A Review of the Literature on Ketamine-Abuse-Uropathy

Background: From 2007 onwards reports of ketamine abuse uropathy have been reported from time to time in the medical literature but most medical practitioners and the public are not aware of the presentation, pathophysiology, investigation and management of this new entity Aims: To review the literature on ketamine-abuse uropathy. To summarise the investigation and management of the disease. Literature Review Literature search has revealed that: About 110 cases of Ketamine-abuse Uropathy (Ketamine-induced vesicopathy have so far been reported in the world. The effect of ketamine abuse on the urinary bladder is universally similar and the patients present with severe irritating lower urinary tract symptoms and haematuria. The patients also develop small bladder capacities, hydronephrosis and renal impairment. Histology of the bladder biopsy specimens consistently revealed cystitis and denudation of urothelium. Cessation of ketamine abuse before irreversible damage to the urinary tract leads to improvement or resolution of the symptoms. A Multi-disciplinary team approach is required in the management of Ketamine abuse uropathy. Management of Ketamine abuse uropathy entails psychological support; oral medications and counselling, insertion of nephrostomy or ureteric stent, management of renal failure including the possibility of dialysis and in intractable cases operative techniques including bladder substitution or augmentation cystoplasty may be required. A history of ketamine abuse, severe lower urinary tract symptoms and histological evidence of inflammation of a small capacity bladder in the absence of any other pathology of the urinary bladder is diagnostic of ke tam ine abuse u ropa thy (a l so ca l l ed ketamine-induced vesicopathy) Recommendation: There is a great need for the public to be educated about the devastating effect of Ketamine abuse on the urinary tract in order to dissuade people from abusing ketamine Introduction Ketamine is a drug which has been used both in human and veterinary medicine. Ketamine hydrochloride salt is sold as Ketalar, Ketanest, and Ketaset. Pharmacologically, Ketamine is classified as N-methyl D-aspartate (NMDA) receptor antagonist. [2] Ketamine which is a short acting anaesthetic is also being used in night clubs and dance parties as a recreational drug. Its adverse effects on lower urinary tract have been recently described by researchers. Despite sporadic reports of Ketamine Abuse Uropathy in the recent literature a number of practitioners and the public are not yet aware of the adverse effects of Ketamine abuse on the human urinary tract. In order to educate all health care workers and the public about the adverse effects of Ketamine abuse on the urinary tract, there is the need to review the literature on cases of Ketamine abuse uropathy that have so far been reported in the world literature. This paper contains a review of a number of cases of Ketamine abuse uropathy which have been reported in the literature.