濫用卡門所導致之膀胱疼痛症候群及
續發性膀胱攣縮合併雙側膀胱輸尿管逆流性腎水腫
黃建勳1、2、邱文祥1
1台北市立聯合醫院忠孝院區 外科部 泌尿科
1國立陽明大學醫學系 泌尿科
2台北醫學大學 醫學科學研究所
Painful bladder syndrome with secondary urinary bladder contracture and bilateral vesicoureteral reflux with hydronephroureters
Associated with ketamine abuse
Ken-J Chien-Hsun Huang1,2, Allen W. Chiu1
Division of Urology, Department of Surgery, Taipei City Hospital, Zhongxiao branch, Taiwan1
Department of Urology, School of Medicine, National Yang-Ming University1
Graduate Institute of Medical Sciences, Taipei Medical University2
Introduction: Ketamine is a drug used in human for general anesthesia in pediatric and trauma situations. It is classified as a non-competitive N-methyl-D-aspartate (NMDA) receptor antagonist and induced the dissociative anesthesia as a recreational drug. In Taiwan, it has been abused and increases the cases number for several years. The ketamine abusers often visited emergency for their urinary tract problems or lower abdominal pain. Herein, we reported a young man who presented the painful bladder syndrome with secondary urinary bladder contracture and bilateral hydronephroureters caused by grade V vesicoureteral reflux and he is a ketamine abuser off & on for more than 1 year.
Case report:
A 27-year-old young man presented to the emergency department with the lower urinary tract syndrome and gross hematuria. No hydronephrosis was found by the intravenous pyelography. The urine analysis revealed proteinuria (protein: 2+), microscopic hematuria (red blood cell: >100/hpf) and pyuria (white blood cell: >100/hpf). Laboratory data showed normal renal function and mild leukocytosis (white blood cell: 9.57 x 103/µL). Thus, he was admitted to our urology ward for further survey. After history taking, he admitted that the recreational drug ketamine was taken in white powder form, smoking or snorted once per day for more than 1 year. Intravenous pyelography showed small volume of urinary bladder with contracture appearance and bilateral hydronephrosis and hydroureters. Cystoscopy presented severe erythematous bladder mucosa without superficial ulceration. Intraoperative voiding cystourethrograms were done and showed grade V bilateral vesicoureteral reflux. Moreover, bilateral diagnostic ureteroscopys displayed no stenosis in the both vesicoureteral junctions and severe type of hydronephrosis; therefore, cystoscopic hydrodilation was also performed. He was discharged 1 week following the operation favorably.