Systematic review and meta-analysis of ketamine-associated uropathy

Chan, Erica On-Ting; Chan, Vinson Ws; Tang, Tori ST; Cheung, Vanessa; Wong, Martin Cs; Yee, Chi‐Hang; Ng, CF; Teoh, Jeremy YC

doi:10.12809/hkmj209194

Cited by 4 publications

(4 citation statements)

References 27 publications

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“…Sixty percent of patients diagnosed with KIU experienced increased urinary frequency, nocturia, urgency and intolerable suprapubic pain. 9 Dysuria, haematuria and urinary incontinence prevailed by 40%–50%. 9 KIU also involves chronic bladder inflammation, ureteral wall thickening, dysuria and upper urinary tract symptoms.…”

Section: Resultsmentioning

confidence: 99%

“…9 Dysuria, haematuria and urinary incontinence prevailed by 40%–50%. 9 KIU also involves chronic bladder inflammation, ureteral wall thickening, dysuria and upper urinary tract symptoms. 10–12 Hydronephrosis affects 30% of ketamine patients, whereas nearly 20% presented with ureteric strictures and less than 10% with impaired kidney function.…”

Section: Resultsmentioning

confidence: 99%

“…[10][11][12] Hydronephrosis affects 30% of ketamine patients, whereas nearly 20% presented with ureteric strictures and less than 10% with impaired kidney function. 9 Most recreational drug abusers are poly-substance users, and it is uncertain whether ketamine is directly related to urinary toxicity. 13 The timeframe required to cause irreversible damage to the urinary system remains unclear.…”

Section: Clinical Presentationmentioning

confidence: 99%

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Newer therapies and surgical management of ketamine-induced uropathy: A review

Katsiari,

Bae,

Darlington Carbin Joseph

et al. 2023

Urologia

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Background and Aims: Ketamine use as a recreational drug is becoming more popular nowadays. Ketamine-induced uropathy (KIU) is a late finding observed with long-term use of ketamine. A systematic review of Ketamine-Induced Uropathy was performed to emphasise its key clinical manifestations, mechanism of action and establish an effective treatment pathway. Methods and Results: A literature search was conducted in MEDLINE via Pubmed and Cochrane using the keywords ketamine and bladder, ketamine and uropathy, and ketamine and epidemiology. The search strategy was limited to articles published from 2000 to 2023. Both animal and human studies were included. A total of 101 papers were reviewed based on topic relevance from the title and abstracts available. While ketamine is a controlled drug in the United Kingdom (UK) and other countries, 283 ketamine-related deaths have been reported in the UK. There is no definite pathogenesis but multiple potential mechanisms that cause KIU and its related symptoms. KIU involves chronic inflammation of the bladder, ureteral wall thickening, hydronephrosis and finally, chronic renal failure. A multidisciplinary approach is paramount when managing these patients to break the vicious cycle. The mainstay of medical and surgical treatment pathways is continued abstinence to prevent symptom relapse. This review included the pathophysiology, novel medical treatments and surgical management of KIU. Conclusion: KIU is a rare but significantly disabling condition often seen among ketamine abusers. With the rising trend in drug addiction, KIU is expected to be more common. Unfortunately, it is a late complication in chronic ketamine abusers and is only partially reversible even with abstinence. This review discusses this rare entity’s newer medical treatments and surgical options.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Clinical Presentationmentioning

confidence: 99%

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Newer therapies and surgical management of ketamine-induced uropathy: A review

Katsiari,

Bae,

Darlington Carbin Joseph

et al. 2023

Urologia

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“…In severe forms, the bladder mucosa tends to be very friable and 'shed'. On distension ulcerations/lacerations can develop [19,20].…”

Section: Reviewmentioning

confidence: 99%

British Association of Urological Surgeons Consensus statements on the management of ketamine uropathy

Belal,

Downey,

Doherty

et al. 2024

BJU International

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ObjectivesTo provide guidance in the form of consensus statement in the management of ketamine uropathy.MethodsA literature review of ketamine uropathy was performed. The consensus method was of a modified nominal group technique and has been use in the previous British Association of Urological Surgeons (BAUS) consensus documents and was led by the Female, Neurological and Urodynamic Urology Section of the BAUS.ResultsA number of consensus statements detailing the assessment and management of urological complications relate to the recreational use of ketamine (ketamine uropathy) in both elective and emergency urology settings.ConclusionComprehensive management pathway for ketamine‐related urinary tract dysfunction and uropathy has been detailed.

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Importance of well-designed meta-analyses in assessing medical and surgical treatments

2023

World J Meta-Anal

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When evaluating the efficacy of medical or surgical treatments, the most robust study design is often considered to be the high-quality randomized clinical trial (RCT). However, the true answer lies in the meta-analysis of high-quality RCTs. While RCTs have their merits, meta-analyses possess two crucial qualities that make them superior: generalizability and the ability to verify replicability across different trials. A well-designed meta-analysis, defined here as a systematic review that pools data, holds significant advantages over individual RCTs. Retrospective and observational surgical research is prone to biases that are not mutually offsetting; instead, they accumulate. Selection bias, transfer bias, and assessment bias all taint retrospective studies more than randomized trials, making the novel treatment appear more effective than it truly is. Pooling studies suffering from these limitations in a meta-analysis amplifies these biases, causing an overestimation of treatment benefits. This becomes particularly concerning when the treatment itself carries substantial risks, as is often the case in surgical journals. The consequences can result in harm or even death for patients. While a well-designed meta-analysis is the best tool for assessing medical and surgical treatments, a weak meta-analysis amplifies biases and promotes flawed data. Thoughtful readers must become proficient in honing their methodological toolkits, delving deeper into topics like heterogeneity and publication bias. It is essential to avoid wasting time on meta-analyses drawing data from retrospective or observational research regarding surgical treatments.

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Systematic review and meta-analysis of ketamine-associated uropathy

Cited by 4 publications

References 27 publications

Newer therapies and surgical management of ketamine-induced uropathy: A review

Newer therapies and surgical management of ketamine-induced uropathy: A review

British Association of Urological Surgeons Consensus statements on the management of ketamine uropathy

Importance of well-designed meta-analyses in assessing medical and surgical treatments

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