To investigate the characteristics of ketamine induced uropathy in young adults and to assess the effectiveness of treatment on urinary symptoms.

A cross-sectional study was conducted with 20 ketamine-induced uropathy (KIU) participants (75% male, 25% female) aged 16-27 years from January to June 2024. Symptoms prevalence assessed before and after treatment, focusing on frequency, dysuria, urgency, nocturia, incontinence, incomplete emptying, weak stream, and straining. Data analysis was performed using SPSS v. 26.0.

A total of 20 participants were included in the study, with 15 males (75%) and 5 females (25%). The majority of participants were between 16-21 years old (55%), followed by 22-27 years old (40%), and 27-32 years old (5%). Most participants were regular ketamine users (70%), with duration of use above 6 years (75%). The amount of ketamine used per day was mostly between 1-2 grams (70%). The majority of participants (80%) still using ketamine even after being diagnosed with uropathy, and 65% received treatment for 1-3 months. Radiological imaging modalities used included CT (40%) and US (30%). The estimated glomerular filtration rate (eGFR) was greater than 90 ml/min in 80% of participants and between 80-90 ml/min in 20%. 
Pre-treatment, the most common symptoms were frequency (100%), dysuria (100%) and urgency (85%). After treatment, the prevalence of these symptoms decreased to 90%, 75%, and 40%, respectively. Nocturia decreased from 35% to 30%, incontinence from 35% to 10% and incomplete emptying from 30% to 5%, weak stream from 15% to 10%, and straining from 10% to 5%. The symptoms those significantly improved were dysuria (P= 0.016), urgency (P= 0.003), incomplete emptying (P=0.047) and incontinence (P=0.037) 
The International Prostate Symptom Score showed a slight shift from severe symptoms to mild symptoms after treatment, but this change was not statistically significant (P=0.546)

The significant improvements observed in urinary symptoms following treatment in this study are consistent with findings from previous research, which suggests that treatment can lead to symptom reduction in ketamine-induced uropathy (1).
Age distribution showed that 55% of participants were aged 16-21 years, and 40% were aged 22-27 years. This finding is consistent with a study where the younger adults are more likely to engage in recreational drug use, including ketamine(2).
Post-treatment, the prevalence of frequency, dysuria and urgency decreased to 90%, 75%, and 40%, respectively. Also, notable improvement was observed in incontinence, which decreased from 35% to 10%, with a statistically significant P. value of 0.037. Similarly, incomplete emptying decreased from 30% to 5%, with a P. value of 0.047. These results support findings from a comprehensive review which reported non-invasive therapies, including the use of oral anti-inflammatories and anticholinergics, can also lead to improvements in urinary symptoms (3). These treatments, combined with ketamine cessation, contribute to symptom relief and improved bladder function.
The results demonstrate a more substantial reduction in key symptoms. This could be attributed to the comprehensive approach used in our study, which assessed a broad range of symptoms and included a sample that more closely mirrors the demographic of regular ketamine users. These findings support the British Association of Urological Surgeons consensus, which emphasizes the need for personalized, symptom-specific interventions to optimize treatment outcomes.

This study highlights the high prevalence of lower urinary tract symptoms among young ketamine users and demonstrates significant improvements in key symptoms following treatment. These findings are particularly important for young adults, a demographic at risk for long-term urinary dysfunction due to sustained ketamine use. The study emphasizes the need for targeted interventions to improve health and quality of life in this vulnerable population.

Belal M, Downey A, Doherty R, Ali A, Hashim H, Kozan A, Kujawa M, Pakzad M, Rashid T, Osman N, Sahai A, Biers S; BAUS Section of Female, Neurological and Urodynamic Urology. British Association of Urological Surgeons Consensus statements on the management of ketamine uropathy. BJU Int. 2024 Aug;134(2):148-154. doi: 10.1111/bju.16404
Andrew N, Cantrell F, Richard F. Clark. Ketamine exposure demographics and outcomes over 16?years as reported to US poison centers. The American Journal of Emergency Medicine. 2018;16(8):1459-62. doi:10.1016/j.ajem.2018.04.066
Li CC, Wu ST, Cha TL, Sun GH, Yu DS, Meng E. A survey for ketamine abuse and its relation to the lower urinary tract symptoms in Taiwan. Scientific reports. 2019 May 10;9(1):7240. doi: 10.1038/s41598-019-43746-x.