Street ketamine-associated bladder dysfunction: An emerging health problem

  • PY Lee
  • TA Ong
  • CB Chua
  • CCM Lei
  • GC Teh
Keywords: Ketamine, lower urinary tract symptoms, bladder dysfunction

Abstract

Introduction: Ketamine is frequently abused nowadays as a recreational drug. Case reports are emerging since 2007 todescribe a new clinical entity of severe bladder dysfunction associated with chronic abuse of street ketamine.

Clinical presentation: Severe lower urinary tract symptoms of urinary frequency and urgency which are refractory toconventional treatment. Quality of life is adversely affected as a consequence. Chronic kidney disease will develop inadvanced cases.

Investigation findings: The urine is sterile on culture. Ultrasound will show reduced bladder capacity with thickened bladderwall. In advanced stage, hydronephrosis and renal impairment will develop.

Treatment: Patients should be advised to stop street ketamine use immediately. Anticholinergic medication could be triedto alleviate the symptoms. Refractory cases with dilatation of the upper urinary tract might need urinary diversion.

Conclusion: Awareness of this new condition is essential in diagnosis. Early intervention offers better treatment outcome.

References

Shahani R, Streutker C, Dickson B, et al. Ketamine-associated ulcerative cystitis: a new clinical entity. Urology. 2007;69(5):810-2.

Gahlinger PM. Club drugs: MDMA, gamma-hydroxybutyrate (GHB), Rohypnol, and ketamine. Am Fam Physician. 2004;69(11):2619-26.

Jansen KL. Non-medical use of ketamine. BMJ.1993;306(6878):601-2.

Patterns and trends of amphetamine-type stimulants (ATS) and other drugs of abuse in East Asia and the Pacific 2006. United Nations Office on Drugs and Crime Regional Centre for East Asia and the Pacific. 2007:93.

Bid to ship 100kg of ketamine to Malaysia foiled. The Star Online, 2009 March 1;Sect. News (col. Nation).

Chu PS, Ma WK, Wong SC, et al. The destruction of the lower urinary tract by ketamine abuse: a new syndrome? BJU Int. 2008;102(11):1616-22.

White PF, Way WL, Trevor AJ. Ketamine—its pharmacology and therapeutic uses. Anesthesiology. 1982;56(2):119-36.

Dillon P, Copeland J, Jansen K. Patterns of use and harms associated with non-medical ketamine use. Drug Alcohol Depend. 2003;69(1):23-8.

Freese TE, Miotto K, Reback CJ. The effects and consequences of selected club drugs. J Subst Abuse Treat. 2002;23(2):151-6.

Curran HV, Monaghan L. In and out of the K-hole: a comparison of the acute and residual effects of ketamine in frequent and infrequent ketamine users. Addiction. 2001;96(5):749-60.

Jansen KL. Ketamine-can chronic use impair memory? Int J Addict. 1990;25(2):133-9.

Cotman CW, Monaghan DT, Ganong AH. Excitatory amino acid neurotransmission: NMDA receptors and Hebb-type synaptic plasticity. Annu Rev Neurosci. 1988;11:61-80.

Tsai JH, Tsai KB, Jang MY. Ulcerative cystitis associated with ketamine. Am J Addict. 2008;17(5):453.

Chu PS, Kwok SC, Lam KM, et al. ‘Street ketamine’-associated bladder dysfunction: a report of ten cases. Hong KongMed J.2007;13(4):311-3.

Chen KT, Foo NP, Lin HJ. Frequent visits with urinary symptoms: subtle signs of ketamine abuse. Am J Emerg Med. 2008;26(9):1061-2.

Colebunders B, Van Erps P. Cystitis due to the use of ketamine as a recreational drug: a case report. J Med Case Reports. 2008;2:219.

Hoskins R. Ketamine associated cystitis - A case report. Int Emerg Nurs. 2009;17(1):69-71.

Cottrell A, Gillatt D. Ketamine-associated urinary tract pathology: the tip of the iceberg for urologist? British Journal of Medical & Surgical Urology. 2008;1(3):136-8.

Published
2009-03-31
How to Cite
LeeP., OngT., ChuaC., LeiC., & TehG. (2009). Street ketamine-associated bladder dysfunction: An emerging health problem. Malaysian Family Physician, 4(1), 4. Retrieved from https://www.e-mfp.org/ojs3/index.php/MFP/article/view/166
Section
Original Articles