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This study aimed to provide a systematic literature review on KIU clinical presentation, pathophysiology, and treatments.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We performed the literature search in PubMed, Web of Science, Scopus, and Embase using the terms ketamine and bladder. English papers on human and animal studies were accepted.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 75 papers were selected. Regular ketamine users complain about severe storage symptoms and pelvic pain. Hydronephrosis may develop in long\u2010term abusers and is correlated to the contracted bladder, ureteral stenosis, or vesicoureteral reflux due to ureteral involvement and\/or bladder fibrosis. Cystoscopy shows ulcerative cystitis. Ketamine in urine might exert direct toxicity to the urothelium, disrupting its barrier function and enhancing cell apoptosis. The presence of ketamine\/ions in the bladder wall result in neurogenic\/IgE\u2010mediated inflammation, stimulation of the inducible nitric oxide synthase\u2010cytokines\u2010cyclooxygenase pathway with persistent inflammation and fibrosis. Abstinence is the first therapeutic step. Anti\u2010inflammatory drugs, analgesics and anticholinergics, intravesical instillation of hyaluronic acid, hydrodistension and intravesical injection of botulin toxin\u2010A were helpful in patients with early\u2010stage KIU. In patients with end\u2010stage disease, the control of intractable symptoms and the increase of bladder capacity were the main recommendations to perform augmentation enterocystoplasty.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>KIU is becoming a worldwide health concern, which should be taken into account in the differential diagnosis of ulcerative cystitis.<\/jats:p><\/jats:sec>","DOI":"10.1002\/nau.24341","type":"journal-article","created":{"date-parts":[[2020,3,25]],"date-time":"2020-03-25T11:30:00Z","timestamp":1585135800000},"page":"1049-1062","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":59,"title":["What urologists need to know about ketamine\u2010induced uropathy: A systematic review"],"prefix":"10.1002","volume":"39","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7354-9190","authenticated-orcid":false,"given":"Daniele","family":"Castellani","sequence":"first","affiliation":[{"name":"Department of Urology IRCCS INRCA  Ancona Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4209-8670","authenticated-orcid":false,"given":"Giacomo M.","family":"Pirola","sequence":"additional","affiliation":[{"name":"Department of Urology Usl Toscana Sud Est, San Donato Hospital  Arezzo Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3486-1226","authenticated-orcid":false,"given":"Marilena","family":"Gubbiotti","sequence":"additional","affiliation":[{"name":"Department of Urology Usl Toscana Sud Est, San Donato Hospital  Arezzo Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3490-947X","authenticated-orcid":false,"given":"Emanuele","family":"Rubilotta","sequence":"additional","affiliation":[{"name":"Department of Urology Azienda Ospedaliera Universitaria Integrata  Verona Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2335-7419","authenticated-orcid":false,"given":"Kalyan","family":"Gudaru","sequence":"additional","affiliation":[{"name":"Department of Urology University Hospitals of North Midlands NHS Trust  Stoke\u2010on\u2010Trent UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"Gregori","sequence":"additional","affiliation":[{"name":"Department of Urology ASST Fatebenefratelli Sacco  Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1483-3268","authenticated-orcid":false,"given":"Marco","family":"Dellabella","sequence":"additional","affiliation":[{"name":"Department of Urology IRCCS INRCA  Ancona Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2020,3,25]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1007\/s40262-016-0383-6"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1177\/0897190014525754"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1464-410X.2008.07920.x"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.urology.2007.01.038"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1159\/000338098"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1757-5672.2011.00101.x"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.1002\/cpt196563279"},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.1124\/pr.117.015198"},{"key":"e_1_2_7_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cll.2016.07.008"},{"key":"e_1_2_7_11_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00213-010-2062-x"},{"key":"e_1_2_7_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.brainresbull.2016.05.016"},{"key":"e_1_2_7_13_1","unstructured":"HoareJ MoonD. 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