# Ketamine-Induced Uropathy in a High-Prevalence Region: Knowledge, Diagnostic Practices, and Treatment Patterns Among Primary and Secondary Care Providers

## TL;DR

This study explores how healthcare providers in a UK region with high ketamine misuse address ketamine-induced uropathy, finding gaps in awareness and the need for better education and early intervention.

## Contribution

The study identifies disparities in KIU awareness between primary and secondary care and emphasizes the need for standardized guidelines and education.

## Key findings

- Secondary care professionals showed significantly higher awareness of KIU compared to primary care providers.
- Primary care professionals lacked confidence in managing KIU and often deferred care to secondary services.
- High non-attendance rates suggest a need for early psychosocial intervention and targeted education for GPs.

## Abstract

Ketamine-induced uropathy (KIU) is an emerging consequence of recreational ketamine misuse, often leading to progressive urinary tract dysfunction. Despite increasing prevalence, clinician awareness and standardized management remain limited. This study evaluated knowledge and practices among healthcare professionals in Cheshire and Merseyside, a region in the United Kingdom with high KIU incidence.

A convergent mixed-methods observational study was conducted, comprising a cross-sectional knowledge, attitudes, and practice (KAP) survey of 107 primary and secondary care professionals, as well as a retrospective review of 65 KIU patients over six months at a regional high-volume urology center. Survey responses underwent descriptive and comparative statistical analysis; clinical data were reviewed for diagnostic patterns, interventions, and outcomes.

Secondary care professionals demonstrated significantly greater awareness of KIU than primary care counterparts (p=0.005), though overall familiarity with British Association of Urological Surgeons (BAUS) guidelines was limited. Primary care respondents expressed a lack of confidence in managing KIU and were more likely to defer care to secondary services. A notable proportion believed that law enforcement should be involved in management, reflecting broader public health concerns. High rates of non-attendance (41.5%) highlighted the need for early psychosocial intervention. General practitioners (GPs) expressed strong interest in targeted education to improve community-based care.

Awareness and management of KIU remain inconsistent across healthcare settings. The recent BAUS consensus guidelines offer a unified framework that, if widely adopted, could standardize care and curb disease progression. Future directions include establishing multidisciplinary clinics and exploring urological subspecialization in KIU. Enhanced primary care education and earlier intervention are essential to improving patient outcomes and reducing long-term morbidity.