Ketamine‐induced upper urinary tract lesions deserve more attention

Abstract

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...

Epidemiologic characteristics and risk factors in patients with ketamine-associated lower urinary tract symptoms accompanied by urinary tract infection

“…[6,15] Hydronephrosis in patients with KAC, which prevalence varies in different studies, is another important urinary problem that may be misdiagnosed and incorrectly treated. [4,16] In a recent study involving 512 individuals with a history of ketamine use, 96 (16.8%) were found to have hydronephrosis. [17] The risk factors for hydronephrosis included older age, smaller bladder capacity, abnormal serum creatinine, and abnormal liver enzymes.…”

Dysuria due to benign prostatic hyperplasia of the median lobe with ketamine-associated uropathy in a young male

“…Ketamine-induced upper urinary tract lesions seem not to be paid enough attention due to a greater incidence of apparent lower urinary tract syndromes [16]. Hydronephrosis and ureteral wall thickening were reported most frequently in ketamine-induced upper urinary tract damage.…”