Urological Effects of Ketamine Abuse

Abstract

Emerging evidence has shown that long-term and chronic ketamine use or abuse can lead to damages in the urinary tract, a spectrum of clinical presentations from mild irritative lower tract symptoms to painful gross haematuria and renal damages. First reported by a Hong Kong group of urologists in 2007, the phenomenon has since then been identified worldwide. Most of the ketamine abusers were adolescents and young adults, and the symptomatology resembled those of chemical cystitis or interstitial cystitis. Endoscopic features of ulcerative cystitis, radiological features of thickened and contracted bladder wall with or without obstruction to upper urinary tract, and histopathological features of inflammation and fibrosis and urothelial metaplasia changes were described. With increasing clinical experience in managing this group of patients, clinical pathways and medical and surgical treatment options have been developed. Animal studies on the effects of ketamine exposure on the urinary system have also been conducted to help us understand the underlying pathophysiology for this distinct entity.