Beuerle John R, Barrueto Fermin
Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD, USA.
J Med Toxicol. 2008 Jun;4(2):106-8. doi: 10.1007/BF03160964.
The use of 3,4-methylenedioxymethamphetamine (MDMA, known as "ecstasy"), a synthetic amphetamine and "club drug," has been associated with acute, transient urinary retention. We report a case of neurogenic bladder and chronic urinary retention associated with MDMA abuse.
A 21-year-old male presented to the emergency department (ED) because he had abdominal pain and difficulty urinating. He had experienced difficulty in initiating urination over the past 1.5 months, with periods of 24 to 36 hours between voids and large volumes of urine. The patient had a chronic pattern of MDMA use, taking 4 tablets/day for 3 months. Two weeks before coming to the ED, he had been admitted to an inpatient drug rehabilitation center. During the time since that admission, the patient had visited EDs repeatedly for insertion and removal of Foley catheters to relieve the urinary retention until he could be admitted to a urologic service. Cystometrogram was abnormal, finding no sensation of bladder fullness after instillation of 350 mL of saline and inability to generate a voluntary voiding pressure. Cystoscopy revealed no outlet obstruction. The findings were consistent with neurogenic bladder. The patient was given prescriptions for bethanecol and phenazopyridine, and told to continue a 10-day course of sulfamethoxazole/trimethoprim for urinary tract infection. He was discharged with a Foley catheter in place. Symptoms of urinary retention persisted at 1-year follow-up, despite self-catheterization and complete cessation of MDMA use.
Chronic MDMA use may lead to neurogenic bladder and chronic urinary retention.
3,4-亚甲基二氧甲基苯丙胺（MDMA，即“摇头丸”）是一种合成苯丙胺类“俱乐部毒品”，其使用与急性短暂性尿潴留有关。我们报告一例与摇头丸滥用相关的神经源性膀胱和慢性尿潴留病例。
一名21岁男性因腹痛和排尿困难就诊于急诊科。在过去1.5个月里，他一直存在排尿起始困难，排尿间隔时间为24至36小时，尿量较多。该患者有长期使用摇头丸的习惯，连续3个月每天服用4片。在就诊急诊科前两周，他曾入住一家住院戒毒康复中心。自入院以来，该患者因尿潴留反复到急诊科就诊，接受插入和拔除 Foley 导尿管以缓解症状，直到他能被收入泌尿外科。膀胱测压异常，注入350 mL生理盐水后未感觉到膀胱充盈，且无法产生自主排尿压力。膀胱镜检查未发现出口梗阻。检查结果符合神经源性膀胱。患者被给予了氨甲酰甲胆碱和非那吡啶的处方，并被告知继续服用10天的磺胺甲恶唑/甲氧苄啶以治疗尿路感染。他出院时留置了一根 Foley 导尿管。尽管患者进行了自我导尿并完全停止使用摇头丸，但在1年随访时尿潴留症状仍持续存在。
长期使用摇头丸可能导致神经源性膀胱和慢性尿潴留。
