Effects of Analgesic and Anesthetic Medications on Lower Urinary Tract Function

Sammy E. Elsamra, MD; Pamela Ellsworth, MD, FAAP, FACS

Disclosures

Urol Nurs. 2012;32(2):60-67. 

In This Article

Ketamine

Ketamine is an anesthetic commonly used in pediatric and veterinary procedures, and has recently gained some attention within the urologic community. It is a non-competitive N-methyl- D-aspartic acid receptor antagonist that achieves short-lived general anesthesia and has become a drug of abuse. It is metabolized by the liver to norketamine and ultimately excreted in the urine as hydroxynorketamine conjugated with gluconate. Several recent case series have demonstrated severe irritative LUT symptoms associated with eosinophilic ulcerative cystitis after ketamine use (Chu et al., 2008; Tsai et al., 2009). One review of 59 patients who abused ketamine revealed 71% had cystoscopic findings that were consistent with chronic interstitial cystitis, and 80% had detrusor overactivity or decreased bladder compliance on urodynamics. On radiologic imaging, 51% had either unilateral or bilateral hydronephrosis, and 7% had features suggestive of papillary necrosis. Renal in sufficiency was identified in 14%. These changes may be irreversible (Chu et al., 2008).

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