Risk Factors of Lower Urinary Tract Syndrome among Ketamine Users

Abstract

Objective: This study investigated the risk factors of ketamine associated-lower urinary tract symptoms (LUTS), such as duration of use, dosage of ketamine, co-occurring substance use of other psychoactive drugs, comorbidities, and depression.

Methods: This study was a cross-sectional survey. LUTS was assessed with the O'Leary symptom and problem index (OSPI) scores. We included the comorbidities of interstitial cystitis/painful bladder syndrome (IC/PBS) as comorbid factors. Depression was evaluated based on the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM 5). Duration of use, dosage of ketamine and the OSPI scores were subjected to log transformation because of the skewed distribution.

Result: Among 143 participating ketamine users, 25 (17.5%) had LUTS. Duration of ketamine use was significantly positively correlated with OSPI scores (adjusted β [95% CI], 0.21 [0.06-0.35] in log-log model), which equaled a 10% increase in months of ketamine-use increased OSPI scores by 2.02 %. Female and depression were significantly associated OSPI scores (adjusted β [95% CI], 0.20 [0.03-0.37], 0.49 [0.29-0.70], respectively in the log-linear model), with OSPI scores being 1.22 times higher in female, and 1.63 times higher in ketamine users with depression. Dosage of use was not significantly associated with OSPI scores (adjusted β [95% CI], 0.04 [-0.12 to 0.20], P = 0.64 in log-log model), likewise with comorbid diseases (adjusted β [95% CI], 0.07 [-0.08 to 0.21], P = 0.36 in log-linear model).

Conclusion: Depression and longer duration of exposure to ketamine are significantly associated with the development of LUTS among ketamine users. Early evaluation and intervention of depression should be considered in patients of ketamine-associated LUTS.

Keywords: ketamine; ketamine cystitis; lower urinary tract syndrome; pain.