What urologists need to know about ketamine-induced uropathy: A systematic review.
Level 4 - case-series / case-control
Systematic review synthesizing heterogeneous non-randomized observational cohorts, case series, and preclinical animal studies.
PubMed 32212278 · doi:10.1002/nau.24341
What was done
A systematic review was conducted across PubMed, Web of Science, Scopus, and Embase using the search terms 'ketamine' and 'bladder'. The authors included English-language publications of human and animal studies detailing the clinical presentation, pathophysiology, and management of ketamine-induced uropathy (KIU).
What was found
A total of 75 papers were included. Frequent ketamine users present with severe urinary storage symptoms, pelvic pain, and ulcerative cystitis on cystoscopy. Long-term use causes bladder fibrosis, contracted bladder, ureteral stenosis, and hydronephrosis. Proposed mechanisms involve direct urinary ketamine toxicity to the urothelium, barrier disruption, apoptosis, and neurogenic/IgE-mediated inflammatory pathways. Reported management focuses first on ketamine abstinence, with early-stage disease managed using anti-inflammatory drugs, analgesics, anticholinergics, intravesical hyaluronic acid, hydrodistension, or botulinum toxin-A injections, and end-stage contracted bladder managed with augmentation enterocystoplasty. The abstract reports no numerical effect sizes or quantitative outcome data.
Why it matters
This review synthesizes clinical and mechanistic findings to guide clinicians in identifying ketamine abuse as an etiology for severe ulcerative cystitis and outlines conservative to surgical treatment steps.
Limits
The abstract lacks quantitative synthesis, pooled effect estimates, and total human participant counts. The underlying literature consists largely of uncontrolled case series, observational reports, and preclinical animal research rather than randomized comparative trials.