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Ketamine Bladder - Draft

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Overview

Ketamine Bladder Syndrome (KBS) is a painful, chronic urinary tract condition linked to recreational ketamine use. It primarily affects young adults and can lead to irreversible bladder damage if not managed early.

As ketamine misuse increases, GPs play a pivotal role in early detection, patient education, and management.

Ketamine and its metabolites are excreted in urine, where they can cause direct urothelial toxicity. Chronic exposure leads to:

Urothelial inflammation
Submucosal fibrosis
Reduced bladder capacity
Potential upper urinary tract involvement (e.g., hydronephrosis)

Clinical Features may include: dysuria, frequency, urgency, nocturia, haematuria, suprapubic pain, incontinence, flank pain.

Who to Refer

Refer or direct patients with ongoing ketamine use to drug support services. See the Non-opiate drug dependence page for local options.

Refer to urology if symptoms persist more than 4 weeks following cessation of ketamine use or if there are suspected urological complications (e.g. hydronephrosis, retention).

Red Flags

Consider malignancy in the following groups:

Unexplained visible haematuria in adults without UTI - refers to patients where UTI and urinary stone disease have been excluded.
Visible haematuria that persists or recurs after successful treatment of a UTI.

(Patients < 45 with unexplained visible haematuria may be referred urgently but outside USC system. Patients aged 45 years or over should be referred as USC.)

Non- visible haematuria in patients aged 60 or over with either dysuria or raised white cell count on a blood test.

Urology - USC (2WW)

Before Referral

Investigations

Exclude other causes of urological symptoms such as UTI or sexually transmitted infections.
Check bloods - FBC, UE, LFT (1)
Consider renal USS to assess for hydronephrosis or bladder wall thickening.

Symptomatic management in primary care

Anticholinergics may be helpful in reducing frequency and urgency. See the Overactive Bladder page for further advice.
Analgesia - e.g. NSAIDs, amitriptyline (1)

Advise patients

Mild to moderate cases may improve with cessation and conservative management.
Ongoing Ketamine use or severe cases can lead to:
- Permanent bladder dysfunction
- Renal impairment
- Requirement for surgical intervention

Advice and Guidance

If more specific advice is required then consider requesting Urology Advice & Guidance

Referral

If not responding to management in primary care then refer to Urology via eRS.

Resources

(1) British Association of Urological Surgeons Consensus statements on the management of ketamine uropathy

(2) Ketamine misuse: an update for primary care | British Journal of General Practice

Patient information

Ketamine - Bristol Drugs Project - includes advice on risks of ketamine use.

Efforts are made to ensure the accuracy and agreement of these guidelines, including any content uploaded, referred to or linked to from the system. However, BNSSG ICB cannot guarantee this. This guidance does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer, in accordance with the mental capacity act, and informed by the summary of product characteristics of any drugs they are considering. Practitioners are required to perform their duties in accordance with the law and their regulators and nothing in this guidance should be interpreted in a way that would be inconsistent with compliance with those duties.

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