Unmoderated PosterUnmoderated Poster Session 3: Bladder Cancer, BPO/LUTS, History, Sexual Function and Dysfunction, Stones, Training and Education, Ureteral Cancer/Renal Pelvis, and OtherUP-3.073: Dystrophic Calcification of Urinary Bladder Associated with Ketamine Use
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Introduction and Objectives
The use of Ketamine has been reported to cause ulcerative cystitis leading to irritative lower urinary tract symptoms. Ketamine and its metabolites norketamine and hydroxynorketamine can be measured in high quantities in the urine of patients using ketamine. The evidence in case of Ketamine use came from History and response to cessation of use. We present a case of Dystrophic calcification in the urinary bladder in association with use of Ketamine as a recreational drug.
Materials and Methods
Twenty-two year-old male who had been using ketamine twice a week as a recreational drug for the last 2 years presented with worsening dysuria, frequency, urgency, and gross hematuria. Investigations included a urine culture, microscopy, and cytology. Urinary tract was evaluated with Magnetic resonance imaging, Ultrasound scan, Cystoscopy, and bladder biopsies. He was followed up for two years and his symptoms were evaluated with IPSS and QOL scoring system which revealed dramatic improvement
Results
Ketamine associated Cystitis appears to manifest itself as erythematous bladder with increased vascularity on Cystoscopy. No evidence of Urinary tract infection or presence of Acid Fast Bacilli was demonstrated. MRI revealed profound thickening within the bladder wall. Histology showed markedly inflamed bladder wall with focal areas of ulceration and granulation tissue formation. Perineural inflammation was noted. No evidence of schistosomiasis or granulomatous inflammation seen. No bacterial
Conclusions
Ketamine use has been shown to have caused profound inflammatory changes to the bladder. We report the presence of dystrophic calcification in the bladder wall with chronic haemorrhagic cystitis in association with ketamine use. Being Urologists we should bear in mind the possibility of use of ketamine as a recreational drug in young patients presenting with persistent lower urinary tract symptoms.