Urological symptoms following ketamine treatment for psychiatric disorders: A systematic review

Ketamine has emerged as a putative rapid-acting treatment option for psychiatric disorders, particularly treatment-resistant depression. Chronic recreational ketamine use is associated with ketamine-induced urological toxicity, raising concerns over the safety of repeated ketamine treatments. This systematic review aimed to synthesise urological findings from clinical trials and observational studies using ketamine for the treatment of psychiatric disorders. Electronic databases were searched up until 4th April 2024 for trials and observational studies using ketamine treatment for psychiatric disorders in adults, and which reported assessment of urinary, bladder or renal symptoms. Twenty-seven studies were included, mostly in depressive disorders (N = 24). Urological symptoms were reported in 0%-24.5% of patients receiving ketamine treatment; symptoms tended to be mild or moderate in severity. Where reported, continuous outcome measures (urinary parameters and symptom questionnaires) did not show significant changes from baseline to follow-up. Only 15% of studies were rated low risk of bias. Most studies did not assess long-term ketamine treatment, and many included undefined or passive monitoring of urological symptoms rather than systematic assessment. Based on the limited data available, ketamine treatment does not appear to be associated with elevated risk of urological symptoms; however, further long-term studies are required.