K他命間質性膀胱炎合併雙側腎盂水腫:

回溯性及病例系列研究

曲元正、許毓昭、陳煜、謝明里、黃世聰、黃信介、張博誌、李威昌

林口長庚紀念醫院外科部 泌尿科系

Bilateral hydronephrosis in ketamine-induced ulcerative cystitis:

Retrospective review and case series

Yuan-Cheng Chu, Yu-Chao Hsu, Yu Chen, Ming-Li Hsieh, Shih-Tsung Huang, Hsin-Chieh Huang, Po-Chih Chang, Wei-Chang Lee

Division of Urology, Department of Surgery, Chang Gung Memorial Hospital, Linkou medical center, Taoyuan, Taiwan

Purpose:

    The cases of Ketamine-induced ulcerative cystitis ware increasing in recent years. Bilateral hydronephrosis was noted in some of these patients. The mechanism of hydronephrosis remained unknown. Obstructive uropathy was first considered, but in some cases, the hydronephrosis could not be relieved after intra-ureter stent insertion. Therefore, we review the charts to clarify the epidemiology and possible mechanism of hydronephrosis as well as hydroureter. 

Materials and Methods:

    Retrospective review the images of ketamine abusers from 2007 Jan. to 2016 Dec. in Chang Gung Memorial hospital Linkou. All images were reviewed by single urologist. The severity of hydronephrosis was classified by “Classification of hydronephrosis in grade I–IV” (Beetz and others, 2001).

Results:

There are total 153 patients was diagnosed interstitial cystitis in this period. 134 patients were confirmed to be ketamine abusers. The mean age of these patients was 27.7 years-old. There are 39 female patients (29.1%) and 95 male patients (70.9%). There are 107 patients (79.9%) performed computed tomography scan (CT) or intravenous pyelography (IVP). Hydronephrosis or hydroureter was noted in 27 patients (20.1%).

In these 27 patients, 17 patients (63%) was diagnosed hydronephrosis and hydroureter, 8 patients (29.6%) had hydroureter along, and 2 patients (7.4%) had only hydronephrosis. 6 patients(22%) accept intra-ureter double-J stent insertion, but 5 patients (83%) showed hydronephrosis in the following periods.

Conclusions:

Hydronephrosis is very common in ketamine-induced cytsitis patients. Due most of the patient with hydronephrosis are associated with hydroureter, the possible cause of hydronephrosis might be urine reflux due to high intra-bladder pressure instead of ureter obstruction. Double J indwelling cannot release hydronephrosis may also be another evidence for this hypothesis.