title: Ketamine-associated lower urinary tract destruction: a new radiological challenge.
abstract: OBJECTIVE
  Ketamine is a short-acting dissociative anaesthetic whose hallucinogenic side effects have led to an increase in its illicit use amongst club and party goers. There is a general misconception amongst users that it is a safe drug with few long term side effects, however ketamine abuse is associated with severe urinary tract dysfunction. Presenting symptoms include urinary frequency, nocturia, dysuria, haematuria and incontinence.
  
  
  METHODS
  We describe the radiological findings found in a series of 23 patients, all with a history of ketamine abuse, who presented with severe lower urinary tract symptoms (LUTS). Imaging techniques used included ultrasonography (US), intravenous urography (IVU), and computed tomography (CT). These examinations were reviewed to identify common imaging findings. All patients with positive imaging findings had also undergone cystoscopy and bladder wall biopsies, which confirmed the diagnosis. The patients in this series have consented to the use of their data in the ongoing research into ketamine-induced bladder pathology.
  
  
  RESULTS
  Ultrasound demonstrated small bladder volume and wall thickening. CT revealed marked, generalized bladder wall thickening, mucosal enhancement, and perivesical inflammation. Ureteric wall thickening and enhancement were also observed. In advanced cases ureteric narrowing and strictures were identified using both CT and IVU. Correlation of clinical history, radiological and pathological findings was performed to confirm the diagnosis.
  
  
  CONCLUSIONS
  This case series illustrates the harmful effects of ketamine on the urinary tract and the associated radiological findings. Delayed diagnosis can result in irreversible renal tract damage requiring surgical intervention. It is important that radiologists are aware of this emerging clinical entity as early diagnosis and treatment are essential for successful management.
authors.affiliation: Bristol Royal Infirmary, Bristol, UK. k.mason@doctors.org.uk
authors.forename: K
authors.initials: K
authors.lastname: Mason
authors.forename: A M
authors.initials: AM
authors.lastname: Cottrell
authors.forename: A G
authors.initials: AG
authors.lastname: Corrigan
authors.forename: D A
authors.initials: DA
authors.lastname: Gillatt
authors.forename: A E
authors.initials: AE
authors.lastname: Mitchelmore
mesh_terms: D000293:Adolescent; D000328:Adult; D000778:Anesthetics, Dissociative / Q000009:adverse effects*; D003558:Cystoscopy / Q000379:methods; D057210:Delayed Diagnosis; D005260:Female; D006801:Humans; D007649:Ketamine / Q000009:adverse effects*; D008297:Male; D019966:Substance-Related Disorders / Q000000981:diagnostic imaging; D014057:Tomography, X-Ray Computed; D014463:Ultrasonography; D014551:Urinary Tract / Q000187:drug effects* / Q000473:pathology*; D014570:Urologic Diseases / Q000139:chemically induced / Q000000981:diagnostic imaging; D055815:Young Adult
chemical_list: D000778:Anesthetics, Dissociative; D007649:Ketamine