Ketamine uropathy: an update on pathophysiology, complications, and treatment options

Ketamine is a potent anaesthetic drug that has been used for decades. Ketamine abuse is an increasingly common problem, particularly among young people. Over one quarter of ketamine users will have at least one bothersome urological symptom, with heavier and longer use leading to potentially irreversible damage to the lower and upper urinary tract. Hence, this study carried out a narrative review focusing on ketamine-induced uropathy pathophysiology, clinical presentation, and treatment options. It was found that ketamine uropathy is an inflammatory condition affecting predominantly the bladder but also the upper urinary tracts. A hypersensitivity reaction to the drug has been proposed as the potential pathophysiological mechanism that causes inflammatory reaction, muscle hypertrophy, and non-reversible fibrosis in the advanced stages of the disease. Abstinence from ketamine use is the cornerstone of treatment at any stage of the disease, with effective pain management and psychological support being critical to reduce ketamine seeking behaviours. For mildly symptomatic patients, minimally invasive options such as bladder instillations and intravesical Botox injections can provide symptomatic relief. For more severe cases with refractory symptoms and upper urinary tract involvement, reconstructive urological operations might be necessary, including augmentation cystoplasty, cystectomy, or ureteric reconstruction. Ongoing surveillance of the upper tracts is recommended for both groups of patients. Ketamine induced uropathy is an increasingly prevalent condition, and ketamine abuse should always be inquired about in people with unexplained lower urinary tract symptoms. Adequate information of the public regarding ketamine abuse and early consultation with a urologist might prevent irreversible damage.