Ketamine abuse can permanently damage bladder: study

Party drug Ketamine can cause damage to the bladder as it allows urine to penetrate into underlying tissues which causes inflammation and extreme pain, scientists said.

In some cases this pain can be so extreme that patients need to have their bladder removed (cystectomy), researchers from York University who did two studies in this regard the UK said.

They showed that ketamine present in urine causes damage to the epithelial lining of the bladder, allowing urine to penetrate into underlying tissues which causes inflammation and extreme pain.

The first study looked at a cystectomy case. This would determine whether bladder damage was caused by direct contact with urinary ketamine or whether the drug causes a systemic change in the whole body that affects the organ.

Reporting a rare physiological coincidence, researchers studied epithelial cells lining the bladder and also in an adjacent remnant of the foetal urinary tract, not in contact with urine, known as an urachus.

Finding that epithelial cells lining the bladder were almost completely absent, having died and been sloughed off into the urine, epithelial cells from the urachus appeared healthy. This shows direct contact with urine is critical to the toxicity of ketamine to the bladder epithelium, ruling out systemic factors.

In the second study, researchers used epithelium cells taken from healthy patients to study how ketamine affects the bladder. Used to produce laboratory models, cells were exposed to ketamine and their responses analysed.

They found that ketamine overwhelms the cell's internal power stations, known as mitochondria, causing a catastrophic release of toxins. To avoid this "melt-down", cells commit a controlled form of suicide (apoptosis) resulting in cell death.

This occurs in a regulated fashion that does not cause excessive toxicity to other cells in an attempt to protect the remaining tissue; however, in the case of chronic ketamine abuse, all epithelial cells are killed, researchers said.

"These two studies combine to demonstrate that direct contact with urinary ketamine causes significant bladder damage, and shows how this drug causes the death of previously healthy bladder cells," said Simon Baker from York University.

"We now have a more detailed understanding of how and why chronic ketamine abuse results in bladder problems and cystitis," he said.

The study was published in the Urology journal.