Ketamine cystitis: practical considerations in management

`Objective. The aim of this study was to investigate and report the clinical spectrum and practical problems in the management of a cohort of patients presenting with lower urinary tract symptoms (LUTS) related to abuse of ketamine. Material and methods. The clinical presentation, cystoscopic findings, radiological features and outcomes of patients presenting with LUTS related to ketamine abuse between January 2008 and April 2013 were retrospectively reviewed and analysed. Results. In total, 34 patients were seen during this period. All patients had LUTS, haematuria and abdominal pain to varying degrees. Two patients (7%) had a concomitant urinary tract infection. Upper tract imaging was carried out in 18 out of 34 patients and bilateral hydronephrosis was found in two cases (6%). Cystoscopy showed a small inflamed bladder (capacity 60-350 ml) in 14 out of the 16 cases where this was performed. Bladder biopsies showed denudation of urothelium and infiltration of submucosa with lymphocytes and eosinophils with no increase in mast cells. Fifty-nine per cent of patients did not attend their clinic, imaging and/or cystoscopy appointments. One patient underwent a subtotal cystectomy and bladder reconstruction. Conclusions. Ketamine cystitis is a complex problem whose exact pathological mechanism and natural history remain unknown. The only known effective treatment is to abstain from the drug. Urologists need to recognize the condition early and work together with the local substance misuse service, focusing on drug cessation therapy to reduce complications.