The destruction of the lower urinary tract by ketamine abuse: a new syndrome?
The destruction of the lower urinary tract by ketamine abuse: a new syndrome?
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DOI：
10.1111/j.1464-410x.2008.07920.x
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发表时间：
2008-12-01
影响因子：
4.5
通讯作者：
Man, Chi-Wai
中科院分区：
文献类型：
--
作者：
Chu, Peggy Sau-Kwan;Ma, Wai-Kit;Man, Chi-Wai
报告街头滥用氯胺酮的青少年的临床表现（经常在街头滥用氯胺酮，因为它有致幻作用），出现明显的下尿路症状（LUTS），但没有细菌感染的证据。我们回顾性分析了临床表现，盆腔疼痛和紧迫/频率评分，视频尿动力学研究，膀胱镜检查结果，从2000年3月至2007年12月，59名氯胺酮滥用者被转介至香港玛嘉烈医院及屯门医院泌尿科，他们的膀胱活检组织学特征及放射学检查结果显示，59名滥用者均出现中度至重度下尿路症状，即尿频、尿急、排尿困难，急迫性尿失禁和偶尔疼痛的血尿。42例（71%）患者行膀胱镜检查，显示不同程度的上皮炎症，与慢性间质性膀胱炎相似。所有12个可用的膀胱活检组织学特征类似于间质性膀胱炎。尿动力学检查，47例患者均有不同程度的逼尿肌过度活动或膀胱顺应性下降，伴或不伴膀胱输尿管反流。30例患者（51%）在肾脏超声检查中有单侧或双侧肾积水，4例（7%）在放射学成像中显示提示乳头坏死的特征。8例患者血清肌酐水平升高，膀胱炎和膀胱收缩综合征可能与街头氯胺酮滥用有关。严重病例可能发生继发性肾损害，这可能是不可逆的，使患者依赖透析。目前的数据不能确定确切的原因或发病率。街头氯胺酮滥用不仅是一个药物问题，而且可能与严重的泌尿系统疾病有关，对医疗资源造成重大负担。
To report the clinical spectrum seen in young abusers of street-ketamine (regular recreational abusers of street-ketamine, for its hallucinogenic effects) in Hong Kong, presenting with significant lower urinary tract symptoms (LUTS) but with no evidence of bacterial infection.We retrospectively analysed the clinical presentations, pelvic pain and urgency/frequency scores, video-urodynamic studies, cystoscopy findings, histological features of bladder biopsies and radiological findings of 59 ketamine abusers who were referred to the urology units of Princess Margaret and Tuen Mun Hospital, Hong Kong, from March 2000 to December 2007.Of the 59 patients, all had moderate to severe LUTS, i.e. frequency, urgency, dysuria, urge incontinence and occasionally painful haematuria. Forty-two (71%) patients had a cystoscopy that showed various degrees of epithelial inflammation similar to that seen in chronic interstitial cystitis. All of 12 available bladder biopsies had histological features resembling those of interstitial cystitis. Urodynamically, either detrusor overactivity or decreased bladder compliance with or without vesico-ureteric reflux was detected to some degree in all of 47 patients. Thirty patients (51%) had unilateral or bilateral hydronephrosis on renal ultrasonography, and four (7%) showed features suggestive of papillary necrosis on radiological imaging. Eight patients had a raised serum creatinine level.A syndrome of cystitis and contracted bladder can be associated with street-ketamine abuse. Secondary renal damage can occur in severe cases which might be irreversible, rendering patients dependent on dialysis. The present data do not establish the precise cause nor the incidence. Street-ketamine abuse is not only a drug problem, but might be associated with a serious urological condition causing a significant burden to healthcare resources.