Vizgan Gabriel, Huamán Michael, Rychik Kevin, Edeson Max, Blaivas Jerry G
SUNY Downstate Brooklyn New York USA.
Department of Urology Institute for Bladder and Prostate Research New York New York USA.
BJUI Compass. 2023 Apr 19;4(4):377-384. doi: 10.1002/bco2.239. eCollection 2023 Jul.
Refractory ketamine-induced uropathy (KU) (RKU) has devastating effects on the lower urinary tract leading to ureteral obstruction and even renal failure. The only effective treatment for RKU is major surgical reconstruction or urinary diversion. Nevertheless, there is a paucity of awareness about this destructive condition; the aim of this study is to conduct a narrative systemic review of all surgical outcomes of RKU.
This is an English language literature review of surgical outcomes in KU patients who underwent reconstructive lower urinary tract surgery or urinary diversion through 5 August 2022. Two independent researchers assessed the relevance of each paper and disputes were settled by a third party. In-vitro, animal studies, letters to the editor and papers that did not evaluate surgical outcomes were excluded.
Of the 50 763 identified articles, 622 were relevant based on title, 150 based on abstract, but only 23 papers were relevant by content. In all, 875 patients were documented as having KU, of whom 193 (22%) underwent reconstructive surgery. The data were disconcerting, as the apparent rapid progression from the beginning of KU to end-stage bladder was only a 1-year difference of ketamine abuse between those patients who required surgery (4.4 years) and those that did not (3.4 years).
The data suggest that the time interval from the beginning of ketamine-induced uropathy to the end-stage bladder may be measured in months, confounding decision making. There is a dearth of literature about KU, and more research is needed to better understand this pathology.
难治性氯胺酮诱发的尿路病（KU）（RKU）对下尿路具有毁灭性影响，可导致输尿管梗阻甚至肾衰竭。RKU唯一有效的治疗方法是进行大型手术重建或尿流改道。然而，人们对这种破坏性疾病的认识不足；本研究的目的是对RKU的所有手术结果进行叙述性系统评价。
这是一项对截至2022年8月5日接受下尿路重建手术或尿流改道的KU患者手术结果的英文文献综述。两名独立研究人员评估每篇论文的相关性，争议由第三方解决。体外研究、动物研究、致编辑的信以及未评估手术结果的论文均被排除。
在检索到的50763篇文章中，根据标题有622篇相关，根据摘要有150篇相关，但按内容只有23篇相关。总共记录了875例KU患者，其中193例（22%）接受了重建手术。数据令人不安，因为从KU开始到终末期膀胱的明显快速进展在需要手术的患者（4.4年）和不需要手术的患者（3.4年）之间仅存在1年的氯胺酮滥用差异。
数据表明，从氯胺酮诱发尿路病开始到终末期膀胱的时间间隔可能以月计算，这给决策带来了困扰。关于KU的文献匮乏，需要更多研究来更好地了解这种病理情况。
