Comparison of bladder autoaugmentation by transurethral vesicomyotomy and hydrodistention for ketamine cystitis

Abstract

Background: To illustrate the bladder autoaugmentation by transurethral vesicomyotomy (BATV) and compare the efficacy and safety of BATV to bladder hydrodistention (BH) for managing ketamine cystitis (KC). Methods:We retrospectively analyzed clinical data for 53 patients with KC who received surgical intervention between 2014 and 2019 at our hospital. Of these, 41 (77.4%) underwent BH and 12 (22.6%) were subjected to BATV, with a minimum of 1-year follow-up. These groups were compared with reference to urodynamic parameters, subjective symptom scores as well as all complications.Results: Both groups were matched in age, addiction time, preoperative urodynamic parameters, postvoid residual urinary volume (PVR), and symptom scores. All urodynamic parameters including maximum cystometric capacity (MCC), maximum detrusor pressure (P det max ), compliance, maximum urinary flow rate (Q max ) and symptom scores had improved significantly in two groups whether at 3 or 12 months. Moreover, the MCC was significantly increased after BATV than BH, at a mean [standard deviation (SD)] of 281.0 (25.7) vs. 213.5 (35.6) mL (P<0.001) at 12-month follow-up. The Q max and the Pelvic Pain and Urgency/Frequency (PUF) symptom score were still noted better in the BATV group at 3 months after surgery. Additionally, patients in both groups had similarly low rates of complications.Conclusions: BATV is superior to BH with increased bladder capacity and urodynamic outcomes, although showing equivalent in symptom relief and a similar rate of complications.

Newer therapies and surgical management of ketamine-induced uropathy: A review

“…Bladder Auto augmentation by Transurethral Vesicomyotomy (BATV) and Bladder Hydrodistention (BH) can be performed in patients with a curative intention and is an option between conservative and surgical management. 47 Tan et al studied the safety and efficacy of both in 53 patients with KC, of whom 41 underwent BH and 12 BATV. 47 Indications for surgery included patients with worsening Upper Urinary system, Maximum Cystometric Capacity (MCC) <150 ml, bladder compliance <30 ml/cmH 2 O, refractory and/or relapse KC.…”

“…After 1 year of a follow-up, BATV proved superior to BH in relation to Pelvic Pain and Urgency / Frequency (PUF) symptom score and MCC. 47 The Postvoidal Urinary Volume (PVR) was significantly raised in patients who underwent BATV at 12-month follow-up compared to BH patients with no significant change at any follow-up interval. 47…”

“…47 The Postvoidal Urinary Volume (PVR) was significantly raised in patients who underwent BATV at 12-month follow-up compared to BH patients with no significant change at any follow-up interval. 47…”

“…47 Indications for surgery included patients with worsening Upper Urinary system, Maximum Cystometric Capacity (MCC) <150 ml, bladder compliance <30 ml/cmH 2 O, refractory and/or relapse KC. 47 BATV involves longitudinal incision of the urinary bladder mucosa and detrusor with the usage of cystoresectoscope. 47 During BH, the pressure was continuously maintained at 60 cmH 2 O for 10 min.…”

“…47 BATV involves longitudinal incision of the urinary bladder mucosa and detrusor with the usage of cystoresectoscope. 47 During BH, the pressure was continuously maintained at 60 cmH 2 O for 10 min. After 1 year of a follow-up, BATV proved superior to BH in relation to Pelvic Pain and Urgency / Frequency (PUF) symptom score and MCC.…”