Abstract: PD38-08
Sources of Funding: none

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, haematuria and renal failure. _x000D_ _x000D_ The aim of this study was to evaluate management strategies and outcomes in patients undergoing surgical intervention following damage to their urinary tract associated with ketamine use. _x000D_

Methods

A retrospective review of prospectively collected data between 2007 and 2015 was performed. 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 (mean 190 mls, range 70-550). _x000D_ _x000D_ 29 patients were treated conservatively with a view to symptom resolution. 2 patients underwent dilatation for urethral strictures. 4 patients underwent repeated intra-detrusor onabotulinum toxin injection with minimal subjective symptom relief. 2 of these patients proceeded to have major reconstruction._x000D_ 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 one or more complications requiring additional intervention _x000D_ _x000D_ Complications included urine leak (1/7), anastomotic leak (2/7), adhesional small bowel obstruction (1/7), wound necrosis (1/7), ureteric stricture (3/7) and Mitrofanoff stenosis (1/7). One patient was lost to follow up and there was 1 death from pneumonia 5 years following and unrelated to surgery. _x000D_

Conclusions

In a tertiary, high volume reconstructive unit we found ketamine patients seemed to be at particular risk of significant peri-operative complications. There did not appear to be any other common factor apart from their use of ketamine and the significant inflammatory change associated with its misuse. _x000D_ _x000D_ We therefore recommend meticulous pre-operative evaluation and multidisciplinary consultation for all patients to determine optimal treatment strategies prior to undertaking major bladder reconstructive surgery. _x000D_

Funding

none