From Pathophysiology to Surgical Treatment: A Comprehensive Narrative Review of Ketamine-Induced Cystitis

Ketamine-induced cystitis (KIC) is an increasingly recognised complication of recreational ketamine use, predominantly affecting young adults and causing severe lower urinary tract symptoms, bladder pain, and progressive structural damage.Its pathophysiology involves urothelial toxicity, chronic inflammation, neurogenic sensitisation, and progressive fibrosis, with advanced disease potentially resulting in a contracted, poorly compliant bladder and upper urinary tract compromise.This narrative review summarises current evidence on the epidemiology, pathophysiology, clinical presentation, diagnosis, and management of KIC, including its distinction from interstitial cystitis/bladder pain syndrome.A literature search was conducted in November 2025 using MEDLINE, Embase, PubMed, and Google Scholar, with relevant literature identified using combinations of terms including "ketamine", "ketamine-induced cystitis", "ketamine cystitis", and "ketamine uropathy".Ketamine cessation remains the cornerstone of management and may improve symptoms and early inflammatory changes.Medical and intravesical therapies may provide symptomatic benefit, although the supporting evidence is predominantly derived from observational studies and small case series.Patients with advanced bladder contracture, poor compliance, or upper urinary tract compromise may require reconstructive surgery or urinary diversion.Early recognition, ketamine cessation, multidisciplinary addiction support, and appropriate escalation of urological management are central to limiting irreversible urinary tract damage.