Systematic review and meta-analysis of ketamine-associated uropathy.
Level 4 - case-series / case-control
Systematic review and meta-analysis of observational studies and case series
PubMed 36464318 · doi:10.12809/hkmj209194
What was done
A systematic review and meta-analysis of literature on ketamine-associated uropathy searched across MEDLINE, Embase, and Cochrane Central up to June 26, 2020. The review extracted demographics, symptoms, urodynamic/urological findings, histopathology, and management outcomes across 45 included studies comprising 4,921 patients.
What was found
The most prevalent symptoms were urinary frequency (pooled prevalence 77.1%, 95% CI: 56.9%–92.2%), urgency (69.9%, 95% CI: 48.8%–87.3%), and suprapubic pain (60.4%, 95% CI: 35.3%–82.9%). Upper tract disease was evident with a pooled hydronephrosis prevalence of 30.2% (95% CI: 22.0%–39.2%). Objective metrics revealed a pooled functional bladder capacity of 95.23 mL (95% CI: 63.57–126.88 mL), voided volume of 113.31 mL (95% CI: 59.44–167.19 mL), and maximum urine flow rate of 8.69 mL/s (95% CI: 5.54–11.83 mL/s). Biopsies and cystoscopy frequently showed urothelial denudation and inflammatory infiltration. Multiple medical and surgical treatments were used, but ketamine cessation was noted as necessary for recovery.
Why it matters
This review provides quantitative estimates of lower urinary tract dysfunction and upper tract involvement caused by chronic ketamine misuse, establishing baseline clinical and urodynamic expectations for clinicians.
Limits
The review relies on observational cohorts and case series without unexposed control groups. Wide confidence intervals indicate substantial heterogeneity across studies, and the abstract does not report dose-response thresholds or comparative treatment efficacy data.