Yong Guo Liang, Kong Chia Yew, Ooi Michelle Wei Xin, Lee Eng Geap
University of Aberdeen,56C, Ashgrove Road, AB25 3AD Aberdeen, Scotland, UK.
University of Glasgow, UK.
Int J Surg Case Rep. 2015;8C:49-51. doi: 10.1016/j.ijscr.2015.01.008. Epub 2015 Jan 12.
Upper urinary tract occlusion is well recognized in patients with chronic ketamine abuse. The mechanism is generally unknown, but the ulcerative cystitis contracture may be responsible for obstruction. We present the first reported use of the Resonance metallic ureteric stent in the management ureteric obstruction caused by ketamine-induced uropathy.
A 31-year-old lady with one-year history of recreational ketamine abuse presented with symptoms related to drug-induced ulcerative cystitis over twelve-months. She presented with acute renal failure with bilateral pyonephrosis and sepsis, and was initially treated with bilateral nephrostomy insertions and antegrade stenting. The J stents recovered the renal function, but the patient suffered from recurrent urinary tract infections (UTI's) with the prosthesis in-situ. The patient successfully underwent bilateral insertion of 12cm 6.0 French Cook Resonance metallic ureteric stents. One year following the placement of the metallic stents, the patient maintained optimal renal function with no episode of UTI.
Ketamine induced uropathy is a well documented complication of chronic drug-induced ulcerative cystitis. The mechanical strength and inert property of metallic ureteric stents make it an ideal device to manage this problematic benign cause of ureteric obstruction.
This is the first reported case of therapeutic bilateral metallic ureteric stents in the management of patients with ketamine induced uropathy with one year follow up.
慢性氯胺酮滥用患者中，上尿路梗阻已得到充分认识。其机制通常不明，但溃疡性膀胱炎挛缩可能是梗阻的原因。我们首次报道了使用共振金属输尿管支架治疗氯胺酮所致肾病引起的输尿管梗阻。
一名31岁女性，有一年娱乐性氯胺酮滥用史，出现与药物性溃疡性膀胱炎相关症状超过12个月。她因双侧肾盂积脓和脓毒症出现急性肾衰竭，最初接受双侧肾造瘘插管和顺行支架置入治疗。J型支架恢复了肾功能，但患者在支架在位时反复发生尿路感染。患者成功接受了双侧12厘米6.0法国库克共振金属输尿管支架置入术。金属支架置入一年后，患者肾功能维持最佳，未发生尿路感染。
氯胺酮所致肾病是慢性药物性溃疡性膀胱炎的一种有充分文献记载的并发症。金属输尿管支架的机械强度和惰性使其成为处理这种导致输尿管梗阻的棘手良性病因的理想装置。
这是首例报道的双侧金属输尿管支架治疗氯胺酮所致肾病患者并随访一年的病例。
