The clinical presentation and diagnosis of ketamine-associated urinary tract dysfunction in Singapore

Abstract

Ketamine is a short-acting anaesthetic agent that has gained popularity as a 'club drug' due to its hallucinogenic effects. Substance abuse should be considered in young adult patients who present with severe debilitating symptoms such as lower urinary tract symptoms, even though the use of controlled substances is rare in Singapore. Although the natural history of disease varies from person to person, a relationship between symptom severity and frequency/dosage of abuse has been established. It is important to be aware of this condition and have a high degree of clinical suspicion to enable early diagnosis and immediate initiation of multidisciplinary and holistic treatment. A delayed diagnosis can lead to irreversible pathological changes and increased morbidity among ketamine abusers.

Histopathological characteristics of ketamine‐associated uropathy and their clinical association

“…A previous study suggested that patients with interstitial cystitis/bladder pain syndrome (IC/BPS) and KU have similar clinical presentations and histological findings, such as mucosal inflammation with urothelial denudation . We further found that the inflammation in bladders with KU also involves the muscle and subserosal layers of the bladder.…”

“…A previous study suggested that patients with interstitial cystitis/bladder pain syndrome (IC/BPS) and KU have similar clinical presentations and histological findings, such as mucosal inflammation with urothelial denudation. 16 We further found that the inflammation in bladders with KU also involves the muscle and subserosal layers of the bladder. The histopathological changes in bladders with KU are more similar to eosinophilic cystitis (EC), which is characterized by bladder wall thickening, an eosinophilic predominant pancystitis, and may involve ureter change.…”

What urologists need to know about ketamine‐induced uropathy: A systematic review

“…Urine culture is usually negative. Sterile pyuria, red blood cells and proteinuria can be present at urinalysis 68 . Urine cytology is negative 3,4,60 .…”

Ketamine abuse potential and use disorder

“…Unlike first-time users of ketamine, patients with a history of chronic ketamine use commonly reported abdominal pain and urinary tract symptoms (Skeldon and Goldenberg, 2014). A number of cases reports suggest that ketamine abuse can cause suprapubic pain, dysurria and hematuria (Mason et al, 2010;Peng et al, 2014;Yek et al, 2015). Radiology results revealed decreased bladder volume, bladder wall thickening, musosal enhancement, dilation of ureter, and perivesical inflammation in ketamine abusers Wu et al, 2012).…”