Ketamine cystitis: practical considerations in management

Misra, Saumya; Chetwood, Andrew; Coker, Charles; Thomas, Philip

doi:10.3109/21681805.2014.909530

Cited by 33 publications

(30 citation statements)

References 14 publications

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“…While ketamine-induced urinary symptoms and pathology have sometimes been referred to as ketamine cystitis in the literature [12], the urological sequelae of ketamine abuse extend beyond the lower urinary tract. In the 59 patients with ketamine abuse reported by Chu et al [9], 30 (51%) were found to have either unilateral or bilateral hydronephrosis in the initial assessment.…”

Section: Discussionmentioning

confidence: 99%

The Risk of Upper Urinary Tract Involvement in Patients With Ketamine-Associated Uropathy

et al. 2017

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PurposeThe aims of this study were to investigate the prevalence of upper tract involvement in ketamine-associated uropathy, and to determine the predictors of hydronephrosis in patients with a history of ketamine abuse. MethodsThis was a cross-sectional study of a prospective cohort of patients with ketamine-associated uropathy. Data including demographics, pattern of ketamine abuse, pelvic pain and urgency or frequency (PUF) symptom score, uroflowmetry (UFM) parameters, serum renal function, and liver function tests were collected. Upon consultation, ultrasonography was performed to assess the function of the urinary system. ResultsFrom December 2011 to October 2015, we treated 572 patients with ketamine-associated uropathy. Of these patients, 207 (36.2%) had managed to achieve abstinence at the time of their first consultation. Ninety-six patients (16.8%) in the cohort were found to have hydronephrosis on ultrasonography. Univariate analysis identified age, duration of ketamine abuse, PUF symptom score, voided volume on UFM, serum creatinine levels >100 μmol/L, and an abnormal serum liver enzyme profile as factors associated with hydronephrosis. Logistic regression revealed the following parameters to be statistically related to hydronephrosis: age (adjusted odds ratio [OR], 1.090; 95% confidence interval [CI], 1.020–1.166; P=0.012), functional bladder capacity (adjusted OR, 0.997; 95% CI, 0.995–0.999; P=0.029), serum creatinine >100 μmol/L (adjusted OR, 3.107; 95% CI, 1.238–7.794; P=0.016, and an abnormal serum liver enzyme profile (adjusted OR, 1.967; 95% CI, 1.213–3.187; P=0.006). ConclusionsKetamine-associated uropathy can involve the upper urinary tract. Patient demographics as well as investigations of UFM, renal function tests, and liver function tests may allow us to identify at-risk patients.

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Section: Discussionmentioning

confidence: 99%

The Risk of Upper Urinary Tract Involvement in Patients With Ketamine-Associated Uropathy

et al. 2017

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“…However, none have shown lasting or significant success, especially if ketamine abuse continues 2. Treatment failure and disease progression often requires more invasive management ranging from hydrodistension to urinary diversion and augmentation cystoclasty 4 5. In contrast, few studies have commented on upper tract involvement.…”

Section: Discussionmentioning

confidence: 99%

Autotransplantation for the management of ketamine ureteritis

et al. 2015

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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.

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“…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.…”

Section: Dear Editormentioning

confidence: 99%

“…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 . Upper urinary tract lesions may be caused by these reasons: (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. The actual mechanisms of katemine‐induced upper urinary tract lesions need advanced investigations.…”

Section: Dear Editormentioning

confidence: 99%

Ketamine‐induced upper urinary tract lesions deserve more attention

Wang

Liang

Zhu

2016

Neurourology and Urodynamics

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Ketamine has been used as an anesthetic agent since 1960s, and as a recreational drug since 1990s.1 Bladder dysfunction is one of the complications in patients with ketamine abusing, and ketamine-induced cystitis was first reported in 2007. 2 Urologists had paid enough attentions to lower urinary tract syndromes since 2007; however, Wei and Yang 3 considered the ketamine-induced urological lesions labelling as ''ketemineinduced uropathy,'' because complex cystic pathological changes and upper urinary tract damages could be coexist. Wood 4 concluded that upper urinary tract should be paid enough attention because the whole urinary system could be at risk in ketamine-abused patients. Wood 4 also hold the viewpoint that CT may be not necessary if the renal function is within normal range and no hydronephrosis detected by ultrasound. 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. [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. 7-10Upper 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. The actual mechanisms of katemineinduced upper urinary tract lesions need advanced investigations. Abstinence of ketamine has been an effective method to relief LUTS caused by ketamine-induced cystitis. However, some pathological damages could not be completely reversed after cessation of ketamine, such as fibrosis of bladder wall. 8,10 Some urinary symptoms even deteriorate after cessation of ketamine.11 An earlier detection of upper urinary tract to monitor kidney function, a less burden and payment the patient would bear. Huang et al. 9 thought that renal function and imaging should be closely monitored because upper urinary tract lesions may progress rapidly. CT has been an useful tool in the aid of diagnosis upper urinary tract lesions and detection potential etiologies, such as ureteric wall thickness, obstruction, and other lesions. 9,12 We propose that renal function, plain and enhancement CT should be recommended in monitoring ketamine-induced uropathy, especially upper urinary tract involved, renal function, and lesions should be dynamically evaluated during long term follow-up.Upper urinary tract in ketamine-induced uropathy should be paid more attention for clinicians. Renal function and CT should be taken into considerations in clinical practice.Yours si...

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Ketamine cystitis: practical considerations in management

Cited by 33 publications

References 14 publications

The Risk of Upper Urinary Tract Involvement in Patients With Ketamine-Associated Uropathy

The Risk of Upper Urinary Tract Involvement in Patients With Ketamine-Associated Uropathy

Autotransplantation for the management of ketamine ureteritis

Ketamine‐induced upper urinary tract lesions deserve more attention

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