Shahani Rohan, Streutker Cathy, Dickson Brendan, Stewart Robert J
Department of Surgery, St. Michael's Hospital and University of Toronto, Toronto, Ontario, Canada.
Urology. 2007 May;69(5):810-2. doi: 10.1016/j.urology.2007.01.038.
Ketamine hydrochloride is an N-methyl-D-aspartic acid receptor antagonist used as an anesthetic agent in human and veterinary procedures. Increasingly, it is being used as a recreational drug. Recreational ketamine users have anecdotally reported increased lower urinary tract symptoms while using the substance.
We describe a series of 9 patients, all of whom were daily ketamine users, who presented with severe dysuria, frequency, urgency, and gross hematuria. Investigations, including urine culture, microscopy, and cytology, in addition to computed tomography, cystoscopy, and bladder biopsies, were performed to identify a relationship between recreational ketamine use and these symptoms.
The urine cultures were sterile in all cases. Computed tomography revealed marked thickening of the bladder wall, a small capacity, and perivesicular stranding, consistent with severe inflammation. At cystoscopy, all patients had severe ulcerative cystitis. Biopsies in 4 patients revealed epithelial denudation and inflammation with a mild eosinophilic infiltrate. Cessation of ketamine use, with the addition of pentosan polysulfate, appeared to provide some symptomatic relief.
This case series has described a new clinical entity of severe ulcerative cystitis as a result of chronic ketamine use. As illicit ketamine becomes more easily available, ulcerative cystitis and potential long-term bladder sequelae related to its use may be a more prevalent problem confronting urologists.
盐酸氯胺酮是一种N-甲基-D-天冬氨酸受体拮抗剂，在人类和兽医手术中用作麻醉剂。越来越多的人将其用作消遣性药物。消遣性氯胺酮使用者称在使用该物质时出现下尿路症状增多。
我们描述了9例患者，他们均为每日使用氯胺酮者，表现为严重尿痛、尿频、尿急和肉眼血尿。进行了包括尿培养、显微镜检查和细胞学检查在内的各项检查，此外还进行了计算机断层扫描、膀胱镜检查和膀胱活检，以确定消遣性使用氯胺酮与这些症状之间的关系。
所有病例的尿培养均无菌。计算机断层扫描显示膀胱壁明显增厚、容量小和膀胱周围条索状阴影，符合严重炎症表现。膀胱镜检查时，所有患者均患有严重的溃疡性膀胱炎。4例患者的活检显示上皮剥脱和炎症，伴有轻度嗜酸性粒细胞浸润。停止使用氯胺酮并加用聚多卡醇似乎能缓解一些症状。
该病例系列描述了因长期使用氯胺酮导致严重溃疡性膀胱炎这一新的临床实体。随着非法氯胺酮越来越容易获得，与其使用相关的溃疡性膀胱炎和潜在的长期膀胱后遗症可能成为泌尿外科医生面临的更普遍问题。
