Ketamine urinary tract

Mason K, Cottrell AM, Corrigan AG, Gillatt DA, Mitchelmore AE. Ketamine-associated lower urinary tract destruction a new radiological challenge. Clin Radiol... 

R Urinary tract dysfunction after recreational use of ketamine... 

Urinary tract dysfunction has been associated with recreational use of ketamine [43 ]. It was first described in a series of nine patients, all of whom were daily ketamine users, who presented with severe dys-uria, frequency, urgency, and gross hematuria [44 J. The urine cultures were sterile in all cases. CT scans showed marked thickening of the bladder wall, a small capacity, and perivesicular stranding, consistent with severe inflammation. All had severe ulcerative cystitis. Biopsies in four patients showed epithelial denudation and inflammation with a mild eosinophilic infiltrate. Withdrawal of ketamine, and treatment with pentosan polysulfate, gave symptomatic relief. 

In a retrospective chart review of 233 abusers of ketamine aged 13-60 (median 22) years, there were lower urinary tract symptoms in 12% [45 J. 

The cause of this complication is not known. One postulated mechanism is direct damage to the urinary tract mucosa from metabolites of ketamine causing submucosal inflammation and eventually edema and fibrosis microvascular changes may compromise the intrinsic microcirculation, causing neovascularization. The preponderance of abnormalities in the lower urinary tract may be due to increased time spent in contact with ketamine metabolites. 

A 26-year-old man, a known ketamine user, collapsed. He had previously had severe urinary tract dysfunction treated with antibiotics [5Z J. A CT scan of the abdomen showed bilateral hydronephrosis and cystoscopy showed a significantly reduced bladder capacity without ureteric obstruction. He was hypotensive, acidotic, and in acute renal failure and... 

A 19-year-old woman who had abused ketamine daily for 3 years developed severe lower urinary tract symptoms [57 ]. Her symptoms resolved after she took duloxetine 60 mg/day for 2 weeks. 

In 17 patients with ketamine-associated cystitis, who underwent urinary tract biopsies, the characteristic histopathological features were ulceration, eosinophilia, and atypical urothelium [6if]. Urine cytology in four patients showed hypercellularity and cellular atypia. Immunohistochemistry in 10 patients showed a high expression of p53 (9/10) and Ki67 (6/10) and no expression of CK20. Two had metaplastic changes. These markers are expressed in most cases of bladder carcinoma in situ, which... 

The radiological findings of this adverse reaction have been described in 23 patients, all with a history of ketamine abuse, who had severe lower urinary tract symptoms /62 7-... 

Storr TM, Quibell R. Can ketamine prescribed for pain cause damage to the urinary tract Palliat Med 2009 23(7) 670-2. 

Chao JY, Shai HA. Duloxetine treatment of long-term ketamine abuse-related lower urinary tract symptoms a case report. Gen Hosp Psychiatry 2010 32(6) 647.e5-6. 

Pal R, Balt S, Erowid E, Erowid F, Baggott MJ, Mendelson J, et al. Ketamine is associated with lower urinary tract signs and symptoms. Drug Alcohol Depend 2013 132 189-94. 

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