The destruction of the lower urinary tract by ketamine abuse: a new syndrome?
OBJECTIVE
To report the clinical spectrum seen in young abusers of street-ketamine (regular recreational abusers of street-ketamine, for its hallucinogenic effects) in Hong Kong, presenting with significant lower urinary tract symptoms (LUTS) but with no evidence of bacterial infection.


METHODS
We retrospectively analysed the clinical presentations, pelvic pain and urgency/frequency scores, video-urodynamic studies, cystoscopy findings, histological features of bladder biopsies and radiological findings of 59 ketamine abusers who were referred to the urology units of Princess Margaret and Tuen Mun Hospital, Hong Kong, from March 2000 to December 2007.


RESULTS
Of the 59 patients, all had moderate to severe LUTS, i.e. frequency, urgency, dysuria, urge incontinence and occasionally painful haematuria. Forty-two (71%) patients had a cystoscopy that showed various degrees of epithelial inflammation similar to that seen in chronic interstitial cystitis. All of 12 available bladder biopsies had histological features resembling those of interstitial cystitis. Urodynamically, either detrusor overactivity or decreased bladder compliance with or without vesico-ureteric reflux was detected to some degree in all of 47 patients. Thirty patients (51%) had unilateral or bilateral hydronephrosis on renal ultrasonography, and four (7%) showed features suggestive of papillary necrosis on radiological imaging. Eight patients had a raised serum creatinine level.


CONCLUSIONS
A syndrome of cystitis and contracted bladder can be associated with street-ketamine abuse. Secondary renal damage can occur in severe cases which might be irreversible, rendering patients dependent on dialysis. The present data do not establish the precise cause nor the incidence. Street-ketamine abuse is not only a drug problem, but might be associated with a serious urological condition causing a significant burden to healthcare resources.
Chu
Peggy Sau-Kwan
PS
Division of Urology, Department of Surgery, Tuen Mun Hospital, Hong Kong, China. peggychului@gmail.com
Ma
Wai-Kit
WK
Wong
Simon Chun-Wing
SC
Chu
Ringo Wing-Hong
RW
Cheng
Cheung-Hing
CH
Wong
Shun
S
Tse
Johnny Man-Li
JM
Lau
Fei-Lung
FL
Yiu
Ming-Kwong
MK
Man
Chi-Wai
CW
D000293:Adolescent; D000328:Adult; D003558:Cystoscopy; D005260:Female; D006801:Humans; D007649:Ketamine / Q000009:adverse effects*; D008297:Male; D012189:Retrospective Studies; D019966:Substance-Related Disorders / Q000150:complications*; D013577:Syndrome; D014551:Urinary Tract / Q000473:pathology*; D014570:Urologic Diseases / Q000139:chemically induced* / Q000473:pathology; D055815:Young Adult
D007649:Ketamine