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Ketamine Misuse and Adverse Body Effects: A Focus on Uropathy

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Handbook of Substance Misuse and Addictions

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Abstract

Ketamine is a general anesthetic. Ketamine has become an illegal recreational drug in young adults due to its dissociative effects, short duration of action, and low cost. Ketamine-induced uropathy (KU) is one of the complications detected in abusers.

Regular ketamine users complain about severe storage symptoms (urgency, dysuria, frequency) and pelvic pain. Hydronephrosis may develop in long-term abusers and is correlated with a fibrotic and contracted bladder, ureteral stenosis, or vesicoureteral reflux due to bladder fibrosis and direct ureteral involvement. Cystoscopy demonstrates ulcerative cystitis. Ketamine is excreted in the urine and exerts direct toxicity to the urothelium, interrupting its barrier function and increasing cell apoptosis. The presence of ketamine/ions in the bladder wall results in neurogenic/IgE-mediated inflammation, stimulation of the inducible nitric oxide synthase-cytokine-cyclooxygenase pathway with persistent inflammation, and, finally, end-stage fibrosis. Abstinence is the first therapeutic step. Anti-inflammatory drugs, analgesics and anticholinergics, intravesical instillation of hyaluronic acid, hydrodistension, and intravesical injection of botulin toxin-A are useful treatments in patients with early-stage KU. In patients with end-stage disease, the control of intractable symptoms and the increase of bladder capacity were the main advice to perform augmentation enterocystoplasty (AEC).

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Abbreviations

AEC:

Augmentation enterocystoplasty

Ig-E:

Immunoglobulin E

KC:

Ketamine cystitis

KU:

Ketamine-induced uropathy

LUTS:

Lower urinary tract symptoms

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Authors and Affiliations

  1. Urology Unit, Azienda Ospedaliero-Universitaria Ospedali Riuniti di Ancona, Università Politecnica delle Marche, Ancona, Italy

    Daniele Castellani

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  1. Daniele Castellani
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Correspondence to Daniele Castellani .

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Editors and Affiliations

  1. School of Life Sciences, University of Westminster, London, UK

    Vinood B. Patel

  2. School of Life Course and Population Sciences, Faculty of Life Sciences and Medicine, King’s College London, London, UK

    Victor R. Preedy

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Castellani, D. (2022). Ketamine Misuse and Adverse Body Effects: A Focus on Uropathy. In: Patel, V.B., Preedy, V.R. (eds) Handbook of Substance Misuse and Addictions. Springer, Cham. https://doi.org/10.1007/978-3-030-92392-1_126

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