From the Research
Ketamine-induced cystitis is a condition characterized by chronic inflammation and damage to the bladder resulting from long-term ketamine abuse, with the primary risk factor being recreational ketamine abuse, and severity correlating with frequency, duration, and dosage of use, as supported by the most recent study 1. The pathophysiology of ketamine-induced cystitis involves direct toxic effects of ketamine and its metabolites on the urothelium, leading to denudation of the protective glycosaminoglycan layer of the bladder epithelium, allowing urine to penetrate the underlying tissues, causing inflammation, ulceration, and fibrosis of the bladder wall. Key factors contributing to the development of ketamine-induced cystitis include:
- Recreational ketamine abuse, with daily users and those with prolonged exposure facing the highest risk
- Route of administration, with injection potentially causing more rapid damage than intranasal use
- Individual susceptibility, with some users developing symptoms after relatively short exposure periods
- Concurrent use of other substances, particularly alcohol and stimulants, which may exacerbate bladder damage
- Poor hydration during ketamine use, which can increase urinary concentration of ketamine metabolites, potentially worsening toxicity The most recent and highest quality study 1 highlights the importance of cessation of ketamine use as the mainstay of treatment, with lower urinary tract symptoms usually relapsing if patients reuse ketamine after stopping, and augmentation enterocystoplasty being a potential solution for patients with severe ketamine cystitis. Other studies, such as 2 and 3, also support the importance of cessation of ketamine use and the potential for severe bladder damage and other complications, including hydronephrosis, ureteral stricture, vesicoureteral reflux, and renal failure, if ketamine use continues. Overall, the evidence suggests that ketamine-induced cystitis is a serious condition that requires prompt diagnosis and treatment, with cessation of ketamine use being the most critical step in preventing further damage and improving symptoms.