What urologists need to know about ketamine-induced uropathy: A systematic review.

Ketamine is a general anesthetic. Dissociative effects and low cost led ketamine becoming an illegal recreational drug in young adults. Ketamine-induced uropathy (KIU) is one of the complications observed in abusers. This study aimed to provide a systematic literature review on KIU clinical presentation, pathophysiology, and treatments.

We performed the literature search in PubMed, Web of Science, Scopus, and Embase using the terms ketamine and bladder. English papers on human and animal studies were accepted.

A total of 75 papers were selected. Regular ketamine users complain about severe storage symptoms and pelvic pain. Hydronephrosis may develop in long-term abusers and is correlated to the contracted bladder, ureteral stenosis, or vesicoureteral reflux due to ureteral involvement and/or bladder fibrosis. Cystoscopy shows ulcerative cystitis. Ketamine in urine might exert direct toxicity to the urothelium, disrupting its barrier function and enhancing cell apoptosis. The presence of ketamine/ions in the bladder wall result in neurogenic/IgE-mediated inflammation, stimulation of the inducible nitric oxide synthase-cytokines-cyclooxygenase pathway with persistent inflammation and fibrosis. Abstinence is the first therapeutic step. Anti-inflammatory drugs, analgesics and anticholinergics, intravesical instillation of hyaluronic acid, hydrodistension and intravesical injection of botulin toxin-A were helpful in patients with early-stage KIU. In patients with end-stage disease, the control of intractable symptoms and the increase of bladder capacity were the main recommendations to perform augmentation enterocystoplasty.

KIU is becoming a worldwide health concern, which should be taken into account in the differential diagnosis of ulcerative cystitis.

Neurourology and urodynamics. 2020 Mar 25 [Epub ahead of print]

Daniele Castellani, Giacomo M Pirola, Marilena Gubbiotti, Emanuele Rubilotta, Kalyan Gudaru, Andrea Gregori, Marco Dellabella

Department of Urology, IRCCS INRCA, Ancona, Italy., Department of Urology, Usl Toscana Sud Est, San Donato Hospital, Arezzo, Italy., Department of Urology, Azienda Ospedaliera Universitaria Integrata, Verona, Italy., Department of Urology, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, UK., Department of Urology, ASST Fatebenefratelli Sacco, Milan, Italy.