Cystitis due to the use of ketamine as a recreational drug: a case report

Abstract

IntroductionKetamine is a derivative of phencyclidine and is a dissociative anaesthetic. Its use as a recreational drug is on the increase among young adults attending clubs and parties.Case presentationWe describe the case of a 20-year-old man who presented with a 7-month history of urinary frequency, nocturia, urgency, suprapubic discomfort during micturition and episodes of severe haematuria shortly after commencing weekly recreational ketamine use. Complementary examinations were negative except for a thickened bladder wall on ultrasound examination and mild inflammatory changes on cystoscopy. So far only nine cases of ketamine-associated ulcerative cystitis have been described.ConclusionWe expect that in the future an increasing number of cases of cystitis caused by ketamine use will be seen in young adults.

Genitourinary toxicity of ketamine

“…There was no obvious atypia or malignancy. The features of the biopsy specimens were consistent with ulceration and chronic inflammation with high p53 immunoreactivity but negative for cytokeratin 20,26,35 and with moderate-to-high levels of immunohistochemical Ki67 reactivity. 35 These findings are important, as cytokeratin 20 has been associated with urothelial dysplasia and raises the suspicion of malignancy.…”

“…Multiple erythematous patches of the bladder biopsies with active cystitis were identified Colebunders and Van Erps, 20 2008…”

“…19 Other forms of pharmacotherapy are generally regarded as unsuccessful or show no obvious effect, though very few patients may enjoy symptomatic benefit. 1,13,[20][21][22] Regrettably, ketamine cessation is not an effective means of relieving all symptoms in every patient completely; symptoms may be partially alleviated only and impaired quality of life often persists. 1,8,23 It has been reported that after stopping of ketamine use, in about a third of cases LUTS resolve, in another third symptoms progress, and in the remainder there is no change.…”

“…11,16 Cystoscopic findings classically associated with IC are detailed in the Table. 1,2,7,8,[10][11][12][13][16][17][18]20,24,[26][27][28][29][30][31][32][33][34][35] They include low bladder capacity, contracted bladder, marked inflammation consistent with in-situ carcinoma or significant infection, 8 severe bladder ulceration, 1,16 multiple erythematous swelling 12,13 with necrotic mucosa, 13 various degrees of epithelial inflammation with neovascularisation and petechial haemorrhages, 11 or cystitis glandularis confirmed by biopsies only. 2 It has been noted that after cystodilation or cystoscopy on filling the bladder, there may be erythematous bladder bleeding, 21 glomerulation (bladder haemorrhages) and mucosal bleeding diffusely into the lumen, 28 and even persistent active bleeding from a bladder ulcer 16 (Fig 2).…”

Ketamine and damage to the urinary tract

“…This concept is supported by scientific findings demonstrating that neurobiological impairments in the neurocircuitry of the motivation-reward system underlie addiction [6]. Implicitly, to present with an 'addiction' and then a loss of control (LOC), it is necessary to have possessed a form of control previously, which supposes the ownership of a form of free will.…”