Chung Shiu-Dong, Wang Chung-Cheng, Kuo Hann-Chorng
Division of Urology, Department of Surgery, Far Eastern Memorial Hospital, New Taipei, Taiwan; Department of Urology, Buddhist Tzu Chi General Hospital and Tzu Chi University, Hualien, Taiwan.
Neurourol Urodyn. 2014 Nov;33(8):1207-11. doi: 10.1002/nau.22477. Epub 2013 Aug 29.
To report our early results of augmentation enterocystoplasty (AE) for severe bladder pain associated with chronic ketamine cystitis (KC).
We performed AE for 14 patients with refractory KC-related bladder pain, which is based on the criteria including severe bladder pain, urgency and frequency and/or upper urinary tract damage such as bilateral hydronephrosis, and contracted bladder. Every patient had been treated conservatively with medication or cystoscopic hydrodistention for at least 1 year before they had received surgical intervention. Video-urodynamic studies were obtained before AE and 3-6 months after surgery. Outcome measurements included visual analogue score (VAS) for pain, cystometric bladder capacity (CBC), maximum urinary flow rate (Qmax), post-void residual, and maximal detrusor pressure (Pdet). The patients' general satisfaction with regard to treatment outcome was also assessed by the Patient Perception of Bladder Condition (PPBC).
A total of 4 men and 10 women underwent this procedure as indicated. The mean age was 26.7 (ranged 20-38) years old and the duration of ketamine abuse was 3.82 years (ranged 2-7). Contracted bladder was noted in all patients, hydronephrosis in nine and vesicoureteral reflux (VUR) in eight. At 3-6 months after AE, VAS was remarkably improved from baseline to the end-point (8.29 ± 1.54 vs. 2.14 ± 1.51, P < 0.0001), CBC increased from 50.9 ± 15.7 to 309.2 ± 58.0 ml (P < 0.0001), Qmax increased from 6.94 ± 3.60 to 15.2 ± 5.51 ml/sec (P < 0.0001) and Pdet reduced from 29.7 ± 16.0 to 17.9 ± 8.2 cmH2 O (P = 0.008). All patients reported marked improvement in PPBC from 6.0 to 1.4 ± 0.89 (P < 0.0001). All hydronephrosis disappeared and VUR was resolved in five patients after AE with ureteral reimplantation.
This pilot study demonstrated that AE is effective in relieving refractory ketamine-related bladder pain and lower urinary tract symptoms.
报告我们采用扩大肠膀胱成形术（AE）治疗与慢性氯胺酮膀胱炎（KC）相关的严重膀胱疼痛的早期结果。
我们对14例难治性KC相关膀胱疼痛患者实施了AE，这些患者符合包括严重膀胱疼痛、尿急、尿频和/或上尿路损害（如双侧肾积水）以及膀胱挛缩等标准。每位患者在接受手术干预前均已接受至少1年的药物保守治疗或膀胱镜水扩张治疗。在AE术前及术后3 - 6个月进行了影像尿动力学检查。结果测量指标包括疼痛视觉模拟评分（VAS）、膀胱容量测定膀胱容量（CBC）、最大尿流率（Qmax）、排尿后残余尿量以及最大逼尿肌压力（Pdet）。还通过患者膀胱状况感知（PPBC）评估了患者对治疗结果的总体满意度。
共有4名男性和10名女性按指征接受了该手术。平均年龄为26.7岁（范围20 - 38岁），氯胺酮滥用时间为3.82年（范围2 - 7年）。所有患者均存在膀胱挛缩，9例有肾积水，8例有膀胱输尿管反流（VUR）。AE术后3 - 6个月，VAS从基线显著改善至终点（8.29±1.54对2.14±1.51，P < 0.0001），CBC从50.9±15.7增加至309.2±58.0 ml（P < 0.0001），Qmax从6.94±3.60增加至15.2±5.51 ml/秒（P < 0.0001），Pdet从29.7±16.0降至17.9±8.2 cmH2O（P = 0.008）。所有患者报告PPBC从6.0显著改善至1.4±0.89（P < 0.0001）。AE术后，所有肾积水均消失，5例患者经输尿管再植术后膀胱输尿管反流得到解决。
这项初步研究表明，AE在缓解难治性氯胺酮相关膀胱疼痛和下尿路症状方面是有效的。
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