Case report. Met ketaminegebruik geassocieerde urologische symptomen

Ketamine associated urological symptoms: Ketamine is used as an anaesthetic and in third line pain management. Furthermore, recreational use is increasingly popular due to its dissociative and hallucinogenic effects. Ketamine can affect the urothelium, possibly with long term damage of the bladder and kidneys. An otherwise healthy 22 year old smoking female was referred to our clinic. Shortly after starting recreational ketamine, she experienced gross haematuria, urgency, frequency and dysuria. There were no febrile episodes or flank pain. Her urine cultures were sterile. Physical examination, blood tests, urinary cytology and abdominal ultrasound were normal. At cystoscopy a severely inflamed bladder was seen. Biopsies showed denuded urothelium and inflammation of the submucosa without malignancy. Currently the precise mechanism of ketamine associated urological symptoms is unknown. Treatment therefore is symptom targeted and cessation of ketamine is imperative. We recommend that ketamine use is considered in patients with otherwise unexplained urological symptoms.