Clinical Outcome of Augmentation Enterocystoplasty for Patients with Ketamine-induced Cystitis

Background: Ketamine abuse has become a global phenomenon in recent years. Ketamineinduced cystitis (KC) is a new clinical syndrome which can result in severely inflamed bladderand intractable bladder pain. Currently there is no guideline for managing patients with KC.Objectives: To analyze the clinical outcome of patients with KC managed with augmentationenterocystoplasty (AE).Study Design: Retrospective interventional study.Setting: A tertiary teaching hospital, Hualien Tzu Chi Hospital.Methods: We retrospectively collected and analyzed the medical records and videourodynamic (VUD) test results of 26 patients who underwent AE as treatment for refractoryKC during the period 2009 – 2014. All of these patients abused ketamine with nasal snorting,at least 3 grams per dose, twice per week for 6 months. Data from VUD studies performedbefore AE and 3 – 6 months after surgery that were analyzed in this study included cystometricbladder capacity (CBC), post-void residual (PVR) urine volume, maximum urinary flow rate(Qmax), voided volume, and bladder compliance. A self-report questionnaire was used toassess patient satisfaction with AE.Results: Patients included 14 women and 12 men aged 20 – 43 years (mean age, 28.5 years)with an average duration of ketamine abuse of 4.7 years (range, 1 – 10 years). All patientshad contracted bladder, 9 had hydronephrosis, and 10 had vesicoureteral reflux (VUR). Therewas significant improvement in CBC (52.7 ± 29.7 v 327 ± 69.4 mL, P < 0.0001), Qmax (6.94± 4.32 v 13.7 ± 4.96 mL/s, P < 0.0001), PVR (8.08 ± 19.2 v 82.6 ± 91.5 mL, P < 0.0001),voided volume (44.1 ± 28.3 v 250.7 ± 133.4 mL, P < 0.0001), and bladder compliance (11.1± 11.9 v 54 ± 43, P < 0.0001) after AE. Hydronephrosis resolved in 7 patients after AE andVUR resolved in all patients who underwent AE with ureteral reimplantation. All patients whostopped using ketamine were free of bladder pain postoperatively. However, 10 patients whoreused ketamine had recurrent bladder pain and recurrent urinary tract infection.Limitations: Small number of patients limits scope of study.Conclusions: AE is effective at treating KC-induced bladder pain and restoring normallower urinary tract function. However, absolute cessation of ketamine is the key to success inKC treatment.Key words: Ketamine-induced cystitis, augmentation enterocystoplasty, bladder pain,contracted bladder, inflammation, surgery