Impact of Histopathology and Bladder Dysfunction on the Treatment Strategy Selection of Ketamine‐Associated Cystitis
Jia‐Fong Jhang, Wan‐Ru Yu, Yuan‐Hong Jiang, Hann‐Chorng KuoABSTRACT
Objective
To investigate predictors for selecting an appropriate treatment strategy for ketamine‐associated cystitis (KC) due to chronic ketamine abuse for entertainment.
Methods
This retrospective study included 62 patients with KC who underwent baseline videourodynamics and bladder cold‐cup biopsy; 43 subsequently underwent AE and 19 continued conservative treatment. Histopathology–urodynamic associations were assessed using Spearman correlations. A parsimonious logistic model evaluated factors associated with subsequent AE. The exploratory five‐item histopathological score was assessed in complete cases with bootstrap resampling.
Results
Patients subsequently undergoing AE had lower first sensation of filling, fullness sensation, compliance, Q max , and voided volume, while cystoscopic maximal bladder capacity was not significantly different ( p = 0.085). Urothelial denudation severity correlated with lower first sensation ( ρ = −0.36, p = 0.017) and fullness sensation ( ρ = −0.49, p < 0.001). In the multivariable model ( N = 44), higher voided volume was associated with lower odds of AE (OR: 0.72 per 10 mL, 95% CI: 0.57–0.90, p = 0.004), whereas severe urothelial denudation was associated with higher odds (OR: 27.24, 95% CI: 1.73–428.36, p = 0.019). The complete‐case score ( N = 50) had AUC 0.941 (bootstrap 95% CI: 0.875–0.988); cutoff ≥ 2 yielded 94.4% sensitivity and 78.6% specificity.
Conclusion
Lower voided volume and severe urothelial denudation were associated with subsequent AE. The composite histopathological score is exploratory and requires external validation.