Urinary tract disease associated with chronic ketamine useBMJ 2008; 336 doi: https://doi.org/10.1136/bmj.39562.711713.80 (Published 01 May 2008) Cite this as: BMJ 2008;336:973
- Angela M Cottrell, clinical research fellow1,
- Rachel Athreeres, volunteer manager2,
- Pete Weinstock, senior practitioner2,
- Kate Warren, urology registrar3,
- David Gillatt, consultant urological surgeon4
- 1Bristol Urological Institute, Southmead Hospital, Bristol BS10 5NB
- 2Bristol Drug Project, Bristol BS2 8PE
- 3Weston General Hospital, Weston super Mare BS23 4TQ
- 4Bristol Urological Institute, Bristol
Regarding the case study by Dhillon et al,1 we have seen an alarming increase in people presenting to urological services in South West England with bladder symptoms associated with chronic ketamine use. Two case series in Hong Kong and Canada have been published, but ketamine associated bladder pathology has not been reported in the UK.2 3
Over the past two years, nine patients have presented to local urologists with symptoms of severe urinary frequency, urgency, macroscopic haematuria, and suprapubic pain. They all had a history of chronic ketamine use, either recreationally or therapeutically for chronic pain. Urine culture results were negative and cystoscopy showed a contracted shrunken bladder with erythema and contact bleeding. Histological examination showed ulcerative cystitis and a severely denuded urothelium.
They were given analgesics and encouraged not to use ketamine. Complications included hydronephrosis and renal impairment. They were treated by nephrostomy and insertion of a suprapubic catheter to manage painful urge urinary incontinence.
Discussions with the patients and contact with Bristol Drugs Project indicated that these cases are just the “tip of the iceberg.” Recreational use of ketamine is increasing in the West Country. Urinary symptoms are often reported by ketamine users. Symptoms may improve and even reverse once ketamine intake is stopped, but two of our patients still have intractable symptoms despite abstaining. The pathological mechanism of ketamine is not known, but chronic ketamine use may affect the whole urinary tract. Some patients have acute renal failure, renal papillary necrosis, and ureteric obstruction (Peggy Chu, personal communication). Further work is needed to establish the mechanism of action of ketamine on the urinary tract and to educate healthcare professionals who may come in contact with these patients. Ketamine users must be made aware of the serious and potentially irreversible sequelae of chronic ketamine use, and we are working with Bristol Drugs Project to develop evidence based harm reduction advice for this population.
Competing interests: None declared.