title: Street ketamine-associated bladder dysfunction: an emerging health problem.
abstract: BACKGROUND
  Ketamine is frequently abused nowadays as a recreational drug. Case reports are emerging since 2007 to describe a new clinical entity of severe bladder dysfunction associated with chronic abuse of street ketamine.
  
  
  METHODS
  Severe lower urinary tract symptoms of urinary frequency and urgency which are refractory to conventional treatment. Quality of life is adversely affected as a consequence. Chronic kidney disease will develop in advanced cases. Investigation findings: The urine is sterile on culture. Ultrasound will show reduced bladder capacity with thickened bladder wall. In advanced stage, hydronephrosis and renal impairment will develop.
  
  
  METHODS
  Patients should be advised to stop street ketamine use immediately. Anticholinergic medication could be tried to alleviate the symptoms. Refractory cases with dilatation of the upper urinary tract might need urinary diversion.
  
  
  CONCLUSIONS
  Awareness of this new condition is essential in diagnosis. Early intervention offers better treatment outcome.
authors.affiliation: MFamMed, Department of Family Medicine, Faculty of Medicine & Health Sciences, University Malaysia Sarawak, Kuching, Sarawak. (Lee Ping Yein).
authors.forename: Py
authors.initials: P
authors.lastname: Lee
authors.affiliation: FRCS, Department of Surgery, Faculty of Medicine & Health Sciences, University Malaysia Sarawak, Kuching, Sarawak. (Ong Teng Aik).
authors.forename: Ta
authors.initials: T
authors.lastname: Ong
authors.affiliation: FRCS, Urology & Lithotripsy Unit, Sunway Medical Centre, Petaling Jaya, Selangor. (Chua Chong Beng).
authors.forename: Cb
authors.initials: C
authors.lastname: Chua
authors.affiliation: FRCS, Urology & Kidney Centre, Normah Medical Specialist Centre, Kuching, Sarawak. (Clarence Lei Chang Moh).
authors.forename: Ccm
authors.initials: C
authors.lastname: Lei
authors.affiliation: FRCS, Department of Urology, Sarawak General Hospital, Kuching, Sarawak. (Teh Guan Chou).
authors.forename: Gc
authors.initials: G
authors.lastname: Teh
keywords: Ketamine; bladder dysfunction; lower urinary tract symptoms