Neurogenic bladder and chronic urinary retention associated with MDMA abuse.
BACKGROUND
The use of 3,4-methylenedioxymethamphetamine (MDMA, known as "ecstasy"), a synthetic amphetamine and "club drug," has been associated with acute, transient urinary retention. We report a case of neurogenic bladder and chronic urinary retention associated with MDMA abuse.


METHODS
A 21-year-old male presented to the emergency department (ED) because he had abdominal pain and difficulty urinating. He had experienced difficulty in initiating urination over the past 1.5 months, with periods of 24 to 36 hours between voids and large volumes of urine. The patient had a chronic pattern of MDMA use, taking 4 tablets/day for 3 months. Two weeks before coming to the ED, he had been admitted to an inpatient drug rehabilitation center. During the time since that admission, the patient had visited EDs repeatedly for insertion and removal of Foley catheters to relieve the urinary retention until he could be admitted to a urologic service. Cystometrogram was abnormal, finding no sensation of bladder fullness after instillation of 350 mL of saline and inability to generate a voluntary voiding pressure. Cystoscopy revealed no outlet obstruction. The findings were consistent with neurogenic bladder. The patient was given prescriptions for bethanecol and phenazopyridine, and told to continue a 10-day course of sulfamethoxazole/trimethoprim for urinary tract infection. He was discharged with a Foley catheter in place. Symptoms of urinary retention persisted at 1-year follow-up, despite self-catheterization and complete cessation of MDMA use.


CONCLUSIONS
Chronic MDMA use may lead to neurogenic bladder and chronic urinary retention.
Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD, USA.
John R
JR
Beuerle
Fermin
F
Barrueto
D000328:Adult; D019969:Amphetamine-Related Disorders / Q000150:complications*; D000892:Anti-Infective Agents, Urinary / Q000627:therapeutic use; D018723:Bethanechol / Q000627:therapeutic use; D000697:Central Nervous System Stimulants / Q000009:adverse effects*; D002908:Chronic Disease; D003558:Cystoscopy; D006801:Humans; D008297:Male; D018721:Muscarinic Agonists / Q000627:therapeutic use; D018817:N-Methyl-3,4-methylenedioxyamphetamine / Q000009:adverse effects*; D010621:Phenazopyridine / Q000627:therapeutic use; D016896:Treatment Outcome; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000627:therapeutic use; D001750:Urinary Bladder, Neurogenic / Q000139:chemically induced* / Q000473:pathology / Q000628:therapy; D014546:Urinary Catheterization; D016055:Urinary Retention / Q000139:chemically induced* / Q000473:pathology / Q000628:therapy
D000892:Anti-Infective Agents, Urinary; D000697:Central Nervous System Stimulants; D018721:Muscarinic Agonists; D018723:Bethanechol; D015662:Trimethoprim, Sulfamethoxazole Drug Combination; D010621:Phenazopyridine; D018817:N-Methyl-3,4-methylenedioxyamphetamine