Drug points: Urinary retention with misuse of “ecstasy”

Dr A A BRYDEN, Mr P J N ROTHWELL, and Mr P H O'REILLY, (Stepping Hill Hospital, Stockport, Cheshire 5K2 7JE) write: A healthy 19 year old man was referred to us with a 24 hour history of acute retention of urine. Other than a painful palpable bladder, general examination and analysis of urine showed nothing abnormal. We inserted a urethral catheter and removed it after 36 hours on free drainage. No further retention of urine occurred. He gave a history of drug misuse which included taking amphetamine and smoking marijuana. For 12 months before admission, however, he had used only 3, 4-methylenedioxymethamphetamine (ecstasy), taking one or two tablets once or twice a week, usually at parties. He later admitted to having taken 15 tablets during the 36 hours before admission.

3, 4-Methylenedioxymethamphetamine is a synthetic amphetamine analogue, structurally similar to methamphetamine. It is a “designer drug,” widely and illegally used for its psychotropic effects. Reported complications include trismus, loss of appetite, chest pain, aching muscles, sweating, and high fever.1 2 To our knowledge, the only urological complication previously noted was urgency of micturition.3

The bladder is innervated by both (alpha) and ß adrenergic neurones; ß adrenergic neurones supply the detrusor muscle, (alpha) adrenergic fibres supply the trigone and the bladder neck. Blocking (alpha) adrenergic fibres relaxes the bladder neck, thus relieving symptoms of urinary retention. Conversely, stimulation of (alpha) adrenergic fibres can produce bladder neck dysfunction or closure. 3, 4-Methylenedioxymethamphetamine is a potent (alpha) adrenergic agonist, and its misuse in this case almost certainly led to acute urinary retention. The effect of amphetamine on the bladder has been reported previously.4 In view of this case, and the widespread use of 3, 4-methylenedioxymethamphetamine we recommend that synthetic amphetamine misuse be considered in cases of unexplained urinary retention among young people.