Ketamine uropathy: rising to the challenges of a new condition

Forster, James A.; Harrison, Simon

doi:10.1111/j.1464-410x.2012.10988.x

Cited by 13 publications

(12 citation statements)

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“…The recreational use of ketamine was first reported in the 1970s, and it has become increasingly common in the past 20 years [5]. An increase in ketamine use from 0.8% in 2007–2008 to 2.1% in 2010–2011 was noted among young people aged 16–24 years in the United Kingdom [6], and it has been the substance most commonly abused by teenagers since 2005 in Asian cities such as Hong Kong [7]. …”

Section: Introductionmentioning

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: Introductionmentioning

confidence: 99%

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

et al. 2017

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“…The urinary bladder is predominantly affected, although concomitant upper tract damage occurs in some patients . The exact mechanism for the injury is not fully understood but emerging evidence suggests a receptor‐mediated toxic effect of ketamine on the urothelium . Patients present typically with LUTS including severe urgency, urinary frequency, intermittent haematuria, nocturia, dysuria, and bladder pain .…”

Section: Introductionmentioning

confidence: 99%

“…In Hong Kong, ketamine is the most popular illicitly used psychotropic substance . An increase in ketamine use from 0.8% in 2007/2008 to 2.1% in 2010/2011 has also been noted among young people aged 16–24 years in the UK . It is unquestionable that there is a growing demand for a urology service to manage patients with ketamine‐associated uropathy, which may potentially become a heavy burden to the healthcare system.…”

Section: Introductionmentioning

confidence: 99%

“…Cystectomy with neobladder construction and augmentation cystoplasty have been reported in extreme cases . However, characteristics of patients other than the typical LUTS and cystoscopy findings are largely unknown and evidence‐based recommendations on investigations and treatment for such patients are completely lacking in the existing literature, given the paucity of prospective clinical studies and quality data . Prospective studies have been hampered by the difficulty in recruiting the patients who are always hidden youths in the community.…”

Section: Introductionmentioning

confidence: 99%

“…The mission of YUTC is to provide early urological assessment and treatment to young patients with ketamine‐associated uropathy, and to formulate a practical and cost‐effective management protocol by concentrating the experience in a single centre. In a national meeting focusing on ketamine‐associated uropathy held in the UK in 2011, the attendees expressed their view that cessation is beneficial to patients . A recent on‐line survey among non‐treatment‐seeking ketamine abusers in the UK found high‐dose and frequent users had higher prevalence rates of LUTS .…”

Section: Introductionmentioning

confidence: 99%

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One‐stop clinic for ketamine‐associated uropathy: report on service delivery model, patients' characteristics and non‐invasive investigations at baseline by a cross‐sectional study in a prospective cohort of 318 teenagers and young adults

Tam

Pang

et al. 2014

BJU International

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ObjectiveTo describe a service delivery model and report the baseline characteristics of patients investigated by a non-invasive approach for ketamine-associated uropathy. Patients and MethodsThis was a cross-sectional study in a prospective cohort of patients who attended their first visit and underwent non-invasive investigations at a dedicated centre to treat ketamine-associated uropathy in Hong Kong from December 2011 to July 2013. Data on demographics, illicit ketamine use, symptoms scores and voiding function parameters at baseline were prospectively collected. Differences between active abusers and ex-abusers, and risk factors for the most symptomatic group were investigated by univariate and multivariate analysis. ResultsIn all, 318 patients completed the non-invasive assessment at their first visit and were eligible for inclusion. In all, 174 were female and the mean (SD) age of the entire cohort was 24.4 (3.1) years. Patients had used ketamine for a mean (SD) period of 81 (36) months. The mean (SD) ketamine use per week was 18.5 (15.8) g. In all, 214 patients were active abusers while 104 were ex-abusers but had persistent lower urinary tract symptoms. The mean (SD) voided volume, bladder capacity, and bladder emptying efficiency were 111.5 (110) mL, 152.5 (126) mL and 73.3 (26.9)%, respectively. The ex-abusers had a lower symptom score (19.3 vs 24.1; P < 0.001), a larger voided volume (126 vs 85 mL; P < 0.001), and a larger bladder capacity (204.8 vs 126.7 mL; P < 0.001) compared with active abusers. Multivariate analysis found female gender was associated with a higher symptom score (odds ratio [OR] 2.39; 95% confidence interval [CI] 1.35-4.23; P = 0.003) and a smaller voided volume (OR 1.9; 95% CI 1.1-3.3; P = 0.02). Ketamine taken (g/week) was another risk factor for a higher symptom score (OR 1.03; 95% CI 1.01-1.05; P = 0.002). Status of ex-abuser was the only protective factor associated with fewer symptoms, larger voided volume and bladder capacity. ConclusionsAn effective service model for recruiting patients with ketamine-associated uropathy is possible. With such a service model as a platform, further prospective studies are warranted to investigate the appropriate choice of treatment for this new clinical entity.

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Clinical staging of ketamine-associated urinary dysfunction: a strategy for assessment and treatment

Wang

Huang

et al. 2016

World J Urol

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Ketamine uropathy: rising to the challenges of a new condition

Cited by 13 publications

References 10 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

One‐stop clinic for ketamine‐associated uropathy: report on service delivery model, patients' characteristics and non‐invasive investigations at baseline by a cross‐sectional study in a prospective cohort of 318 teenagers and young adults

Clinical staging of ketamine-associated urinary dysfunction: a strategy for assessment and treatment

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