Effective treatment of ketamine-associated cystitis with botulinum toxin type a injection combined with bladder hydrodistention

Zeng, Jianfeng; Lai, Haibiao; Zheng, Dongxiang; Liu, Zhong; Huang, Zhifeng; Wang, Shanyun; Zou, Weiwei; Wei, Lianbo

doi:10.1177/0300060517693956

Cited by 25 publications

(19 citation statements)

References 27 publications

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“…In the current study, intravesical botulinum injection had the highest response rate among different kinds of intravesical therapy; however, the patient number was small. This result is compatible with that of a previous study 17 . Nonetheless, whether this should be considered as a primary therapy for ketamine cystitis needs further investigation.…”

Section: Discussionsupporting

confidence: 94%

A survey for ketamine abuse and its relation to the lower urinary tract symptoms in Taiwan

Cha

et al. 2019

Sci Rep

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We aimed to explore the correlation between ketamine abuse and lower urinary tract symptoms (LUTS) and epidemiology of ketamine cystitis. Questionnaire records of ketamine abusers, such as sex, age, and details of using ketamine, including consumption method, amount, duration of ketamine use, and LUTS, were obtained from two private rehabilitation centers. We analyzed these factors and established a severity forecasting module. One hundred and six ketamine abusers completed the questionnaires. LUTS showed an onset time of 24.67 ± 26.36 months among ketamine abusers. Overactive bladder symptom score, international prostate symptom score-storage, interstitial cystitis symptom index, interstitial cystitis problem index, and visual analogue scale score were 5.25 ± 4.43, 5.95 ± 5.72, 10.96 ± 6.66, 9.73 ± 5.82, and 2.55 ± 3.18, respectively. All symptom scores were positively correlated with the duration of ketamine abuse. Ketamine snorting was significantly correlated with all symptom scores compared to smoking. Hydrodistention, intravesical hyaluronic acid instillation, intravesical injection with botulinum toxin, and hyperbaric-oxygen therapy showed better effect than oral treatment. Ketamine can induce severe storage symptoms, such as frequency or nocturia depending on the duration of abuse. Ketamine snorting may cause worse LUTS than smoking. Combining ketamine and other substances may exacerbate LUTS. Intravesical therapy may lead to better outcomes than oral treatment.

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Section: Discussionsupporting

confidence: 94%

A survey for ketamine abuse and its relation to the lower urinary tract symptoms in Taiwan

Cha

et al. 2019

Sci Rep

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“…We also study two of them, the dissociative NPS, diphenidine (DPH) and its methoxylated derivative 2-methoxydiphenidine (methoxphenidine, 2-MXP/MXP), in vitro using the above neurobiological methods. DPH and 2-MXP replaced a ketamine-like drug methoxetamine (MXE) which was banned the UK in 2013; MXE was branded as a bladder-friendly ketamine, while ketamine has been associated with cystitis and bladder fibrosis [ 19 , 20 ].…”

Section: Introductionmentioning

confidence: 99%

Mechanistic Insights into the Stimulant Properties of Novel Psychoactive Substances (NPS) and Their Discrimination by the Dopamine Transporter—In Silico and In Vitro Exploration of Dissociative Diarylethylamines

et al. 2018

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Novel psychoactive substances (NPS) may have unsuspected addiction potential through possessing stimulant properties. Stimulants normally act at the dopamine transporter (DAT) and thus increase dopamine (DA) availability in the brain, including nucleus accumbens, within the reward and addiction pathway. This paper aims to assess DAT responses to dissociative diarylethylamine NPS by means of in vitro and in silico approaches. We compared diphenidine (DPH) and 2-methoxydiphenidine (methoxphenidine, 2-MXP/MXP) for their binding to rat DAT, using autoradiography assessment of [125I]RTI-121 displacement in rat striatal sections. The drugs’ effects on electrically-evoked DA efflux were measured by means of fast cyclic voltammetry in rat accumbens slices. Computational modeling, molecular dynamics and alchemical free energy simulations were used to analyse the atomistic changes within DAT in response to each of the five dissociatives: DPH, 2-MXP, 3-MXP, 4-MXP and 2-Cl-DPH, and to calculate their relative binding free energy. DPH increased DA efflux as a result of its binding to DAT, whereas MXP had no significant effect on either DAT binding or evoked DA efflux. Our computational findings corroborate the above and explain the conformational responses and atomistic processes within DAT during its interactions with the dissociative NPS. We suggest DPH can have addictive liability, unlike MXP, despite the chemical similarities of these two NPS.

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“…Intravesical injection of botulinum toxin‐A also proved to be a reasonable treatment. Zeng et al reported good functional results of an intravesical dose of 200 UI combined with bladder hydrodistension in 36 patients who previously failed antimuscarinic treatment 80 . One month after treatment, all patients showed symptom relief, and the bladder capacity, time between micturition and voided volume improvement.…”

Section: Evidencementioning

confidence: 99%

What urologists need to know about ketamine‐induced uropathy: A systematic review

Castellani

Pirola

Gubbiotti

et al. 2020

Neurourology and Urodynamics

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Aims: Ketamine is a general anesthetic. Dissociative effects and low cost led ketamine becoming an illegal recreational drug in young adults. Ketamineinduced uropathy (KIU) is one of the complications observed in abusers. This study aimed to provide a systematic literature review on KIU clinical presentation, pathophysiology, and treatments. Methods: We performed the literature search in PubMed, Web of Science, Scopus, and Embase using the terms ketamine and bladder. English papers on human and animal studies were accepted. Results: A total of 75 papers were selected. Regular ketamine users complain about severe storage symptoms and pelvic pain. Hydronephrosis may develop in long-term abusers and is correlated to the contracted bladder, ureteral stenosis, or vesicoureteral reflux due to ureteral involvement and/or bladder fibrosis. Cystoscopy shows ulcerative cystitis. Ketamine in urine might exert direct toxicity to the urothelium, disrupting its barrier function and enhancing cell apoptosis. The presence of ketamine/ions in the bladder wall result in neurogenic/IgE-mediated inflammation, stimulation of the inducible nitric oxide synthase-cytokines-cyclooxygenase pathway with persistent inflammation and fibrosis. Abstinence is the first therapeutic step. Anti-inflammatory drugs, analgesics and anticholinergics, intravesical instillation of hyaluronic acid, hydrodistension and intravesical injection of botulin toxin-A were helpful in patients with early-stage KIU. In patients with end-stage disease, the control of intractable symptoms and the increase of bladder capacity were the main recommendations to perform augmentation enterocystoplasty.Conclusions: KIU is becoming a worldwide health concern, which should be taken into account in the differential diagnosis of ulcerative cystitis. K E Y W O R D S cystitis, inflammation, ketamine, lower urinary tract symptoms, substance-related disorders, urinary tract 1050 | CASTELLANI ET AL.

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Effective treatment of ketamine-associated cystitis with botulinum toxin type a injection combined with bladder hydrodistention

Cited by 25 publications

References 27 publications

A survey for ketamine abuse and its relation to the lower urinary tract symptoms in Taiwan

A survey for ketamine abuse and its relation to the lower urinary tract symptoms in Taiwan

Mechanistic Insights into the Stimulant Properties of Novel Psychoactive Substances (NPS) and Their Discrimination by the Dopamine Transporter—In Silico and In Vitro Exploration of Dissociative Diarylethylamines

What urologists need to know about ketamine‐induced uropathy: A systematic review

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