氯胺酮相关性泌尿系统损害及治疗

目的探讨滥用氯胺酮(K粉)所引发泌尿系损害的临床特征及其诊治方法。方法回顾性分析2006~2010年间我院收治的因长期吸食K粉导致泌尿系统损害患者,收集关于其人口学信息、临床症状、检查结果及治疗结局的信息,进行描述性分析。结果共有10例患者(男/女=4/6),中位数年龄25(22~30)岁,吸食氯胺酮中位数时间2(1~4)年),临床上均有不同程度的尿路刺激症状和(或)血尿。B超示双侧上尿路积水3例;3例行IVU及CT检查均示上尿路积水扩张、膀胱挛缩;1例血生化检查示合并肝肾功能损害;4例活检病理示膀胱黏膜炎性改变。6例在停止或减少吸食氯胺酮后症状缓解;2例在行抗感染及胆碱能受体阻滞剂(托特罗定)治疗后症状缓解;1例在行膀胱镜下膀胱壁肉毒素注入后症状缓解;1例在行膀胱扩大术后症状缓解。结论氯胺酮相关性泌尿系统损害可能是一种以下尿路刺激症状为主要表现的全尿路炎性损害,其发生机制及治疗方法有待进一步研究及完善。     

吸食K粉(氯胺酮)致泌尿系统损害误诊分析

目的探讨吸食K粉(氯胺酮)相关的泌尿系统损害误诊原因.方法回顾性分析23例吸食K粉(氯胺酮)相关的泌尿系统损害患者K粉吸食资料及既往诊治情况.患者全为男性,年龄18~52岁,K粉吸食史1~7年,有严重的排尿困难、尿频、尿急、尿痛、尿等待等下尿路症状,吸食K粉后反复发作或加重.结果23例患者被诊断为尿道炎、膀胱炎、慢性前列腺炎、非淋菌性泌尿生殖道炎、泌尿系结石,无1例诊断为吸食K粉(氯胺酮)相关的泌尿系统损害.结论患者有长期吸食K粉史,并因反复吸食而发作或加重;下尿路症状明显而严重;一般治疗效果不佳,停止吸食K 粉后病情缓解.临床医师应注重病史.     

3例氯胺酮(K粉)相关性泌尿系损害的诊治

目的:探讨氯胺酮(俗称K粉)相关性泌尿系损害的可能致病机制及诊治方法。方法:回顾性分析我院收治的3例氯胺酮(K粉)相关性泌尿系损害患者的临床资料:男2例,女1例,平均年龄32岁。氯胺酮(K粉)滥用时间为6~120个月,使用途径多经鼻直接吸食,偶有将K粉兑入饮料、酒水等饮用。结果:3例患者在接受治疗(包括抗炎、抗胆碱受体,戒除K粉等)后,各种尿路损害相关症状得到不同程度的缓解或逆转,其中以血尿消失最明显;联合透明质酸钠膀胱内灌注治疗后,患者症状改善。结论:戒除K粉及联合透明质酸钠等治疗可缓解氯胺酮(K粉)相关性泌尿系损害。     

氯胺酮相关性下尿路症状1例报告并文献复习

目的探讨滥用氯胺酮引发相关性下尿路症状的诊断及治疗方法。方法回顾性分析1例氯胺酮相关性下尿路症状患者的临床资料,并结合文献复习予以讨论。患者吸食氯胺酮3年,临床主要表现为严重的尿频、尿急、夜尿增多,排尿日记提示白天排尿20次,夜尿5次。每次尿量约50~100 mL,尿动力学提示：逼尿肌不稳定。结果膀胱活检病理提示肉芽样组织,散在淋巴细胞和较多嗜酸性细胞浸润。患者予以膀胱灌注透明质酸钠,4周后患者白天排尿10次,夜尿2次,功能性膀胱容量300 mL,下尿路症状明显好转。结论氯胺酮相关性下尿路症状是一种新的以下尿路刺激症状为主要表现的全尿路炎性损害,诊断时应与间质性膀胱炎和嗜酸性膀胱炎鉴别,其发生机制及治疗方法有待进一步研究,透明质酸钠治疗可能有效。     

小儿先天性膀胱憩室

目的 总结先天性膀胱憩室患儿的诊疗特点.方法 回顾性分析22例先天性膀胱憩室患儿的临床资料.均为男童,年龄7 d～12岁,平均3.5岁.临床表现排尿困难、尿潴留、反复尿路感染等症状,均经排尿性膀胱尿道造影检查确诊.18例25根输尿管合并膀胱输尿管反流,术前18例行IVU检查,上尿路正常7例,上尿路扩张积水10例,右肾发育不良1例.结果 22例均行憩室切除、膀胱修复术,合并膀胱输尿管反流者同期行输尿管膀胱再吻合术.17例随访6个月～11年,平均4.5年,患儿临床症状均消失,憩室无复发.14例原膀胱输尿管反流者,反流消失12例,1例有Ⅰ度反流者,保守治疗半年反流消失,1例仍有双侧膀胱输尿管反流,行膀胱造瘘术后半年,目前仍在随访中.IVU复查12例,上尿路积水好转7例,积水无变化3例,2例左肾不显影者术后仍不显影.结论 小儿先天性膀胱憩室较少见,但可引起上尿路严重损害甚至危及生命,早期诊断、早期合理治疗是提高疗效的关键.     

后尿道瓣膜切除术后膀胱及上尿路功能损害的影响因素

目的 探讨后尿道瓣膜切除术后膀胱及上尿路功能损害的尿动力学危险因素.方法 1999年至2005年收治后尿道瓣膜切除术后患儿32例,年龄1.2～9.0岁,平均3.5岁.瓣膜切除术后6个月～6年,平均3.2年行尿动力学检查,其中5例行影像尿动力学检查.手术前后行IVU、B超及排尿性膀胱尿道造影等,11例行肾核素检查.比较手术前后膀胱及上尿路功能变化,分析引起上尿路损害的危险因素.结果 术后影像学检查有肾及输尿管扩张、积水加重19例31侧,肾输尿管积水减轻13例19侧,包括积水消失2例4侧及膀胱输尿管反流消失2例3侧.上尿路损害加重占59%.19例上尿路损害加重者膀胱顺应性(6.53±4.34)ml/cm H2O,最大膀胱测压容积(75.60±15.30)ml,13例上尿路损害减轻者膀胱顺应性(45.23±8.17)ml/cm H2O,最大膀胱测压容积(120.80±19.60)ml,2组比较差异有统计学意义(P＜0.01).结论 膀胱顺应性和膀胱容积是决定后尿道瓣膜切除术后上尿路损害是否加重的关键因素,可以作为后尿道瓣膜患者术后主要的随访监测指标.良好的膀胱顺应性和大的膀胱容量预示患者预后良好.     

膀胱灌注透明质酸钠治疗氯胺酮相关性膀胱炎的临床疗效

目的 探讨膀胱灌注透明质酸钠治疗氯胺酮相关性膀胱炎的临床疗效.方法 收集2010年7 月至2012 年12 月在湛江农垦第二医院及中山大学附属第三医院就诊的因滥用氯胺酮致膀胱炎的患者30 例的临床资料,分析其临床症状、影像学及相关实验室检查特点,令患者戒断氯胺酮并给予膀胱灌注透明质酸钠治疗8 周.结果 经治疗后,21 例(70%)患者下尿路症状完全消失,6 例(占20%)患者症状明显缓解,3 例患者无明显疗效.结论 对于滥用氯胺酮所致的膀胱炎,停止使用氯胺酮加上膀胱灌注透明质酸钠治疗可取得较好的疗效.     

氯胺酮相关性膀胱功能障碍（附8例报告）

目的：探讨滥用氯胺酮所引起的膀胱功能障碍及诊治方法.方法：回顾分析8例有滥用氯胺酮病史患者的泌尿系症状,给予常规检查及泌尿系统相关检查,根据不同情况给予患者探讨性治疗.结果：氯胺酮相关性膀胱功能障碍是以尿频,尿急为主的下尿路症状,膀胱镜检示膀胱黏膜不同程度炎症变化,8例患者经治疗有5例患者病情有所减轻.结论：氯胺酮相关性的膀胱功能障碍发生机制、发展、转归、治疗都缺乏足够的认识,需要更进一步的研究. 关键词：膀胱功能障碍;氯胺酮;滥用 分类号：R694 文献标识码：A 文章编号：1001-1420（2011）01-0039-03     

乙状结肠膀胱扩大成形术治疗氯胺酮所致膀胱挛缩

目的 探讨氯胺酮所致膀胱挛缩的手术治疗方法.方法 吸食氯胺酮导致膀胱挛缩患者25例.均为男性.平均年龄24(19～28)岁.服用氯胺酮时间0.7～4.0年.均有严重的尿频、尿急、尿痛和(或)血尿症状.尿培养阴性.肝肾功能正常.B超检查提示双侧上尿路积水23例,集合系统分离(1.8±0.7)cm.膀胱残余尿22例,残余尿量平均80(45～150)ml.IVU检查提示肾小盏扩大呈圆形、膀胱挛缩呈球形23例.尿动力检查25例,膀胱容量(89±34)ml,储尿期最大逼尿肌压力(48±26)cm H2O(1 cm H2O=0.098 kPa),最大尿流率(7.8±2.3)ml/s,残余尿量(82±47)ml.膀胱镜下活检均提示为膀胱黏膜炎性改变.停用氯胺酮,系统药物治疗(抗生素、肾上腺素能受体阻滞剂、胆碱能受体阻滞剂、戊聚硫钠和透明质酸钠膀胱灌注治疗)后症状无明显缓解,行乙状结肠膀胱扩大术. 结果25例手术顺利.平均随访18(6～36)个月.尿动力学检查排尿状况明显改善,膀胱容量增至(375±53)ml,储尿期最大逼尿肌压力降至(13±9)cm H2O,最大尿流率增至(17.6±5.8)ml/s,残余尿减少至消失,与术前比较差异均有统计学意义(P<0.01).患者排尿通畅有力,无尿失禁、遗尿,尿频、尿痛等症状消失,尿常规检查(-).IVU检查输尿管无反流现象,肾盏无扩张或肾小盏穹窿变钝.结论 乙状结肠膀胱扩大术可降低膀胱内压力,增加膀胱容量及顺应性,明显改善氯胺酮所致膀胱挛缩患者肾积水状况及尿频、尿急、尿痛等症状,提高患者生活质量.     

肾移植术后输尿管并发症17例临床分析

目的 总结肾移植术后输尿管并发症的诊治经验.方法 回顾分析济南军区总医院诊治的17例肾移植术后输尿管并发症患者的临床资料.结果 17例患者伴有不同程度的少尿和局部肿胀不适等症状,实验室检查血清肌酐（Scr）升高,彩色多普勒超声（彩超）检查示移植肾积水、移植肾输尿管扩张,经磁共振水成像或计算机断层摄影术（CT）尿路成像明确诊断.其中输尿管膀胱吻合口狭窄15例,输尿管坏死2例.治疗经过：14例行开放性手术,包括行移植肾输尿管膀胱重新吻合术12例,移植肾输尿管-自体输尿管吻合1例,移植肾输尿管游离、重新放置输尿管支架管1例.3例行非开放性手术治疗,包括输尿管皮肤造瘘1例、腔内球囊导管扩张术1例、软膀胱镜下逆行输尿管支架管插管治疗1例.疗效：14例开放手术治疗患者与1例输尿管皮肤造瘘患者的移植肾肾盂与膀胱的连接部恢复通畅,移植肾功能均明显改善.另2例非开放手术治疗患者,包括1例腔内球囊导管扩张术及1例行软膀胱镜下逆行输尿管支架管插管术患者术后复发,行开放手术治疗.结论 彩超及磁共振成像水成像或CT尿路成像等影像学检查是确诊移植肾输尿管并发症的主要方法.肾移植术后输尿管并发症应以预防为主,确诊后视具体情况行开放性手术或非开放性手术治疗,开放手术治疗的疗效较佳.     

Upper urinary tract damage caused by ketamine snorting—A report of nine cases

ObjectiveThe toxicity of ketamine to genitourinary system not only involved in lower urinary tract, which include urinary frequency, urgency, suprapubic pain, dysuria and hematuria, but also upper urinary tracts. However, the reports of ketmaine-induced upper urinary tract damage were rare.Materials and methodsHerein, we reported nine ketamine abusers presented with moderate flank pain with hydronephrosis and lower urinary tract symptoms from three medical centers located around Taiwan.ResultsAll patients were diagnosed of hydronephrosis by sonography or abdominal computed tomography scans and 7 cases combined with acute kidney injury. They all receive ureteroscopy exam and double-J stenting. All of their flank pain and renal function impairment improved during follow up.ConclusionTo the best of our knowledge, currently there is no standard therapy for ketamine-induced nephropathy, we therefore supplied a therapeutic choice for those ketamine abuser combined with hydronephrosis and/or acute kidney injury.     

The destruction of the lower urinary tract by ketamine abuse: a new syndrome?

OBJECTIVE

To report the clinical spectrum seen in young abusers of street‐ketamine (regular recreational abusers of street‐ketamine, for its hallucinogenic effects) in Hong Kong, presenting with significant lower urinary tract symptoms (LUTS) but with no evidence of bacterial infection.

PATIENTS AND METHODS

We retrospectively analysed the clinical presentations, pelvic pain and urgency/frequency scores, video‐urodynamic studies, cystoscopy findings, histological features of bladder biopsies and radiological findings of 59 ketamine abusers who were referred to the urology units of Princess Margaret and Tuen Mun Hospital, Hong Kong, from March 2000 to December 2007.

RESULTS

Of the 59 patients, all had moderate to severe LUTS, i.e. frequency, urgency, dysuria, urge incontinence and occasionally painful haematuria. Forty‐two (71%) patients had a cystoscopy that showed various degrees of epithelial inflammation similar to that seen in chronic interstitial cystitis. All of 12 available bladder biopsies had histological features resembling those of interstitial cystitis. Urodynamically, either detrusor overactivity or decreased bladder compliance with or without vesico‐ureteric reflux was detected to some degree in all of 47 patients. Thirty patients (51%) had unilateral or bilateral hydronephrosis on renal ultrasonography, and four (7%) showed features suggestive of papillary necrosis on radiological imaging. Eight patients had a raised serum creatinine level.

CONCLUSION

A syndrome of cystitis and contracted bladder can be associated with street‐ketamine abuse. Secondary renal damage can occur in severe cases which might be irreversible, rendering patients dependent on dialysis. The present data do not establish the precise cause nor the incidence. Street‐ketamine abuse is not only a drug problem, but might be associated with a serious urological condition causing a significant burden to healthcare resources.     

Ketamine-associated bladder dysfunction

Objective:   To assess the impact of ketamine abuse on genitourinary tract dysfunction.
Methods:   Eleven patients with urinary tract symptoms and a history of ketamine abuse in recent years were studied. Urinalysis, urine culture, renal function tests, abdominal sonography and urodynamic studies were done. Bladder biopsies were carried out in selected cases.
Results:   The most common complaints were lower urinary tract symptoms, including dysuria, frequency, urgency and gross hematuria. Urinalyses showed nonbacterial pyuria and were negative for tuberculosis. All biopsy specimens showed infiltrations of granulocytes (mostly eosinophils) and mast cells within the bladder tissue. Medications produced only slight clinical improvements. Intravesical instillation of hyaluronan solution was performed for some patients and a significant improvement of lower urinary tract symptoms was observed.
Conclusions:   Although the dosage and duration of ketamine abuse causing severe side-effects are still unclear, some patients develop irreversible histological changes in the urinary tract. Therefore, clinicians should be aware of the negative effects of ketamine abuse on genitourinary tract function.     

小儿下尿路梗阻的球囊扩张治疗

目的探讨球囊导管扩张术治疗小儿下尿路梗阻的临床疗效.方法 1990年4月～2004年8月,收治下尿路梗阻患儿26例,年龄18 d～12岁,其中后尿道瓣膜23例,前尿道瓣膜2例,外伤性后尿道狭窄1例.术前常规行排尿性膀胱尿道造影确诊.双肾均有不同程度的肾盂及输尿管扩张.术前伴尿潴留及肾功能不良者行尿液引流及纠正电解质紊乱后,再行球囊扩张术.术中采用静脉氯胺酮麻醉,30%泛影葡胺作为球囊扩张剂,应用囊径分别为5、8和10 mm,囊长4 cm的球囊导管扩张尿道.术后常规留置双腔气囊导尿管.结果 23例后尿道瓣膜扩张28次,2例前尿道瓣膜扩张2次,1例后尿道狭窄扩张1次后症状好转改用金属探子扩张治疗后3个月治愈,扩张术中均可见球囊被挤压痕迹消失.术后1周拔管,患儿均排尿通畅,尿线增粗.6例术后1～3个月行膀胱输尿管防返流术返流消失.术后25例获随访1～13年,患儿生长发育良好,排尿通畅,双侧肾积水有不同程度的改善.结论球囊扩张术是小儿下尿路梗阻的一种有效的治疗方法,且安全简便.     

Sexual dysfunction in 1,274 European men suffering from lower urinary tract symptoms

PURPOSE: We determine the prevalence and bothersomeness of erectile and ejaculatory dysfunction in men with lower urinary tract symptoms suggestive of bladder outlet obstruction in real life practice, and analyze predictors of sexual dysfunction in this population. MATERIALS AND METHODS: Sexual function of 1,274 European men with lower urinary tract symptoms was assessed by the DAN-PSSsex questionnaire. The relationship between sexual dysfunction and selected clinical characteristics was analyzed. RESULTS: The proportion of sexually active men decreased from 91% in those 60 years old or younger to 60% in those 70 years old or older. Erectile dysfunction, reduced ejaculation and pain/discomfort on ejaculation were reported by 62%, 63% and 23% of patients, respectively. Erectile dysfunction strongly related with age (40% younger than 60 years, 80% 70 years old or older), lower urinary tract symptom severity (55% mild, 70% severe) and body mass index, hypertension and concomitant treatment with calcium channel antagonists. Reduced ejaculation was significantly related to age (42% younger than 60 years, 82% 70 years old or older), lower urinary tract symptom severity (55% mild, 68% severe) and previous benign prostatic hyperplasia surgery. Pain/discomfort on ejaculation was only related to lower urinary tract symptom severity (7% mild, 31% severe). Erectile dysfunction, reduced ejaculation and pain/discomfort on ejaculation were considered a problem by 96%, 82% and 91% of patients younger than 60 years, respectively. These 3 sexual symptoms were still highly bothersome in patients 70 years old or older. CONCLUSIONS: Erectile dysfunction and reduced ejaculation are highly prevalent in men with lower urinary tract symptoms, and are strongly related to increasing age and lower urinary tract symptom severity. Both these aspects of sexual dysfunction are also highly bothersome, even in advanced age. Sexual function should be carefully assessed in the initial evaluation of patients with lower urinary tract symptoms and in deciding on treatment options, as it may have a negative impact on sex life.     

Interstitial cystitis: a guide to recognition, evaluation, and management for nurse practitioners.

Interstitial cystitis (IC) is a chronic disorder of unknown etiology that affects the lower urinary tract of up to 500,000 women and men in the United States. It is characterized by bladder and pelvic pain that varies from moderate discomfort to severe, debilitating pain and related lower urinary tract symptoms including nocturia, diurnal urinary frequency, and urgency. Because the symptoms of IC superficially resemble a urinary tract infection, it is often misdiagnosed and may remain so for months or even years. This article discusses the clinical manifestations of IC, including its differentiation from acute or recurring bacterial cystitis. Options for managing this significant and often debilitating voiding dysfunction are also discussed.     

Ketamine cystitis: Its urological impact and management

Ketamine, an n-methyl-d-aspartic acid receptor complex antagonist, has been used as an anesthetic and/or analgesic. However, in the past decade, ketamine has been illegally available as a recreational drug in Asian countries and Taiwan. Due to the characteristic of being short-acting, youngsters widely assume that ketamine is not as harmful as other drugs, such as heroin. Consequently, many young patients used this drug for a longer duration before they presented with severe urinary frequency and urgency symptoms. Subsequently, other cases have been reported in Taiwan, Hong Kong, Singapore, Malaysia, and Europe. Ketamine abuse is increasing, with rates of 0.30% in 2006 to 0.40% in 2007 among those in the 16–59 year age group. In general, affected patients tend to be young with a peak age range of 16–35 years. The incidence of lower urinary tract symptoms in ketamine abuse patients is around 30%. The actual underlying pathomechanism of ketamine cystitis (KC) and associated pelvic pain remains unclear. It is speculated that chronic contact and stimulation to the bladder or ureteral mucosa due to metabolites of ketamine will result in submucosal edema, vascular ectasia, fibrosis, detrusor muscle inflammation, and fibrosis. Presentations of KC include remarkable dysuria, urinary frequency/urgency, urge incontinence, and bladder pain. Urine culture usually fails to yield any microbiology in KC with bladder pain alone. The majority of patients can enjoy clinical improvement after cessation of ketamine and urological treatment similar to interstitial cystitis/bladder pain syndrome (IC/BPS). However, patients who are still abusing ketamine and/or who have a longer duration of ketamine abuse might suffer from severe bladder pain, which does not respond to empirical oral or intravesical treatments such as hyaluronic acid. Among these patients, most have a remarkably impaired quality of life and are at risk of developing upper urinary tract damage, including hydronephrosis and kidney injury. To reduce bladder pain, improve quality of life, and avoid further deterioration of renal function, surgical intervention might be indicated.     

Destruction of the urinary tract by ketamine abuse: Hong Kong local experience

Aim: To report and analyze the disastrous effects of ketamine abuse on the urinary system seen in young Hong Kong patients. Methods: The hospital records of 80 ketamine abusers who attended the urology clinics of Princess Margaret Hospital and Tuen Mun Hospital were retrospectively reviewed. Their blood creatinine level, cystoscopic and urodynamic findings were analyzed. Results: Up to 30–50% of our patients had either contracted bladder with diminished bladder capacity (< 100 mL) or sonographic evidence of hydronephrosis Conclusion: Ketamine abuse can lead to structural damage of the entire urinary tract, but whether the damage is reversible after quitting ketamine abuse requires further studies.