Ketamine cystitis

Ketamine cystitis

Ketamine is an N -methyl-d-aspartate (NMDA) antagonist. It has been used for decades as an anaesthetic agent but has because of its euphoric and psychedelic e ff ects. As a result of long-term ketamine abuse, up to 30% develop the condition of ketamine cystitis – a chronic inflammatory bladder condition ladder with characterised b y a small, contracted, inflamed b ureteric stricture and hydronephrosis in advanced cases. The severity of the inflammatory e ff ect is related to the duration of abuse. The clinical presentation is very similar to that of BPS/ IC and investigation with cystoscopy , bladder biopsy and CT urogram should be performed to exclude other inflammatory or infective conditions (e.g . TB, schistosomiasis) and to evaluate the e ff ect on the upper urinary tract ( Figure 83.33 ). - - - Initial management is centred around the cessation of ket - amine use as surgical intervention should not be performed in those continuing to use ketamine. If patients have upper - tract obstruction due to ureteric involvement in the inflamma - - tory process, renal drainage with stent or nephrostom y will be required as a temporising measure to preserve renal function. Management of LUTS and pain follows the same pathway of oral and intravesical therapies as for BPS/IC, although regimes for analgesia consisting of co-codamol, amitriptyline - and buprenorphine patches have proved particularly beneficial in this condition. Surgical approaches are similar to those for the other chronic inflammatory conditions, namely augmentation enterocystoplasty , supratrigonal cystectomy and ureteric reim - plantation, total cystectomy with orthotopic neobladder, het - erotopic neobladder with appendicovesicostomy or urinary diversion with or without a cystectomy . However, the rate of perioperative complications with major reconstructive surgery in this popula tion is high; those with upper tract involvement at presentation are likely be at higher risk of postoperative com - plications.

(a) (b) Figure 83.33 Computed tomography showing a thickened bladder (a) and bilateral hydroureteronephrosis (b) secondary to ketamine cystitis.

Chronic inflammatory conditions of the bladder /uni25CF /uni25CF /uni25CF

Patients with chronic in /f_l ammatory bladder conditions should have a bladder biopsy to identify a treatable cause (e.g. TB) Upper tracts should be evaluated with cross-sectional imaging to identify renal obstruction due to a high-pressure bladder Management is aimed at symptomatic improvement and maintaining low bladder pressure