Augmentation Enterocystoplasty is Effective in Relieving Refractory Ketamine-Related Bladder Pain

作者：Chung Shiu Dong; Wang Chung Cheng; Kuo Hann Chorng^*

来源：Neurourology and Urodynamics, 2014, 33(8): 1207-1211.

DOI：10.1002/nau.22477

• bladder pain
• drug abuse
• ketamine
• surgery
• pelvic pain

AimsTo report our early results of augmentation enterocystoplasty (AE) for severe bladder pain associated with chronic ketamine cystitis (KC).
MethodsWe performed AE for 14 patients with refractory KC-related bladder pain, which is based on the criteria including severe bladder pain, urgency and frequency and/or upper urinary tract damage such as bilateral hydronephrosis, and contracted bladder. Every patient had been treated conservatively with medication or cystoscopic hydrodistention for at least 1 year before they had received surgical intervention. Video-urodynamic studies were obtained before AE and 3-6 months after surgery. Outcome measurements included visual analogue score (VAS) for pain, cystometric bladder capacity (CBC), maximum urinary flow rate (Qmax), post-void residual, and maximal detrusor pressure (Pdet). The patients' general satisfaction with regard to treatment outcome was also assessed by the Patient Perception of Bladder Condition (PPBC).
ResultsA total of 4 men and 10 women underwent this procedure as indicated. The mean age was 26.7 (ranged 20-38) years old and the duration of ketamine abuse was 3.82 years (ranged 2-7). Contracted bladder was noted in all patients, hydronephrosis in nine and vesicoureteral reflux (VUR) in eight. At 3-6 months after AE, VAS was remarkably improved from baseline to the end-point (8.291.54 vs. 2.14 +/- 1.51, P<0.0001), CBC increased from 50.9 +/- 15.7 to 309.2 +/- 58.0ml (P<0.0001), Qmax increased from 6.94 +/- 3.60 to 15.2 +/- 5.51ml/sec (P<0.0001) and Pdet reduced from 29.7 +/- 16.0 to 17.9 +/- 8.2cmH(2)O (P=0.008). All patients reported marked improvement in PPBC from 6.0 to 1.4 +/- 0.89 (P<0.0001). All hydronephrosis disappeared and VUR was resolved in five patients after AE with ureteral reimplantation.
ConclusionsThis pilot study demonstrated that AE is effective in relieving refractory ketamine-related bladder pain and lower urinary tract symptoms. Neurourol. Urodynam. 33:1207-1211, 2014.

• 出版日期2014-11