Autotransplantation for the management of ketamine ureteritis

Abstract

Ketamine-associated cystitis is a well-recognised syndrome; yet upper urinary tract involvement remains poorly understood. We present the case of a 33-year-old man who developed ketamine-associated cystitis and ureteritis. The patient's severe bladder symptoms required subtotal cystectomy and orthotopic reconstruction. However, the associated ureteritis led to bilateral ureteric obstruction and renal failure. Bilateral autotransplantation with pyelovesicostomy was performed. This first case of autotransplantation for ketamine uropathy helps to demonstrate the potentially devastating effects of ketamine on the urinary tract.

Participants’ experiences of ketamine bladder syndrome: A qualitative study

“…However, in advanced stages, damage to the bladder and urinary tract are likely to be extensive, intractable and potentially irreversible. Such patients, most of whom are relatively young, may therefore require several invasive procedures and treatments for symptomatic relief, and in severe cases, bladder reconstruction or cystectomy, which will usually require costly, lifetime follow‐up . Other long‐term effects of chronic ketamine use are also poorly understood but can include lethargy, insomnia, impaired cognition, paranoia and psychosis .…”

Ketamine‐induced upper urinary tract lesions deserve more attention

“…Urologists focus on lower urinary symptoms because of several uncomfortable to the abusers, potential upper urinary lesions may be neglected by doctors. Recently, some serious upper urinary cases had been reported, and a separate attention should be paid on upper urinary tract including ketamine‐induced cystitis . We would like to update recent evidences on ketamine‐induced upper urinary tract lesions, and emphasis more attention on upper urinary tract system.…”

“…Recently, some serious upper urinary cases had been reported, and a separate attention should be paid on upper urinary tract including ketamine-induced cystitis. [5][6][7] We would like to update recent evidences on ketamine-induced upper urinary tract lesions, and emphasis more attention on upper urinary tract system.According to clinical prospective researches and retrospective cases summaries, the incidence of hydronephrosis (bilateral or unilateral) ranged from 6% to 64.3% in different centers. 7-10 Upper urinary tract lesions may be caused by these reasons 7,8 : (i) contracted, overactive bladder, and decreased compliant bladder; (ii) vesicoureteric reflux; (iii) ureteric wall thickness or obstruction; (iv) abnormal ureter peristalsis; and (v) acute papillary necrosis.…”

“…Recently, some serious upper urinary cases had been reported, and a separate attention should be paid on upper urinary tract including ketamine-induced cystitis. [5][6][7] We would like to update recent evidences on ketamine-induced upper urinary tract lesions, and emphasis more attention on upper urinary tract system.…”

Current approaches for the treatment of ketamine‐induced cystitis

“…Under regular follow-up, the patient's renal function was impaired but stable for 18 months postoperatively. 52 Surgical interventions have been used in KIC patients when all other options fail to provide adequate relief of symptoms. However, based on the literature there is considerable variations in outcomes following surgical interventions, with many patients experiencing recurrent symptoms and post-operative complications.…”