Effective treatment of ketamine-associated cystitis with botulinum toxin type a injection combined with bladder hydrodistention

J Int Med Res. 2017 Apr;45(2):792-797. doi: 10.1177/0300060517693956. Epub 2017 Mar 8.


Objective Ketamine-associated cystitis (KAC) has been described in a few case reports, but its treatment in a relatively large number of patients has not been documented. This study aimed to describe our experience of treatment of 36 patients with KAC. Methods Thirty-six patients (30 males and 6 females, aged 19-38 years) with KAC, who had previously taken a muscarinic receptor blocker and/or antibiotics, but without symptomatic relief, were treated with botulinum toxin A injection combined with bladder hydrodistention. Urodynamic testing, and the O'Leary-Sant interstitial cystitis symptom index (ICSI) and problem index (ICPI) were used to evaluate baseline values and improvement before and after the treatment. Results One month post-treatment, all patients achieved marked relief of symptoms. The nocturia time was markedly reduced, while bladder capacity, the interval between micturition, the void volume, and the maximum flow rate were remarkably increased at 1 month. Additionally, the ICSI and ICPI were significantly improved. Conclusion Botulinum toxin A injection along with bladder hydrodistention is effective for managing KAC.

Keywords: Ketamine-associated cystitis; botulinum toxin A; hydrodistention; urodynamic testing.

MeSH terms

  • Adult
  • Anesthetics, Dissociative / adverse effects
  • Botulinum Toxins, Type A / therapeutic use*
  • Cystitis / chemically induced
  • Cystitis / physiopathology
  • Cystitis / therapy*
  • Female
  • Humans
  • Hydrotherapy / methods*
  • Ketamine / adverse effects
  • Male
  • Prospective Studies
  • Tissue Expansion / methods*
  • Treatment Outcome
  • Urinary Bladder / drug effects*
  • Urinary Bladder / physiopathology
  • Urination / drug effects
  • Urination / physiology
  • Urodynamics


  • Anesthetics, Dissociative
  • Ketamine
  • Botulinum Toxins, Type A