Bourillon Alice, Cornu Jean Nicolas, Herve François, Pangui Raphael, Thuillier Caroline, Doizi Steeve, Lebdai Souhil, Peyronnet Benoit
Department of Urology, Rennes University Hospital, Rennes, France.
Department of Urology, Rouen University Hospital, Rouen, France.
Fr J Urol. 2024 Nov;34(14):102754. doi: 10.1016/j.fjurol.2024.102754. Epub 2024 Oct 3.
The objective of the CUROPF and CTMH was to establish recommendations about ketamine induced uropathy management.
A systematic review of the literature was conducted on Pubmed/Medline by the members of the French committees of female urology and male lower urinary tract symptoms focusing on the epidemiology, pathophysiology, diagnosis and treatment of ketamine induced uropathy, evaluating references and level of evidence.
Recommendations include epidemiology, pathophysiology, diagnosis and treatment of ketamine induced uropathy. It represents a rising healthcare issue, with major augmentation of ketamine consumers and new patients across the world. Several pathophysiology pathways are suspected and need clinical validation. The diagnosis is clinical, with hyperactive bladder symptoms mostly including pollakiuria, but also lower urinary tract symptoms, and histological, requiring bladder biopsies to rule out carcinoma and show specific features and inflammation. Therapeutics are currently limited and non-specific, combining abstinence, hydrodistension, pentosane polysulfate and Botox injections. Complex reconstructive surgeries should be avoided and be considered as a last resort.
These guidelines should provide tools to help every physician confronted to ketamine induced uropathy patients, which represents a growing issue. Hopefully, this work will allow the improvement of the screening, management and care of ketamine induced uropathy in the future.
“欧洲儿科泌尿外科学会（CUROPF）”和“法国男性下尿路症状委员会（CTMH）”的目标是制定关于氯胺酮所致尿病管理的建议。
法国女性泌尿外科学委员会和男性下尿路症状委员会的成员在PubMed/Medline上对文献进行了系统综述，重点关注氯胺酮所致尿病的流行病学、病理生理学、诊断和治疗，评估参考文献和证据水平。
建议包括氯胺酮所致尿病的流行病学、病理生理学、诊断和治疗。这是一个日益严重的医疗问题，全球氯胺酮使用者和新患者大幅增加。怀疑有几种病理生理途径，需要临床验证。诊断基于临床，膀胱过度活动症状主要包括尿频，但也有下尿路症状，以及组织学诊断，需要进行膀胱活检以排除癌症并显示特定特征和炎症。目前治疗方法有限且缺乏特异性，包括禁欲、膀胱扩张、戊聚糖多硫酸盐和肉毒杆菌毒素注射。应避免进行复杂的重建手术，将其视为最后的手段。
这些指南应提供工具，帮助每位面对氯胺酮所致尿病患者的医生，这是一个日益严重的问题。希望这项工作将有助于未来改善氯胺酮所致尿病的筛查、管理和护理。
