**8. Conclusions**

Long-term ketamine abuse leads to the development of ketamine cystitis. Symptoms are debilitating and interfere significantly with the patient's daily activities. Furthermore, the upper tract may also suffer from irreversible damage, such as ureteric stricturing and finally chronic renal failure. Management of ketamine cystitis starts with its identification. This could be achieved using standardised symptom score questionnaires in known abusers of ketamine. Investigations such as blood tests, computed tomography, and cystometrogram are useful to characterise and delineate the extent of ketamine cystitis and its sequelae. The cornerstone of effective treatment is abstinence. This is done via a multidisciplinary approach involving urologists, psychiatrists, social workers, and other relevant disciplines. Intravesical therapies, such as hyaluronic acid instillation and botulinum toxin injection, are emerging options that have shown promising results. Upper tract protection in the form of long-term percutaneous nephrostomies may save the patient from suffering from chronic renal failure.
