Elsevier

Urology

Volume 86, Issue 2, August 2015, Pages 236-243
Urology

Female Urology
Clinical Outcome of a Prospective Case Series of Patients With Ketamine Cystitis Who Underwent Standardized Treatment Protocol

https://doi.org/10.1016/j.urology.2015.05.003Get rights and content

Objective

To assess the outcome of a prospective cohort of patients with ketamine-associated uropathy after standardized treatment.

Methods

This is a prospective case series of patients with ketamine-related urologic problems. Management for the patients includes a 4-tier approach, namely anti-inflammatory or anti-cholinergic drugs, opioid analgesics or pregabalin, intravesical hyaluronic acid, and finally, surgical intervention including hydrodistension and augmentation cystoplasty. Outcome was assessed with functional bladder capacity, pelvic pain and urgency or frequency (PUF) symptom scale, and the EuroQol visual analog scale.

Results

Between December 2011 and June 2014, 463 patients presented with ketamine-associated uropathy. All were managed by the same standardized protocol. Among these patients, 319 patients came back for follow-up assessment. Overall mean follow-up duration was 10.7 ± 8.5 months. For those patients who received first-line treatment (290 patients), there was a significant improvement in PUF scores, the EuroQol visual analog scale, and functional bladder capacity. Both abstinence from ketamine usage and the amount of ketamine consumed were factors predicting the improvement of PUF scores. For those patients who required second-line oral therapy (62 patients), 42 patients (67.7%) reported improvement in symptoms. Eight patients have completed intravesical therapy. There was a significant improvement in voided volume for the patients after treatment.

Conclusion

The study demonstrated the efficacy of managing ketamine-associated uropathy using a 4-tier approach. Both anti-inflammatory drugs and analgesics could effectively alleviate symptoms. Being abstinent from ketamine abuse and the amount of ketamine consumed have bearings on treatment response.

Section snippets

Methods

Since December 2011, all consecutive patients who attended our center for ketamine-related urologic problems were seen in a dedicated clinic and were recruited into a prospective cohort with standardized treatment regime. Written informed consent was given by all participants before entering the study.

Basic demographic data were recorded before clinic attendance. On the first consultation, serum creatinine level, urine microscopy and culture, and uroflowmetry were performed. Functional bladder

Results

Between December 2011 and June 2014, there were 463 patients who attended our clinic for ketamine-associated uropathy. There were slightly more women in our cohort (258 patients; 55.7%), and the mean age was 25.0 ± 3.8 years. After their first consultation, 319 patients came back for follow-up assessment (default rate 31.1%), with an overall mean follow-up of 10.7 ± 8.5 months, and 126 patients have more than 1-year follow-up data available for review (Table 1). Among these, 101 patients were

Comment

Since the initial case series of ketamine cystitis reported by Shahani et al11 and Chu et al6 in 2007, this unique disease entity has been gaining an increasing recognition. Investigators from various countries have reported their clinical observation in this aspect.12, 13 Typical features of lower urinary tract symptoms (LUTS) after prolonged ketamine abuse include dysuria, painful hematuria, urinary urgency, urge incontinence, frequency, and nocturia.14 In our series, the mean FBC of our

Conclusion

Ketamine abuse produced significant LUTS and pain, which were more severe in active users than ex-users. This is a prospective case series demonstrating the efficacy of managing ketamine-associated uropathy using a 4-tier approach. Both nonsteroidal anti-inflammatory drugs and analgesics could effectively alleviate symptoms of ketamine cystitis. Abstinence from ketamine usage and the amount of ketamine consumed have bearings on treatment response and symptom relief. Further study is needed to

Acknowledgments

The research project was funded by Beat Drugs Fund, The Government of the Hong Kong Special Administrative Region.

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    Financial Disclosure: The authors declare that they have no relevant financial interests.

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