Efficacy of cystectasia in the treatment of ketamine-induced bladder contracture

Background: The treatment of ketamine-induced bladder contractures remains poorly studied. We therefore evaluated the efficacy of cystectasia with a sodium hyaluronate balanced solution in this kind of bladder contracture. Methods: Eighteen patients presenting with ketamine-induced bladder contracture between July 2010 and February 2018 were selected and analysed. Ketamine was discontinued in all patients, who were then treated with weekly cystectasia (0.09% sodium hyaluronate balanced solution) 3 times. The volume of the first perfusion was twice the preoperatively measured bladder capacity, and the volume of the subsequent two perfusions was increased by 100 mL each time. The Pelvic Pain and Urgency/Frequency (PUF) symptom score, O'Leary-Sant Interstitial Cystitis (IC) Symptom Index (ICSI), IC Problem Index (ICPI), Quality of Life (QOL) score, and bladder capacity were recorded before surgery and 3 and 12 months after the 3rd expansion. Results: No significant complications were observed during the 3 expansions. Fourteen patients completed the full follow-up schedule. Preoperatively and at the 3- and 12-month follow-up evaluations performed after the 3rd expansion, the PUF symptom scores were 20.4 +/- 3.6, 11.5 +/- 3.1, and 13.2 +/- 3.3, respectively; the mean ICSI was 13.6 +/- 2.8, 7.7 +/- 2.3, and 8.2 +/- 2.5, respectively; the mean ICPI was 10.6 +/- 2.6, 7.3 +/- 2.1, and 7.7 +/- 2.5, respectively; and the mean QOL scores were 6.0 +/- 0, 2.1 +/- 0.5, and 2.7 +/- 0.8, respectively; and the mean bladder catheter volume was 83 +/- 27, 234 +/- 56, and 228 +/- 52 mL, respectively. There were significant differences between all preoperative and postoperative values. Conclusions: Cystectasia with a sodium hyaluronate balanced solution is an effective treatment modality for ketamine-induced bladder contracture.