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Cited by 106Urinary Bladder and Prostate ResearchUrinary Tract Infections ManagementUrinary and Genital Oncology Studies

Possible pathophysiology of ketamine‐related cystitis and associated treatment strategies

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Jhang, Jia‐Fong, Hsu, Yung‐Hsiang, Kuo, Hann‐Chorng·2015·International Journal of Urology
DOI 10.1111/iju.12841
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Abstract

Ketamine‐related cystitis is characterized by ketamine‐induced urinary frequency and bladder pain. It has become a serious problem in recent years. The most typical grossly pathological bladder change with ketamine related cystitis is a contracted bladder and bladder wall thickening. Ulcerative cystitis with an easily bleeding mucosa is a common cystoscopic finding. Microscopically, the urothelium is denuded and is infiltrated by inflammatory cells, such as mast cells and eosinophils. The pathogenesis of ketamine‐related cystitis is complicated and involves many different pathways. Past evidence suggests a direct toxic effect, bladder barrier dysfunction, neurogenic inflammation, immunoglobulin‐E‐mediated inflammation, overexpression of carcinogenic genes, abnormal apoptosis and nitric oxide synthase‐mediated inflammation contribute to the pathogenesis of ketamine‐related cystitis. The first step to managing ketamine‐related cystitis is always asking patients to cease ketamine. Medical treatment might be helpful in patients with early ketamine‐related cystitis and abstinence from ketamine. Several case studies showed that the intravesical installation of hyaluronic acid and intravesical injection of botulinum toxin type A were effective for symptom relief in selected patients. For patients with irreversible pathological change, such as contracted bladder, augmentation enterocystoplasty might be the only solution to increase bladder capacity and relieve intractable bladder pain.

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  • Ketamine is a potential drug of abuse, and high doses, particularly for long periods of time, can result in increased severity of side effects as well as severe urological side effects.

    “It should also be remembered that ketamine is a potential drug of abuse, and high doses, particularly for long periods of time, can result in increased severity of the abovementioned side effects as well as severe urological side effects.80”

    From Ketamine as an antidepressant: Overview of its mechanisms of action and potential predictive biomarkers (2020) · cites this paper as [80]

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Authors
Jhang, J., Hsu, Y., & Kuo, H.
Affiliations
Tzu Chi University (TW)
Corresponding author
Kuo, Hann‐Chorng
ORCID
Venue
International Journal of Urology
Publisher
Wiley
Published
2015-06-18
Volume
22
Issue
9
Pages
816-825
ISSN
  • 0919-8172 (ISSN-L)
  • 1442-2042
DOI
10.1111/iju.12841
OpenAlex
W1537963116
Cited by
106
References
80
Citations by year
2026: 9 · 2025: 7 · 2024: 3 · 2023: 12 · 2022: 15 · 2021: 17 · 2020: 8 · 2019: 6 · 2018: 11 · 2017: 7 · 2016: 7 · 2015: 4
FWCI
2.05
Type
journal article
Language
en
Open access
Licence
onlinelibrary.wiley.com/termsAndConditions#vor (vor)
Locations
  • International Journal of Urology (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Urology › Urinary Bladder and Prostate Research
  • Health Sciences › Medicine › Epidemiology › Urinary Tract Infections Management
  • Health Sciences › Medicine › Surgery › Urinary and Genital Oncology Studies
Keywords
pathogenesis, bladder pain, urinary frequency, mast cells, eosinophils, neurogenic inflammation, apoptosis, nitric oxide synthase, bladder contraction, hyaluronic acid, botulinum toxin type A, augmentation enterocystoplasty
MeSH terms
Anesthetics, Dissociative, Anti-Inflammatory Agents, Non-Steroidal, Urinary Bladder, Cystitis, Drug Hypersensitivity, Humans, Hyaluronic Acid, Ketamine, Prostaglandin-Endoperoxide Synthases, Steroids, Apoptosis, Cholinergic Antagonists, Nitric Oxide Synthase, Botulinum Toxins, Type A, Neurogenic Inflammation, Acetylcholine Release Inhibitors

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