This patient was asked to completely stop taking ketamine. He was started on paracetamol and ibuprofen with not much help. He was also trialed on neuropathic agents, amitriptyline and pregabalin, with only minimal benefit. He was referred to urology for trial of botulinum toxin A injection into the bladder. He has responded well with this intervention with the pain levels coming down drastically. He was also referred to the substance misuse team for further support.
Ketamine use has a significant effect on the urinary tract. It is important to ask about recreational ketamine use when assessing a patient with bladder pain. Every effort should be made to help with the cessation of the drug and prevent irreversible damage to the urinary tract. A multidisciplinary approach to patient management is important with regards to substance misuse, psychological assessment and the best choice of treatment and symptom control.
