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. 2025 Jun 19;17(6):e86373.
doi: 10.7759/cureus.86373. eCollection 2025 Jun.

Ketamine-Induced Uropathy in a High-Prevalence Region: Knowledge, Diagnostic Practices, and Treatment Patterns Among Primary and Secondary Care Providers

Zakaria W Shkoukani  1 , Praveen Gopi  1 , Lauren Tate  1 , Alina Calmuc  1 , Ahmad Omar  1 , Mohamed I Abdulmajed  1
Affiliations

Ketamine-Induced Uropathy in a High-Prevalence Region: Knowledge, Diagnostic Practices, and Treatment Patterns Among Primary and Secondary Care Providers

Zakaria W Shkoukani et al. Cureus. .

Abstract

Ketamine-induced uropathy (KIU) is an emerging consequence of recreational ketamine misuse, often leading to progressive urinary tract dysfunction. Despite increasing prevalence, clinician awareness and standardized management remain limited. This study evaluated knowledge and practices among healthcare professionals in Cheshire and Merseyside, a region in the United Kingdom with high KIU incidence. A convergent mixed-methods observational study was conducted, comprising a cross-sectional knowledge, attitudes, and practice (KAP) survey of 107 primary and secondary care professionals, as well as a retrospective review of 65 KIU patients over six months at a regional high-volume urology center. Survey responses underwent descriptive and comparative statistical analysis; clinical data were reviewed for diagnostic patterns, interventions, and outcomes. Secondary care professionals demonstrated significantly greater awareness of KIU than primary care counterparts (p=0.005), though overall familiarity with British Association of Urological Surgeons (BAUS) guidelines was limited. Primary care respondents expressed a lack of confidence in managing KIU and were more likely to defer care to secondary services. A notable proportion believed that law enforcement should be involved in management, reflecting broader public health concerns. High rates of non-attendance (41.5%) highlighted the need for early psychosocial intervention. General practitioners (GPs) expressed strong interest in targeted education to improve community-based care. Awareness and management of KIU remain inconsistent across healthcare settings. The recent BAUS consensus guidelines offer a unified framework that, if widely adopted, could standardize care and curb disease progression. Future directions include establishing multidisciplinary clinics and exploring urological subspecialization in KIU. Enhanced primary care education and earlier intervention are essential to improving patient outcomes and reducing long-term morbidity.

Keywords: geographic variations in drug misuse; ketamine-induced uropathy; multidisciplinary management; primary care awareness; secondary care practices.

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Conflict of interest statement

Human subjects: Informed consent for treatment and open access publication was obtained or waived by all participants in this study. Quality Improvement and Clinical Audit Department of Mersey and West Lancashire Teaching Hospitals NHS Trust issued approval S367-24-25. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. Number of ketamine misuse cases seen in the last year across sectors
Figure 2
Figure 2. Frequency of clinical enquiry into the impact of ketamine misuse on sexual function
Figure 3
Figure 3. Investigations considered necessary in primary care
FBC, full blood count; U&Es, urea and electrolytes; LFTs, liver function tests; KUB, kidneys, ureters, and bladder
Figure 4
Figure 4. Interventions considered appropriate before urologist referral
Figure 5
Figure 5. Perceived multidisciplinary teams involved in the management of KIU
KIU, ketamine-induced uropathy
Figure 6
Figure 6. Diagnostic investigations arranged for KIU patients
Baseline blood includes full blood count, urea and electrolytes, and liver function tests. Imaging modalities include renal ultrasonography, computed tomography, or MAG-3 renography. KIU, ketamine-induced uropathy
Figure 7
Figure 7. Treatment regimens offered to KIU patients
KIU, ketamine-induced uropathy
See this image and copyright information in PMC

References

    1. Ketamine use in current clinical practice. Gao M, Rejaei D, Liu H. Acta Pharmacol Sin. 2016;37:865–872. - PMC - PubMed
    1. Mechanism of action of ketamine. Stahl SM. CNS Spectr. 2013;18:171–174. - PubMed
    1. To use or not to use: an update on licit and illicit ketamine use. Li JH, Vicknasingam B, Cheung YW, Zhou W, Nurhidayat AW, Jarlais DC, Schottenfeld R. Subst Abuse Rehabil. 2011;2:11–20. - PMC - PubMed
    1. Management of complications of ketamine abuse: 10 years' experience in Hong Kong. Hong YL, Yee CH, Tam YH, Wong JH, Lai PT, Ng CF. Hong Kong Med J. 2018;24:175–181. - PubMed
    1. Pathophysiology, clinical presentation, and management of ketamine-induced cystitis. Jhang JF, Birder LA, Kuo HC. Tzu Chi Med J. 2023;35:205–212. - PMC - PubMed