Abstract
The clinical study was well designed and conducted. The findings of reduction of pain were valid given the pharmacologic nature of ketamine and in line with its long-standing use in anesthesia. The use of ketamine via an intraurethral route, however, causes great anxiety in our community where we are fighting with a rampant problem of ketamine-induced cystitis from abuse by inhalation of the substance. 1
While there are only a few reports to date, there is emerging evidence that ketamine abuse causes extensive effects—in particular, the urinary bladder. 2,3 The local urology community first described such a phenomenon with symptoms of severe bladder pain and urinary frequency that was suggestive of interstitial cystitis. 2 Then we realized its devastating effect, leading to markedly diminished bladder volume, while the pathogenesis remained obscure. Severe cases ended up necessitating subtotal cystectomy and augmentation. Yet the worst cases were those who continued the ketamine abuse postbladder augmentation where they progressed to develop upper tract strictures. We hypothesize that the increased absorption surface enhances the reabsorption of either ketamine or its metabolites, leading to a higher effective dose. This postulation is currently being studied with support from Security Bureau of the Government of the Hong Kong Special Administration Region. 4
From our study on early urinary symptoms of adolescents abusing ketamine, as well as our work in collaboration with outreach social workers, dose frequency and duration of exposure are related to the severity of urinary symptoms. 5 In addition, relief of otherwise unbearable bladder pain is a commonly cited reason for continuing the abuse of ketamine. It may sound too far fetched to become overly alarmed about using ketamine intraurethrally in a controlled medical setup. We do notice that some of the patients in this study are under surveillance for bladder cancer and thus potentially subjected to repeated exposure to the agent. We therefore feel compelled to share our concern as well as the struggle to fight this rapidly spreading medicosocial condition.