Volume 102, Issue 11 p. 1616-1622

The destruction of the lower urinary tract by ketamine abuse: a new syndrome?

Peggy Sau-Kwan Chu

Peggy Sau-Kwan Chu

Division of Urology, Department of Surgery, Tuen Mun Hospital, Division of Urology, Department of Surgery, and

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Wai-Kit Ma

Wai-Kit Ma

Division of Urology, Department of Surgery, Tuen Mun Hospital, Division of Urology, Department of Surgery, and

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Simon Chun-Wing Wong

Simon Chun-Wing Wong

Division of Urology, Department of Surgery, Tuen Mun Hospital, Division of Urology, Department of Surgery, and

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Ringo Wing-Hong Chu

Ringo Wing-Hong Chu

Division of Urology, Department of Surgery, Tuen Mun Hospital, Division of Urology, Department of Surgery, and

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Cheung-Hing Cheng

Cheung-Hing Cheng

Division of Urology, Department of Surgery, Tuen Mun Hospital, Division of Urology, Department of Surgery, and

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Shun Wong

Shun Wong

Department of Pathology, Princess Margaret Hospital,

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Johnny Man-li Tse

Johnny Man-li Tse

Department of Accident and Emergency, United Christian Hospital, and

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Fei-Lung Lau

Fei-Lung Lau

Hong Kong Poison Information Centre, Hong Kong, China

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Ming-Kwong Yiu

Ming-Kwong Yiu

Division of Urology, Department of Surgery, Tuen Mun Hospital, Division of Urology, Department of Surgery, and

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Chi-Wai Man

Chi-Wai Man

Division of Urology, Department of Surgery, Tuen Mun Hospital, Division of Urology, Department of Surgery, and

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First published: 21 November 2008
Citations: 271
Peggy Sau-Kwan Chu, Division of Urology, Department of Surgery, Tuen Mun Hospital, Hong Kong, China.
e-mail: [email protected]

Abstract

OBJECTIVE

To report the clinical spectrum seen in young abusers of street-ketamine (regular recreational abusers of street-ketamine, for its hallucinogenic effects) in Hong Kong, presenting with significant lower urinary tract symptoms (LUTS) but with no evidence of bacterial infection.

PATIENTS AND METHODS

We retrospectively analysed the clinical presentations, pelvic pain and urgency/frequency scores, video-urodynamic studies, cystoscopy findings, histological features of bladder biopsies and radiological findings of 59 ketamine abusers who were referred to the urology units of Princess Margaret and Tuen Mun Hospital, Hong Kong, from March 2000 to December 2007.

RESULTS

Of the 59 patients, all had moderate to severe LUTS, i.e. frequency, urgency, dysuria, urge incontinence and occasionally painful haematuria. Forty-two (71%) patients had a cystoscopy that showed various degrees of epithelial inflammation similar to that seen in chronic interstitial cystitis. All of 12 available bladder biopsies had histological features resembling those of interstitial cystitis. Urodynamically, either detrusor overactivity or decreased bladder compliance with or without vesico-ureteric reflux was detected to some degree in all of 47 patients. Thirty patients (51%) had unilateral or bilateral hydronephrosis on renal ultrasonography, and four (7%) showed features suggestive of papillary necrosis on radiological imaging. Eight patients had a raised serum creatinine level.

CONCLUSION

A syndrome of cystitis and contracted bladder can be associated with street-ketamine abuse. Secondary renal damage can occur in severe cases which might be irreversible, rendering patients dependent on dialysis. The present data do not establish the precise cause nor the incidence. Street-ketamine abuse is not only a drug problem, but might be associated with a serious urological condition causing a significant burden to healthcare resources.