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Published: 10 May 2019
A survey for ketamine abuse and its relation to the lower urinary tract symptoms in Taiwan
Chiao-Ching Li, Sheng-Tang Wu, …En Meng Show authors
Scientific Reports volume 9, Article number: 7240 (2019) Cite this article
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Abstract
We aimed to explore the correlation between ketamine abuse and lower urinary tract symptoms (LUTS) and epidemiology of ketamine cystitis. Questionnaire records of ketamine abusers, such as sex, age, and details of using ketamine, including consumption method, amount, duration of ketamine use, and LUTS, were obtained from two private rehabilitation centers. We analyzed these factors and established a severity forecasting module. One hundred and six ketamine abusers completed the questionnaires. LUTS showed an onset time of 24.67 ± 26.36 months among ketamine abusers. Overactive bladder symptom score, international prostate symptom score-storage, interstitial cystitis symptom index, interstitial cystitis problem index, and visual analogue scale score were 5.25 ± 4.43, 5.95 ± 5.72, 10.96 ± 6.66, 9.73 ± 5.82, and 2.55 ± 3.18, respectively. All symptom scores were positively correlated with the duration of ketamine abuse. Ketamine snorting was significantly correlated with all symptom scores compared to smoking. Hydrodistention, intravesical hyaluronic acid instillation, intravesical injection with botulinum toxin, and hyperbaric-oxygen therapy showed better effect than oral treatment. Ketamine can induce severe storage symptoms, such as frequency or nocturia depending on the duration of abuse. Ketamine snorting may cause worse LUTS than smoking. Combining ketamine and other substances may exacerbate LUTS. Intravesical therapy may lead to better outcomes than oral treatment.
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Urological manifestations
Introduction
Ketamine is a noncompetitive N-methyl-D-aspartic acid receptor complex antagonist and phencyclidine derivative, which was first synthesized in 1962 by Calvin Lee Stevens1 and first given to American soldiers during the Vietnam war under FDA approval in 19702. It is currently used for general anesthesia and pain management for chronic neuropathic or malignant diseases3.
Ketamine has become a popular recreational drug in nightclubs in Taiwan and other areas, such as Hong Kong and the UK, in the past 10 years4,5,6. Many adolescents use it because of its low price and easy usage. Long-term ketamine abuse may cause severe lower urinary tract symptoms (LUTS), which are very similar to those of interstitial cystitis/bladder pain syndrome (IC/BPS) including increased urinary frequency, urgency, nocturia, intractable dysuria, hematuria, and bladder pain. Since the first report of ketamine-associated urinary tract damage in Canada in 20077, the number of reported cases in recent years has been increasing. Although a study of LUTS in ketamine users reported a prevalence of 26.6% in non-treatment-seeking people8, epidemiological data in Taiwan are still lacking.
The treatment for ketamine-associated LUTS is challenging and it resembles that for interstitial cystitis. According to guidelines of the American Urological Association9,10, there are six-line options for interstitial cystitis. However, the most important step in the management of ketamine-associated LUTS, which differs from interstitial cystitis, is the discontinuation of ketamine use.
We conducted an in-depth epidemiological study to better understand the correlation between ketamine abuse and LUTS in Taiwan. We hypothesized that various ketamine consumption parameters would be associated with LUTS.
Results
Ninety-five men and 11 women (24.87 ± 6.44 years old) submitted the questionnaires. The average age of starting ketamine use in this study was 16.68 ± 3.35 years. The duration of ketamine use was 75.45 ± 43.9 months, and cessation interval was 12.79 ± 13.47 months. Eighty-nine (84%) ketamine users developed LUTS after using ketamine for 24.67 ± 26.36 months. Ketamine use methods were snorting (34%), smoking (33%), and both (33%). Ninety-one (92.9%) subjects used ketamine more than once daily. Most of the abusers used no more than 10 gm per day (Table 1). Approximately 80% of ketamine abusers admitted of having a history of polysubstance abuse, although none of them used drugs other than ketamine regularly. There were different combination substances, such as amphetamine, marijuana, morphine, heroin, codeine, flunitrazepam, and ecstasy. Ecstasy was most frequently combined with ketamine (90.5%). Urinary frequency (66, 67.3%), incomplete bladder emptying (65, 67%), and nocturia (60, 61.9%) were the three most common symptoms caused by long-term ketamine use. In addition, the most bothersome symptoms were urinary frequency (55, 56.7%), nocturia (28, 29.3%), and urinary urgency (34, 35.1%).