A survey for ketamine abuse and its relation to the lower urinary tract symptoms in Taiwan

Chiao-Ching Li,Guang-Huan Sun,En Meng,Dah-Shyong Yu,Sheng-Tang Wu,Tai-Lung Cha

doi:10.1038/s41598-019-43746-x

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.

Highlights

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 years[4,5,6]
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
lower urinary tract symptoms (LUTS) improved after cessation of ketamine use in 81 (83.5%) abusers

Summary

Introduction

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 years[4,5,6]. 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. The treatment for ketamine-associated LUTS is challenging and it resembles that for interstitial cystitis. We conducted an in-depth epidemiological study to better understand the correlation between ketamine abuse and LUTS in Taiwan. Variable Number of ketamine abusers, N Number of men, N (%) Number of women, N (%) Age, years (mean ± SD) Age of first-time ketamine abuse, years Duration of ketamine abuse, months Cessation interval ketamine abuse, months LUTS developed after ketamine abuse, months Method of ketamine abuse, N (%) Only snoring Only smoking Mainly snorting Mainly smoking Half-and-half Frequency of ketamine abuse, N (%) Several times per day Once daily Once every 2–3 days Weekly Sometimes

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