgery that were analyzed in this study included cystometric bladder capacity (CBC), post-void residual (PVR) urine volume, maximum urinary flow rate (Qmax), voided volume and bladder compliance. A self-report questionnaire was used to assess patient satisfaction with AE.
Results: Patients included 14 women and 12 men aged 20-43 years (mean age, 28.5 years) with an average duration of ketamine abuse of 4.7 years (range, 1-7 years). All patients had contracted bladder, 9 had hydronephrosis and 10 had vesicoureteral reflux (VUR). There was significant improvement in CBC (52.7±29.7 v 327±69.4 mL, P< 0.0001), Qmax (6.94±4.32 v 13.7±4.96 mL/s, P<0.0001), PVR (8.08±19.2 v 82.6±91.5 mL, P<0.0001), voided volume (44.1±28.3 v 250.7±133.4 mL, P<0.0001) and bladder compliance (11.1±11.9 v 54±43, P<0.0001) after AE. Hydronephrosis resolved in 7 patients after AE and VUR resolved in all patients who underwent AE with ureteral reimplantation. Perioperative complications included postoperative intestinal obstruction in one patient, short-term urine leakage in one patient and dysuria due to narrowing requiring transurethral incision of the enterovesical anastomosis in two patients. There were no cases of urosepsis and no deaths in this series. All patients who stopped using ketamine were free of bladder pain postoperatively. However, 10 patients who reused ketamine had recurrent bladder pain and recurrent urinary tract infection.
Conclusions: AE is effective at treating KC-induced bladder pain and restoring normal lower urinary tract function. However, absolute cessation of ketamine is the key to success in KC treatment.