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• W2034991806 abstract "You have accessJournal of UrologyInfections/Inflammation of the Genitourinary Tract: Kidney & Bladder1 Apr 2010605 THE MANAGEMENT OF KETAMINE ASSOCIATED URINARY TRACT PATHOLOGY Angela Cottrell, David Gillatt, Pete Weinstock, Rachel Ayres, Cathy Stannard, and Fergus Law Angela CottrellAngela Cottrell More articles by this author , David GillattDavid Gillatt More articles by this author , Pete WeinstockPete Weinstock More articles by this author , Rachel AyresRachel Ayres More articles by this author , Cathy StannardCathy Stannard More articles by this author , and Fergus LawFergus Law More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.919AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The use of the anaestheic agent ketamine as a recreational drug is increasing in popularity. Case series around the world have described severe urinary tract symptoms and pathology associated with such chronic use. Symptoms include severe dysuria, frequency, urgency, incontinence, and haematuria and these can be difficult to manage, especially when ilicit drug use continues. Little is known regarding the long term prognosis of such patients. In the South West of the UK an increasing number of individuals are experiencing urological sequelae of ketamine use. The management strategy for a single centre is described. METHODS Patients referred to urological services with a history of chronic ketamine use and urinary symptoms were investigated. Investigations include urine microscopy and culture, baseline blood tests, imaging (renal tract ultrasound or CT scan), cystoscopy and bladder biopsy. Where appropriate, referral was made to local pain clinic specializing in substance misuse with support from psychiatric services. RESULTS 16 patients (13 male, 3 female) were referred to urological services since 2007. All had a history of ketamine use and severe symptoms. Urine microscopy and culture revealed no bacterial growth. Cystoscopy revealed small capacity, erythematous bladders with contact bleeding. Histology revealed ulcerative cystitis. With regards to management, cystodistension provided minimal short term relief in 2 patients. 2 patients had suprapubic catheters inserted to relieve severe symptoms of urgency and dysuria. One patient underwent cystectomy and neobladder formation for management of severe pain despite stopping ketamine use. Three patients were referred to drug services for formal detox from ketamine and reported symptomatic improvement following abstinence. Four patients were referred to pain clinic for management of symptoms finding symptomatic relief with opiate analgesia. Four patients stopped ketamine intake of their own accord and symptoms resolved. In one patient cystoscopic appearance markedly reduced following cessation of ketamine use,corresponding with symptomatic improvement. CONCLUSIONS The physical effects of chronic ketamine use can be severe and difficult to manage. Whilst short term relief of symptoms can be achieved with analgesia and urinary diversion the most effective management arises from a multidisciplinary approach. The combination of pain team, drug support agencies, psychiatrists and urologists can formulate a strategy that manages acute symptoms, supports the patient whilst drug use decreases and monitor for long term complications. Bristol, United Kingdom© 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e238 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information Angela Cottrell More articles by this author David Gillatt More articles by this author Pete Weinstock More articles by this author Rachel Ayres More articles by this author Cathy Stannard More articles by this author Fergus Law More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ..." @default.
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