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Ketamine-associated urinary tract pathology: The tip of the iceberg for urologists?

Ketamine-associated urinary tract pathology: The tip of the iceberg for urologists?

  1. Anonymous
    Angela M. Cottrell and David A. Gillatta
    British Journal of Medical and Surgical Urology Volume 1, Issue 3, November 2008, Pages 136-138

    Ketamine is a dissociative anaesthetic that is increasing in popularity as a recreational drug. We describe surgical management of a patient with severe bladder pathology associated with chronic ketamine use.
    A 27-year-old man presented to his local district general hospital with a history of severe suprapubic pain, urgency, frequency and haematuria and regular ketamine use. Investigations including renal function, renal tract ultrasound and urine cytology and culture were negative. Cystoscopy revealed a small capacity erythematous bladder which bled on filling and biopsies revealed an ulcerative, haemorrhagic cystitis. He was referred to a tertiary centre and his symptoms had deteriorated to frequency every 10 min, incontinence and severe suprapubic and perineal pain despite having stopped taking ketamine over 6 months previously. He was unable to achieve symptomatic relief with opiate analgesia, antispasmodics and anticholinergic medication. Six months after first presenting to an urologist he underwent cystoprostatectomy and neobladder formation following which recovery was unremarkable. Routine follow up revealed a unilateral abnormality of the distal ureter on IVU. He is currently awaiting further endoscopic management for this possible stricture. He denies further use of ketamine.