Preliminary analysis for risk factors of upper urinary tract dysfunction associated with ketamine abuse

Abstract

Objective To identify the risk factors of chronic ketamine-induced upper urinary tract dysfunction(KUUTD). Methods Medical records of 103 patients with ketamine-associated urinary dysfunction(KAUD)from Sep. 2009 to Jul. 2015 were retrospectively reviewed. All the patients were divided into the upper urinary tract dysfunction group(n=39)or the normal group(n=64)according to the diagnostic criteria. Indexes such as general features(age, gender, BMI), drug-abusing characteristics(abusing time, frequency, dose, abstinent period), duration of LUTS, pelvic pain and urgency/frequency symptom score(PUF score), serum parameters(WBC, ALT, AST, γ-GT), bladder diary(daytime inter-void interval, nocturia, average urine volume), urodynamic data(maximum cystometric capacity, post-void residual, maximum urethral closure pressure, maximum and average flow rate, instable contraction, bladder compliance)and imaging manifestations were compared between the two groups. Logistic regression analysis was performed for the evaluation of variables with statistical significance. Results There was significantly difference between the two groups in BMI(t=2.127, P=0.043), drug-abusing frequency(t=2.335, P=0.029), abstinent period(t=3.451, P=0.003), duration of LUTS(t=2.289, P=0.036), PUF score(t=3.030, P=0.004), γ-GT value(t=2.697, P=0.012), MCC(t=5.056, P<0.001), MUCP(t=3.015, P=0.008), BC(t=8.562, P<0.001)and imaging findings of bladder contracture(χ2=15.155, P<0.001). The multivariate Logistic regression analysis showed that drug-abusing frequency(OR=1.279, P=0.038), abstinent period(OR=0.394, P=0.028), γ-GT value(OR=1.007, P=0.032), MCC(OR=0.775, P=0.011)and BC(OR=0.013, P=0.008)were the key factors of KUUTD. Conclusion Consecutive and frequent drug abuse, combination with chronic obstructive cholangitis, reduced capacity and low compliance bladder are the risk factors of upper urinary tract dysfunction associated with ketamine abuse. Key words: Ketamine; Drug abuse; Urinary dysfunction; Risk factors