Ketamine-associated lower urinary tract destruction: a new radiological challenge.
K Mason, A M Cottrell, A G Corrigan, D A Gillatt, A E Mitchelmore
Clinical radiology October 2010 DOI: 10.1016/j.crad.2010.05.003 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Case series Case report Peer reviewed |
|---|---|
| Sample size | 23 |
| Population | Patients with a history of ketamine abuse presenting with severe lower urinary tract symptoms |
| Intervention | Ketamine |
| Topics | Esketamine Ketamine |
| Key findings | In 23 patients with ketamine abuse and severe lower urinary tract symptoms, imaging showed small bladder volume and wall thickening on ultrasound, and marked generalized bladder wall thickening, mucosal enhancement, perivesical inflammation, and ureteric wall thickening and enhancement on CT; advanced cases had ureteric narrowing and strictures. The authors argue that delayed diagnosis can cause irreversible renal tract damage requiring surgical intervention. |
Abstract
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. 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. 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. 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.
Comparable studies
Other case reports and case series on ketamine, most cited first.
Citations in the library
Cited by 17
- Ketamine and Ketamine Metabolite Pharmacology: Insights into Therapeutic Mechanisms Pharmacological Reviews June 26, 2018
- Ketamine for chronic pain: risks and benefits British Journal of Clinical Pharmacology February 21, 2013
- Ketamine treatment for depression: opportunities for clinical innovation and ethical foresight. The Lancet Psychiatry April 5, 2017
- To use or not to use: an update on licit and illicit ketamine use Substance Abuse and Rehabilitation March 1, 2011
- The clinical toxicology of ketamine Clinical Toxicology June 2, 2023
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