A young lady was recently seen by me presenting with urinary frequency. The consultation was interrupted by her urination for several times. She also had hematuria, terminal stream dysuria, incontinence and suprapubic pain. On further questioning, she confessed that she had the habit of ketamine abuse. She mentioned that similar symptoms also appeared on her peer group. Actually, there were an increasing number of similar cases recently. Moreover, the affected age group was not limited only to youngsters. There was a widening trend of involved social classes, including even housewives and lorry drivers, for example.

Ketamine is detrimental not only to the brain but also to the urinary bladder, leading to ketamine-associated ulcerative cystitis. Studies showed that the severity of urinary symptoms was related to the dose of ketamine abuse. The ulceration can lead to fibrosis and a contracted bladder with a small volume. I had met a patient who needed to go to the toilet every five minutes, severely affecting his job, social life and daily living. The kidneys can also be affected in severe cases, resulting in hydronephrosis and renal failure.

Ketamine is an anaesthetic drug. It can also be used for chronic neuropathic pain. Abusers take the drug because of its neurological side effects. They describe a near-death experience, including a sense of travel through a dark tunnel into a light at high speed, intense visions and buzzing, ringing or whistling sounds. Ketamine entered into the body is metabolized in the liver and excreted by the kidneys. High concentrations of ketamine and its metabolites can be found in the urine.


The cessation of use of ketamine is fundamental to the treatment of the disease. Symptomatic treatments include medications for pain, bleeding and urinary frequency. Studies showed that the drug Pentosan polysulfate was effective. It is a drug for treating interstitial cystitis. Its function is to repair the glycosaminoglycan in the bladder mucosa. Medical treatment may not be able to relieve all the symptoms. Some symptoms may persist. Moreover, symptoms will recur if ketamine is resumed. If the bladder is severely contracted, surgery may be needed to enlarge the bladder with small bowel.

It is important to note that ketamine abuse is a severe social problem. Doctors should have a high index of suspicion when they attend suspected cases. They should take the drug history in detail and strongly advice abusers to stop ketamine immediately. Family members and friends of abusers should give support. Abusers should make up their mind to stop this so-called soft drug altogether.

Dr Cheng Chi Wai, Michael
Specialist in Urology and consultant Urologist at Union Hospital