The ketamine bladder

Ketamine misuse is rising in young adults in Australia. Although ketamine is often perceived as a 'soft' drug, abuse can lead to ketamine-induced uropathy (KIU), also known as ketamine bladder. Characterised by lower urinary tract symptoms, KIU can cause progressive fibrosis of the bladder and upper urinary tract, leading to renal impairment and in some cases requiring reconstructive surgery.

The aim of this article is to: (1) describe the presentation and implications of KIU; (2) outline recommended investigations; (3) introduce management principles; and (4) identify key assessment aspects warranting non-general practitioner (GP) specialist referral.

KIU is a rare but potentially serious complication of ketamine abuse. Awareness of KIU among GPs is vital to ensure early recognition, initial management and coordination of ongoing care. GPs play a key part in supporting ketamine cessation and coordinating timely referral to a multidisciplinary team including urology, drug and alcohol specialists, pain specialists and allied health services.