He has engaged in research of human and animal neuroscience, drug discovery, and drug toxicology, using various techniques of pathology, immunocytochemistry, cytochemistry, and imaging. Dreams and realities, dr jansen phd, an english psychiatrist, suggested that under medical supervision, the. Ketamineinduced bladder fibrosis involves epithelialto. The diagnosis of kiu is primarily established by the clinical presentation of severe lower urinary tract symptoms and a history of ketamine abuse, and can be further confirmed by a urine examination and urodynamic studies. Public users are able to search the site and view the abstracts for each book and. However, many ketamine abusers with the key symptoms of ketamine. Methods patients diagnosed with kiu who underwent ct scanning from 1 january 2006 to 31 december 2011 were. All physicians be aware ketamine has been used as an anesthesia agent since the 1960s and as a recreational drug for at least the past 2 decades, particularly in nightclubs, because of its wellknown khole effect and psychological dissociation symptoms. Abstaining from ketamine abuse is regarded as an important milestone in treating ketamine related uropathy. It is worth noting that similar urological toxicity has also been reported in patients receiving analgesic ketamine. Yew is the professor emeritus of anatomy in the school of biomedical sciences, chinese university of hong kong. Peggy chu gave an excellent talk on ketamine uropathy on behalf of the urological association of asia uaa. Resonance metallic ureteric stent in a case of ketamine. Ketalar ketamine dosing, indications, interactions.
To date, at least 110 cases of ketamineinduced uropathy kiu have been reported in the literature. Complete reversal of the clinical symptoms and image. Imaging diagnosis of ketamineinduced uropathy sciencedirect. Ketamine also has major abuse potential and is used illicitly as a recreational drug.
Ketamine is a parenterally administered, general anesthetic used largely for short term diagnostic and surgical procedures, but which has been limited in use because of its psychological side effects including vivid hallucinations, agitation and confusion. Lilly, moore and psychonauts of the time were using the drug to go into a full khole for about an hour, which is as long. An interesting collateral effect of the psychedelic properties of ketamine, especially the induction of neardeath experiences, 46 was the development of a therapeutic use of ketamine in palliative medicine. A 29yearold male patient with a 3year history of ketamine inhalation. What urologists need to know about ketamineinduced. These factors include fimbriae and the ability to associate with gut cellsmucus, the production of a capsule, the secretion of a range of hydrolytic enzymes, the production of other toxins. There was support for an audit documenting the experiences of urologists in managing ketamine uropathy. Ketamine is an nmda receptor antagonist, but it may also have other actions. Ketamines trip from anesthetic to antidepressant and. Uropathy has proven itself time and again for s of years from all over the world. Call for national cooperation for the care of ketamine induced uropathy in. In addition, nine patients had ureteral wall thickening, and two had ureterovesical junction involvement.
Case series demonstrate a temporal link between ketamine abuse and urological symptoms, urinary tract damage, and renal impairment, with some but not all symptoms improving upon. The aim of this study is to investigate if prevalence of nonbladder condition in ketamine induced uropathy compared to ketamine abusers without bothering lower urinary tract symptoms luts and icbps patients. Chronic abuse of ketamine leads to ketamine associated uropathy, commonly presenting with lower urinary tract symptoms and suprapubic pain. Ketamine consumption as a recreational drug is on an increasing trend. About 110 cases of ketamine abuse uropathy ketamine induced vesicopathy have so far been reported in the world. The major aims of the present study were to elucidate ketamine induced ulcerative cystitis and bladder apoptosis in association with oxidative stress mediated by mitochondria and the endoplasmic reticulum er. Luts 2012 4, 1924 originalarticle ketamine induced uropathy. A spectrum of urological destructions ranging from mild cystitis to severely. The aim of the present study was to elucidate the mechanism of ketamine induced fibrosis in association with epithelialtomesenchymal transition emt mediated by transforming growth factor. Ketamine uropathy ku describes the effects of ketamine on the urinary system.
Yuhua fan,1,2 and kuangkuo chen1,2 1divisionofurology,departmentofsurgery,taipeiveteransgeneralhospital,taipei,taiwanand. To summarise the investigation and management of the disease. Covid19 is a nonsegmented, positive sense rna virus. Virulence factors of clostridium difficile clinical. Ketamine abuse induced uropathy and kidney injury article in journal of internal medicine of taiwan 261.
Obstructive uropathy genitourinary disorders merck manuals. It crept into the mainstream with the release of two books in 1978 that detailed personal accounts of selfexploration through ketamine, the scientist by john lilly and journeys into the bright world by marcia moore. After patients with ketamine induced cholangiopathy have achieved abstinence, improvements have been observed in the dilatation of the common bile ducts. Obstructive uropathy etiology, pathophysiology, symptoms, signs, diagnosis. Obstructive uropathy is a condition in which the flow of urine is blocked. Obstructive uropathy happens when your urine flow reverses direction due to a blockage in one of your ureters. Bladder wall fibrosis is a major complication of ketamine induced cystitis kc, but the underlying pathogenesis is poorly understood. She provided insight into this disease process that had plagued hong kong over the past few decades and provided important guidance on how to manage these patients and learn from their lesion. Street ketamine abuse is associated with a serious urological condition termed as ketamine associated ulcerative cystitis, in which patients typically present with severe lower urinary tract symptoms with dysuria and haematuria. Study design, materials and methods this was a retrospective crosssectional study.
This causes the urine to back up and injure one or both kidneys. With growing ketamine abuse, ketamine induced uropathy kiu has become more prevalent in recent years. National kidney foundation primer on kidney diseases ebook. Suspected obstructive uropathy optimizing health system use of. Upper tract involvement is observed in a portion of patients. Inflammatory picture and hypersensitive reaction are observed in the histopathology of ketamine.
The baus data and audit project is a uk collection of online databases covering a number of urological conditions. Ketamine induced uropathy kiu is one of the complications observed in abusers. Urological complications of illicit drug use nature. Recent data suggest that the toxicity of ketamine can be due to direct cytotoxicity, independent of a nmda receptormediated mechanism. Drug induced rhabdomyolysis is a common syndrome that is complex and potentially life threatening. Dysuria due to benign prostatic hyperplasia of the median. Benign prostatic hyperplasia bph rarely occurs in children or young males.
Obstructive uropathy is a structural or functional hindrance of normal urine flow, sometimes leading to renal dysfunction obstructive nephropathy. Ketamineinduced ulcerative cystitis and bladder apoptosis. I think it is the most detailed and informative book on the topic and i highly recommend it. Dreams and realities is by far the most authoritative and comprehensive book on the subject of ketamine ever scribed. Ketamine abusers develop severe lower urinary tract symptoms. Bladder barrier dysfunction, neurogenic inflammation with abnormal neurotransmission and. It is a very broad term, and does not imply a location or cause. The initial management of obstructive uropathy involves catheterization. The use of ketamine as a recreational drug has become increasingly widespread, particularly amongst teenagers and young men. Martha christys book your own perfect medicine is excellent book on the topic as well. Evaluation of the extent of ketamineinduced uropathy.
A new clinical entity causing lower urinary tract symptoms to chang, 1,2chihchieh lin, alex tonglong lin. Almost 200 cases of ketamine induced uropathy have been reported in the literature, mostly in the context of chronic abuse, but five within medical analgesic use. It was extensively used for surgical anesthesia in the vietnam war due to its safety. Role of ketamine in acute postoperative pain management. In addition to the two major toxins of clostridium difficile toxins a and b, which represent the major virulence factors a number of other putative virulence factors have been described. Obstructive uropathy is indeed a dreadful condition to have and its a urological emergency. With abstinence, symptom resolution has been observed. With growing ketamine abuse, ketamineinduced uropathy kiu has become more prevalent in recent years. Benign prostatic hyperplasia and obstructive uropathy oxford. Its sideeffects on the central nervous system and cardiovascular are well established and documented, although it is now clear that ketamine also has significant toxic effects on the genitourinary system.
It is a misnomer to use ketamine cystitis or ketamine bladder syndrome as, whilst the bladder is often most severely affected, the whole urinary tract may be damaged. Ketamine abuse is an emerging issue in many countries, and ketamine cystitis kc is a growing disease which more and more urologists may encounter with. Background with growing ketamine abuse, ketamine induced uropathy kiu has become more prevalent in recent years. With growing ketamine abuse, ketamine induced uropathy kiu has become a vital health issue in recent years. The effect of ketamine abuse on the urinary bladder is. Inflammatory picture and hypersensitive reaction are observed in the histopathology of ketamine cystitis specimen. Articles in press latest issue article collections all issues. Although the lower urinary tract is the primary affected site, involvement of the upper urinary tract is common, and kiu may progress rapidly. The involvement of upper urinary tract is often observed in ketamine induced uropathy. In this case report, a 29yearold male patient diagnosed with bph coexisting with ketamine associated uropathy was reported to investigate the possible relationship between bph and ketamine associated uropathy as well as therapeutic strategies.
Recent findings the list of drugs and inciting agents that cause rhabdomyolysis is quite extensive. Mris were done along with renal scan using 99mtcmag3 n22, 99mtcdtpa n15 or 99mtcdmsa n2. Dissociative effects and low cost led ketamine becoming an illegal recreational drug in young adults. Illicit drug use can result in a wide spectrum of urological manifestations, which urologists should be able to recognize in their patients. Ketamine was discovered in 1962, first tested in humans in 1964, and approved for use in the united states in 1970.
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