title: Ketorolac suppresses postoperative bladder spasms after pediatric ureteral reimplantation.
abstract: We evaluated the efficacy of ketorolac in suppressing postoperative bladder spasms after ureteroneocystostomy (ureteral reimplantation). Twenty-four pediatric patients undergoing intravesical ureteroneocystostomy were enrolled prospectively to receive either ketorolac or placebo via double-blinded randomization. Twelve patients in each group shared similar preoperative characteristics. All were maintained on an epidural infusion of bupivacaine (0.1%) with fentanyl (2 microg/mL) throughout the study. Patients were given either ketorolac (0.5 mg. kg(-1). dose(-1)) or placebo (equivalent volume saline) IV after surgery and every 6 h thereafter for 48 h. Parents were instructed to record bladder spasm episodes prospectively by using a standardized time-flow diary. Three patients (25%) in the ketorolac group experienced bladder spasms, compared with 10 patients (83%) in the placebo group (two-sided P < 0.05). The median severity score for the ketorolac group was 1.2 (mild = 1.0, severe = 3.0), compared with 2.6 for the placebo group (P = 0.003). We conclude that IV ketorolac reduces the frequency and severity of postoperative bladder spasms after intravesical ureteroneocystostomy.
  
  
  CONCLUSIONS
  We studied the efficacy of ketorolac, a prostaglandin synthesis inhibitor, in the treatment of bladder spasm after ureteroneocystostomy (antireflux operation). Patients were randomized in a double-blinded manner to receive either ketorolac or placebo after the surgery. We demonstrate that ketorolac reduces the frequency and severity of postoperative bladder spasm.
authors.affiliation: Department of Urology, The Children's Hospital and Harvard Medical School, Boston, MA, USA. jmpark@umich.edu
authors.forename: J M
authors.initials: JM
authors.lastname: Park
authors.forename: C S
authors.initials: CS
authors.lastname: Houck
authors.forename: N F
authors.initials: NF
authors.lastname: Sethna
authors.forename: L J
authors.initials: LJ
authors.lastname: Sullivan
authors.forename: A
authors.initials: A
authors.lastname: Atala
authors.forename: J G
authors.initials: JG
authors.lastname: Borer
authors.forename: B G
authors.initials: BG
authors.lastname: Cilento
authors.forename: D A
authors.initials: DA
authors.lastname: Diamond
authors.forename: C A
authors.initials: CA
authors.lastname: Peters
authors.forename: A B
authors.initials: AB
authors.lastname: Retik
authors.forename: S B
authors.initials: SB
authors.lastname: Bauer
mesh_terms: D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D003559:Cystostomy / Q000009:adverse effects*; D004311:Double-Blind Method; D006801:Humans; D020910:Ketorolac / Q000627:therapeutic use*; D011183:Postoperative Complications / Q000517:prevention & control*; D011446:Prospective Studies; D013035:Spasm / Q000209:etiology / Q000517:prevention & control*; D014519:Ureterostomy / Q000009:adverse effects*; D001745:Urinary Bladder Diseases / Q000209:etiology / Q000517:prevention & control*; D014718:Vesico-Ureteral Reflux / Q000601:surgery
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D020910:Ketorolac