Ketamine-related Urological Complications: Radiological Features

Full Article

JTH Yeung, JKF Ma, KKM Kwok, AWT Yung, RLF Cheng, KC To, MK Yiu

Hong Kong J Radiol 2012;15:4-9

Objective: To describe the radiographical features of patients with ketamine-related urological complications.

Methods:All ketamine users who presented to the Urology Division of our hospital during June 2006 to July 2009 were included in this study. Investigations including renal function test, ultrasound, intravenous urogram, micturating cysto-urethrogram, antegrade pyelogram, renal scintigraphy, and computed tomography were performed as appropriate. Their medical records, radiological reports, and corresponding images were reviewed.

Results: A total of 36 patients were included in this study, in which 19% had bilateral hydronephrosis, 8% had unilateral hydronephrosis, and 72% of the patients had no hydronephrosis. Moreover, 6% of the patients with bilateral hydronephrosis had renal stones, and 6% had increased renal parenchymal echogenicity on ultrasound; 11% of patients had episodic or continuously elevated serum creatinine levels. Bilateral ureteral narrowing was demonstrated in 14% of the patients, and features of cystitis were documented in 39%. Bladder stones were detected in 6% of patients, and 11% had a percutaneous nephrostomy.

Conclusion: Ketamine abuse can lead to irreversible damage to the urinary tract, causing cystitis, urinary tract stones, hydronephrosis, renal parenchymal disease, and renal failure. Radiological investigations such as ultrasound and intravenous urogram have an important role in the assessment of these complications. Percutaneous nephrostomy offers relief of significant urinary tract obstruction.






方法:2006年6月至2009年7月期間,所有到本院泌尿科應診的氯胺酮濫用者都納入研究範圍。替病 人進行的檢查包括有腎功能測試、超聲、靜脈尿路造影、排尿式膀胱尿道造影、逆行腎盂造影、腎 核醫學閃爍造影及CT。回顧病人的病歷紀錄、放射學報告及有關圖像。

結果:本研究的36名病人中,19%有雙腎積水,8%有單腎積水,72%無腎積水。雙腎積水患者中6% 有腎石,6%超聲有腎實質性迴聲增强,11%有間歇或不斷上升的血清肌酐水平。14%病人有雙側輸 尿管收窄,39%有膀胱炎症狀。6%有膀胱石,11%接受經皮腎穿刺造瘻術。

結論:濫用氯胺酮可以對輸尿管道造成永久性傷害,引致膀胱炎、尿路結石、腎積水、腎實質性病 及腎衰竭。影像檢查如超聲及靜脈尿道顯影對於檢查這些併發症很重要。此外,經皮腎穿刺造瘻術 可以減輕尿路梗阻的病情。