Does the use of recreational Ketamine pose a challenge on bladder reconstruction?
Author(s):
Dr Neha Sihra
,
Dr Neha Sihra
Affiliations:
Mr Simon Rajendran
,
Mr Simon Rajendran
Affiliations:
Mr Jeremy Ockrim
,
Mr Jeremy Ockrim
Affiliations:
Mr Dan Wood
Mr Dan Wood
Affiliations:
BAUS ePoster online library. Sihra N. 06/27/17; 177370; P4-4
Ms. Neha Sihra
Ms. Neha Sihra
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Abstract
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Introduction:
Regular use of recreational ketamine causes severe damage to the urinary tract. Patients present with a spectrum of debilitating symptoms including pain, urinary frequency and haematuria. The aim of this study was to evaluate management strategies and outcomes in those undergoing surgical intervention.

Materials & Methods:
A retrospective review of prospectively collected data between 2007 and 2015. Evaluation included CT urogram, cystoscopic evaluation of bladder capacity +/- biopsy. Indications and outcomes for surgical intervention were assessed.

Results:
42 patients were identified. 63% were male and mean age at presentation was 28.7 (range 23-55). All bladder biopsies confirmed an eosinophilic inflammatory infiltrate. A significant proportion of patients (83.3%) were found to have reduced cystoscopic and functional bladder capacity of <300 ml.

29 patients were treated conservatively with a view to symptom resolution. 2 patients underwent dilatation for urethral strictures. 4 patients underwent repeated intra-detrusor Botox injection with minimal subjective symptom relief.
13 patients underwent reconstruction which included simple cystectomy (5/13), substitution cystoplasty (6/13), augmentation cystoplasty (6/13), ileal conduit diversion (1/13), ureteric interposition using ileum (2/13) and appendix Mitrofanoff formation (6/13). Of these patients 53.8% (7/13) had ≥1 complications requiring additional intervention.

Complications included urine leak (1/7), anastomotic leak (2/7), small bowel obstruction (1/7), wound necrosis (1/7), ureteric stricture (3/7) and Mitrofanoff stenosis (1/7).

Conclusion:
In a tertiary, high volume reconstructive unit we found ketamine patients to be at particular risk of significant perioperative complications. We recommend meticulous preoperative evaluation and multidisciplinary consultation for all patients to determine optimal treatment strategies.
Introduction:
Regular use of recreational ketamine causes severe damage to the urinary tract. Patients present with a spectrum of debilitating symptoms including pain, urinary frequency and haematuria. The aim of this study was to evaluate management strategies and outcomes in those undergoing surgical intervention.

Materials & Methods:
A retrospective review of prospectively collected data between 2007 and 2015. Evaluation included CT urogram, cystoscopic evaluation of bladder capacity +/- biopsy. Indications and outcomes for surgical intervention were assessed.

Results:
42 patients were identified. 63% were male and mean age at presentation was 28.7 (range 23-55). All bladder biopsies confirmed an eosinophilic inflammatory infiltrate. A significant proportion of patients (83.3%) were found to have reduced cystoscopic and functional bladder capacity of <300 ml.

29 patients were treated conservatively with a view to symptom resolution. 2 patients underwent dilatation for urethral strictures. 4 patients underwent repeated intra-detrusor Botox injection with minimal subjective symptom relief.
13 patients underwent reconstruction which included simple cystectomy (5/13), substitution cystoplasty (6/13), augmentation cystoplasty (6/13), ileal conduit diversion (1/13), ureteric interposition using ileum (2/13) and appendix Mitrofanoff formation (6/13). Of these patients 53.8% (7/13) had ≥1 complications requiring additional intervention.

Complications included urine leak (1/7), anastomotic leak (2/7), small bowel obstruction (1/7), wound necrosis (1/7), ureteric stricture (3/7) and Mitrofanoff stenosis (1/7).

Conclusion:
In a tertiary, high volume reconstructive unit we found ketamine patients to be at particular risk of significant perioperative complications. We recommend meticulous preoperative evaluation and multidisciplinary consultation for all patients to determine optimal treatment strategies.
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