Objective:To assess the impact of ketamine abuse on genitourinary tract dysfunction. Methods: Eleven patients with urinary tract symptoms and a history of ketamine abuse in recent years were studied. Urinalysis, urine culture, renal function tests, abdominal sonography and urodynamic studies were done. Bladder biopsies were carried out in selected cases. Results: The most common complaints were lower urinary tract symptoms, including dysuria, frequency, urgency and gross hematuria. Urinalyses showed nonbacterial pyuria and were negative for tuberculosis. All biopsy specimens showed infiltrations of granulocytes (mostly eosinophils) and mast cells within the bladder tissue. Medications produced only slight clinical improvements. Intravesical instillation of hyaluronan solution was performed for some patients and a significant improvement of lower urinary tract symptoms was observed. Conclusions: Although the dosage and duration of ketamine abuse causing severe side-effects are still unclear, some patients develop irreversible histological changes in the urinary tract. Therefore, clinicians should be aware of the negative effects of ketamine abuse on genitourinary tract function.

No abstract

We thank Dr Wang for responding to our article. We had also faced this problem regarding the management of ketamine addiction in patients who cease taking the drug, although physical dependence has not been noted. 1 Therefore, during the treatment course, we also referred the patients to the psychology department and closely followed their condition. In addition, for the trials involving intravesical instillation of hyaluronan solution in our hospital, we selected only those patients who would actually obey our suggestions. In our limited cases and experiences, we found that in patients who are in an acute state of ketamine-related severe cystitis, a combination of ketamine cessation and intravesical instillation of hyaluronan solution provided immediate relief from the symptoms. Although this therapy could not resolve the irreversible pathological changes in the bladder, such as reduced bladder capacity, it alleviated symptoms such as cystitis and painful bladder. However, long-term follow up of the outcomes has not been carried out. Significantly, if the patient does not cease the ketamine abuse, none of the treatments will be effective in the long term. We also started to try to use animal models to clearly define the pathological changes in the bladder mucosa and determine the chronology and pattern of drug-induced histological changes in the bladder. These models might yield more information on the effects of ketamine in the urinary tract and facilitate identification of an adequate therapeutic method for this group of patients.