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Objective To identify the risk factors of chronic ketamine-induced upper urinary tract dysfunction (KUUTD).Methods Medical records of 103 patients with ketamine-associated urinary dysfunction(KAUD) from Sep.2009 to Jul.2015 were retrospectively reviewed.All the patients were divided into the upper urinary tract dysfunction group(n =39)or the normal group(n =64)according to the diagnostic criteria.Indexes such as general features (age,gender,BMI),drug-abusing characteristics (abusing time,frequency,dose,abstinent period),duration of LUTS,pelvic pain and urgency/frequency symptom score(PUF score),serum parameters (WBC,ALT,AST,γ-GT),bladder diary (daytime inter-void interval,nocturia,average urine volume),urodynamic data (maximum cystometric capacity,post-void residual,maximum urethral closure pressure,maximum and average flow rate,instable contraction,bladder compliance) and imaging manifestations were compared between the two groups.Logistic regression analysis was performed for the evaluation of variables with statistical significance.Results There was significantly difference between the two groups in BMI (t =2.127,P =0.043),drug-abusing frequency (t =2.335,P =0.029),abstinent period (t =3.451,P =0.003),duration of LUTS (t =2.289,P =0.036),PUF score (t =3.030,P =0.004),γ-GT value(t =2.697,P =0.012),MCC(t =5.056,P ＜ 0.001),MUCP(t =3.015,P =0.008),BC (t =8.562,P ＜ 0.001) and imaging findings of bladder contracture (x2 =15.155,P ＜0.001).The multivariate Logistic regression analysis showed that drug-abusing frequency(OR =1.279,P =0.038),abstinent period(OR =0.394,P =0.028),γ-GT value (OR =1.007,P =0.032),MCC (OR =0.775,P =0.011)and BC (OR =0.013,P =0.008)were the key factors of KUUTD.Conclusion Consecutive and frequent drug abuse,combination with chronic obstructive cholangitis,reduced capacity and low compliance bladder are the risk factors of upper urinary tract dysfunction associated with ketamine abuse.
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Objective To establish the a staging system based on scoring of ketamine associated urinary dysfunction (KAUD) and evaluate its diagnosis performance and clinical value.Methods A retrospective analysis of 135 admitted KAUD patients from September 2009 to September 2015 was performed.All patients were classified into three stages according to bladder and upper urinary tract impairment, and treated with subsequent strategy.The behavioral modification and pharmacotherapy was performed in stage Ⅰ which image investigation was normal.Hydrodistension and intravesical perfusion was used if pharmacotherapy failed in stage Ⅱ patients who had bladder impairment in image or urodynamics.Augmentation cystoplasty or cystectomy with urinary diversion was optional if aforementioned treatment failed in stage Ⅲ who had upper urinary tract involvement and abnormal renal function.The voided volume, micturition interval, and nocturnal void frequency as recorded in their 3-day bladder diary, PUF, ICPI and ICSI score after treatment in one month, were compared with their baseline data prior to treatment.Ketamine abusing history, renal and liver function, bladder and upper urinary tract changes, urodynamics and radioisotope renography correlation with stages were analyzed.A scoring system was established and the concordance between the clinical staging and model staging of each patient was compared.Receiver operating characteristic curve was employed to testify the sensitivity and specificity.Results There were 39, 80 and 16 patients included in each stage respectively.After subsequent strategy of treatment, voided volume, micturition interval, and nocturnal void frequency, PUF, ICPI and ICSI were improved significantly.Age (P =0.018), ketamine abusing history (P =0.006), eGFR (P =0.001), ALT (P =0.037), γ-GT (P ＜ 0.001), bladder (P =0.013) and ureteral changes (P ＜ 0.001), hydronephrosis (P ＜ 0.001) and radioisotope renography abnormality (P =0.01) were correlated with clinical stages.In total, 107 cases' stages based on scoring were accordant with clinical stages (30, 65 and 12 cases in each stage respectively).AUC of the scoring model ROC was 0.922 on cut point between Ⅰ and Ⅱ stages and AUC of the scoring model ROC was 0.978 on cut point between Ⅱ and Ⅲ stages.Conclusions We presented a scoring staging system of KAUD based on ketamine abusing history, laboratory test results, and imaging findings.It might be helpful to evaluate the progression on bladder and upper urinary tract, and provide a reference for treatment.This staging system based on scoring still needs further validation and improvement.
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Objective To investigate the relationship of 24 h urinary potassium (K) measurement and the symptoms change in ketamine-associated cystitis.Methods Forty-three ketamine-associated cystitis patients (29 male cases,14 female cases) were analyzed.The average age was 22 (17-29) years.Thirty-two patients without indwelling urinary catheter were categorized as group A,while the other 11 patients with indwelling urinary catheter were in group B.The therapy regimes consisted of anti-inflammatory,antioxidant,relieving spasm and pain,improving the microcirculation and repairing the bladder epithelium barrier.Thirty healthy adults were selected as the controls.Urinary K,sodium (Na) and creatinine (Cr)were determined in 24 h urine samples from all patients and controls before and after treatments.24 h urinary Cr was used as the internal standard.24 h urinary K and Na concentrations of the patients were calculated as relative to the Cr concentrations.The pelvic pain and urgency/frequency symptom (PUF) was used for evaluation before and after the treatments.The differences of urinary K were compared within each group and between groups before and after treatments.In addition,relationship of urinary K and PUF were assessed.Results Urinary Cr concentrations in all groups were not significantly different (P ＞ 0.05).Patients in group A had lower average K-to-Cr ratios than those patients in group B and controls (A 1.80 ± 0.67 vs.B 6.22±0.92 mmolK/mmol Cr,P=0.0001; A 1.80±0.67 vs.controls 6.47 ±0.97 mmol K/mmol Cr,P =0.0001) before treatments.But the ratios of K-to-Cr in group A were not significantly different with group B and controls after treatments (A 6.23 ± 1.42 vs.B 6.02 ± 0.98 mmol K/mmol Cr,A 6.23 ± 1.42vs.controls 6.47 ±0.97 mmol K/mmol Cr,F =0.698,P =0.472).PUF in both groups was not significantly different before treatments.For group A,PUF was negatively correlated with urinary K before and after treatments (before: r=-0.637,P=0.0001; after: r=-0.427,P=0.015).For group B,PUF had no correlation with urinary K before treatment (r=0.581,P =0.188),while there was a negative correlation between them after treatments (r =-0.779,P =0.005).PUF scores in all patients (group A + B)were significantly decreased after treatments when compared to those before treatments (18.12 ± 2.83 vs.22.77 ± 3.63,P =0.0001).Conclusion Urinary potassium measurement may have a role in evaluating the disease status and efficacy of treatments of patients suffered from ketamine-associated cystitis.
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<p><b>OBJECTIVE</b>To summarize the imaging features of urinary dysfunction associated with ketamine abuse (KAUD) for imaging diagnosis of KAUD.</p><p><b>METHODS</b>We analyzed the imaging findings in 45 patients with KAUD, all having a history of ketamine abuse and presenting with severe lower urinary tract symptoms. The patients underwent imaging examinations with ultrasonography (n=45), X-ray (n=38), computed tomography (n=28), magnetic resonance imaging (n=10) or single photon emission computed tomography (n=25), and the results were classified and evaluated to identify the common imaging findings.</p><p><b>RESULTS</b>The imaging changes of KAUD were found primarily in the urinary and biliary system. The most common imaging characteristics included thickening of the bladder wall, contracture and decreased functional volume of the bladder, dilation of the ureter and hydronephrosis, stricture of the upper ureter, renal impairment, dilation of the biliary system, and inflammation or swelling of the adjacent organs and lymph nodes</p><p><b>CONCLUSION</b>KAUD presents with typical imaging changes. Radiologists should be aware of KAUD if the typical imaging features are detected, especially in cases with a history of ketamine abuse.</p>