Ketamine Uropathy: Critical Role of Imaging and Lessons from an Iatrogenic Complication: A Case Report

Introduction: Ketamine-induced uropathy (KIU) is an increasingly recognised condition with significant implications for urological health. It may present insidiously, particularly when patients conceal recreational drug use, posing diagnostic and procedural challenges. Case Report: We present a case of a 23-year-old woman who concealed a history of ketamine abuse and subsequently developed an iatrogenic bladder rupture following rigid cystoscopy. Her bladder, compromised by ketamine-induced cystitis, exhibited marked wall thickening and critically reduced capacity. Following the iatrogenic bladder injury, she developed vesico-uterine and vesico-vaginal fistula formation, confirmed on computed tomography (CT) cystography. Conservative management with urethral catheter drainage and intravesical hyaluronic acid instillations led to fistula resolution, although bladder capacity remained persistently reduced. Conclusion: This case underscores the importance of eliciting a thorough drug history in patients presenting with unexplained lower urinary tract symptoms and highlights the critical role of pre-procedural cross-sectional imaging before invasive urological procedures in patients with suspected KIU.