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Urological complications of illicit drug use

Nature Reviews Urology volume 11, pages 169–177 (2014)Cite this article

Subjects

Key Points

  • Urologists need to be aware of the potential urological complications of illicit drug use and obtain relevant drug histories when appropriate

  • Case–control studies have suggested an association with certain urological cancers including renal cell carcinoma (amphetamines), bladder cancer (cannabis and heroin), prostate cancer (cannabis) and nonseminomatous germ cell tumours (cannabis)

  • Ketamine cystitis is an established entity with one-quarter of users reporting lower urinary tract symptoms

  • Cocaine use is associated with a variety of sexual dysfunctions, including priapism and Fournier's gangrene

  • Increased reporting and epidemiological studies are needed to fully understand the full impact of illicit drug use on urology

Abstract

Illicit drug use is prevalent worldwide; over 24 million people are estimated to have used recreational drugs during the past month in the UK and USA alone. Illicit drug use can result in a wide spectrum of potential medical complications that include many urological manifestations. To ensure optimal care and treatment, urologists need to be cognizant of these complications in their patients, particularly among youths. Ketamine uropathy is thought to affect over one-quarter of ketamine users and can lead to severe lower urinary tract symptoms, as well as upper tract obstruction. Cannabis use has been associated with an increased risk of bladder cancer, prostate cancer and nonseminomatous germ cell tumours in case–control studies. Fournier's gangrene has been reported following injection of heroin and cocaine into the penis. Excessive use of cough medicines can lead to the development of radiolucent stones composed of ephedrine, pseudoephedrine and guaifenesin. As the current evidence is mostly limited to case reports and case series, future epidemiological studies are needed to fully address this issue.

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References

  1. Home Office. Drug Misuse Declared: Findings from the 2011/12 Crime Survey for England and Wales [online], (2012).

  2. Substance Abuse and Mental Health Services Administration. National Survey on Drug Use and Health, 2011 [online], (2011).

  3. Hwang, S. W. Homelessness and health. CMAJ 164, 229–233 (2001).

    CAS  PubMed  PubMed Central  Google Scholar 

  4. US Department of Housing and Urban Development. The 2010 Annual Homeless Assessment Report to Congress [online], (2011).

  5. Christin, N. Traveling the Silk Road: A measurement analysis of a large anonymous online marketplace. arXiv arXiv1207.7139 (2012).

  6. Devlin, R. J. & Henry, J. A. Clinical review: Major consequences of illicit drug consumption. Crit. Care 12, 202 (2008).

    Article  PubMed  PubMed Central  Google Scholar 

  7. Coull, N. & O'Brien, T. 'Street urology': beyond the formulary. BJU Int. 103, 721–722 (2009).

    Article  PubMed  Google Scholar 

  8. Forster, J. A. & Harrison, S. C. Ketamine uropathy: rising to the challenges of a new condition. BJU Int. 109, 1277–1278 (2012).

    Article  PubMed  Google Scholar 

  9. Fronczak, C. M., Kim, E. D. & Barqawi, A. B. The insults of illicit drug use on male fertility. J. Androl. 33, 515–528 (2012).

    Article  CAS  PubMed  Google Scholar 

  10. Hall, W. & Degenhardt, L. Adverse health effects of non-medical cannabis use. Lancet 374, 1383–1391 (2009).

    Article  CAS  PubMed  Google Scholar 

  11. Trabert, B., Sigurdson, A. J., Sweeney, A. M., Strom, S. S. & McGlynn, K. A. Marijuana use and testicular germ cell tumors. Cancer 117, 848–853 (2011).

    Article  PubMed  Google Scholar 

  12. Vescovi, P. P. et al. Chronic effects of marihuana smoking on luteinizing hormone, follicle-stimulating hormone and prolactin levels in human males. Drug Alcohol Depend. 30, 59–63 (1992).

    Article  CAS  PubMed  Google Scholar 

  13. Shamloul, R. & Bella, A. J. Impact of cannabis use on male sexual health. J. Sex. Med. 8, 971–975 (2011).

    Article  PubMed  Google Scholar 

  14. Lacson, J. C. et al. Population-based case–control study of recreational drug use and testis cancer risk confirms an association between marijuana use and nonseminoma risk. Cancer 118, 5374–5383 (2012).

    Article  CAS  PubMed  Google Scholar 

  15. Smith, A. M. et al. Cannabis use and sexual health. J. Sex. Med. 7, 787–793 (2010).

    Article  PubMed  Google Scholar 

  16. Johnson, S. D., Phelps, D. L. & Cottler, L. B. The association of sexual dysfunction and substance use among a community epidemiological sample. Arch. Sex. Behav. 33, 55–63 (2004).

    Article  PubMed  Google Scholar 

  17. Aversa, A. et al. Early endothelial dysfunction as a marker of vasculogenic erectile dysfunction in young habitual cannabis users. Int. J. Impot. Res. 20, 566–573 (2008).

    Article  CAS  PubMed  Google Scholar 

  18. Castelli, M. P. et al. Cannabinoid CB1 receptors in the paraventricular nucleus and central control of penile erection: Immunocytochemistry, autoradiography and behavioral studies. Neuroscience 147, 197–206 (2007).

    Article  CAS  PubMed  Google Scholar 

  19. Gratzke, C., Christ, G. J., Stief, C. G., Andersson, K.-E. & Hedlund, P. Localization and function of cannabinoid receptors in the corpus cavernosum: basis for modulation of nitric oxide synthase nerve activity. Eur. Urol. 57, 342–348 (2010).

    Article  CAS  PubMed  Google Scholar 

  20. Bowles, D. W., O'Bryant, C. L., Camidge, D. R. & Jimeno, A. The intersection between cannabis and cancer in the United States. Crit. Rev. Oncol. Hematol. 83, 1–10 (2012).

    Article  PubMed  Google Scholar 

  21. Chacko, J. A., Heiner, J. G., Siu, W., Macy, M. & Terris, M. K. Association between marijuana use and transitional cell carcinoma. Urology 67, 100–104 (2006).

    Article  PubMed  Google Scholar 

  22. Sidney, S., Quesenberry, C. P., Friedman, G. D. & Tekawa, I. S. Marijuana use and cancer incidence (California, United States). Cancer Causes Control 8, 722–728 (1997).

    Article  CAS  PubMed  Google Scholar 

  23. Daling, J. R. et al. Association of marijuana use and the incidence of testicular germ cell tumors. Cancer 115, 1215–1223 (2009).

    Article  PubMed  Google Scholar 

  24. Hoffmann, D. E. & Weber, E. Medical marijuana and the law. N. Engl. J. Med. 362, 1453–1457 (2010).

    Article  CAS  PubMed  Google Scholar 

  25. Baker, D., Pryce, G., Giovannoni, G. & Thompson, A. J. The therapeutic potential of cannabis. Lancet Neurol. 2, 291–298 (2003).

    Article  CAS  PubMed  Google Scholar 

  26. Wade, D. T., Robson, P., House, H., Makela, P. & Aram, J. A preliminary controlled study to determine whether whole-plant cannabis extracts can improve intractable neurogenic symptoms. Clin. Rehabil. 17, 21–29 (2003).

    Article  PubMed  Google Scholar 

  27. Freeman, R. M. et al. The effect of cannabis on urge incontinence in patients with multiple sclerosis: a multicentre, randomised placebo-controlled trial (CAMS-LUTS). Int. Urogynecol. J. Pelvic Floor Dysfunct. 17, 636–641 (2006).

    Article  CAS  PubMed  Google Scholar 

  28. Kavia, R. B. C., De Ridder, D., Constantinescu, C. S., Stott, C. G. & Fowler, C. J. Randomized controlled trial of Sativex to treat detrusor overactivity in multiple sclerosis. Mult. Scler. 16, 1349–1359 (2010).

    Article  CAS  PubMed  Google Scholar 

  29. Martin, R. S. et al. Effects of cannabinoid receptor agonists on neuronally-evoked contractions of urinary bladder tissues isolated from rat, mouse, pig, dog, monkey and human. Br. J. Pharmacol. 129, 1707–1715 (2000).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  30. Capasso, R. et al. Inhibitory effect of standardized cannabis sativa extract and its ingredient cannabidiol on rat and human bladder contractility. Urology 77, 1006.e9–1006.e15 (2011).

    Article  Google Scholar 

  31. Burton, T. A. Urinary retention following cannabis ingestion. JAMA 242, 351 (1979).

    Article  CAS  PubMed  Google Scholar 

  32. Warner, E. A. Cocaine abuse. Ann. Intern. Med. 119, 226–235 (1993).

    Article  CAS  PubMed  Google Scholar 

  33. Zimmerman, J. L. Cocaine intoxication. Crit. Care Clin. 28, 517–526 (2012).

    Article  PubMed  Google Scholar 

  34. Fabbian, F. et al. Left kidney: an unusual site of cocaine-related renal infarction. A case report. Eur. Rev. Med. Pharmacol. Sci. 16 (Suppl. 1), 30–33 (2012).

    PubMed  Google Scholar 

  35. Madhrira, M. M., Mohan, S., Markowitz, G. S., Pogue, V. A. & Cheng, J.-T. Acute bilateral renal infarction secondary to cocaine-induced vasospasm. Kidney Int. 76, 576–580 (2009).

    Article  PubMed  Google Scholar 

  36. Hoefsloot, W., de Vries, R. A., Bruijnen, R. & Bosch, F. H. Renal infarction after cocaine abuse: a case report and review. Clin. Nephrol. 72, 234–236 (2009).

    Article  CAS  PubMed  Google Scholar 

  37. Bemanian, S., Motallebi, M. & Nosrati, S. M. Cocaine-induced renal infarction: report of a case and review of the literature. BMC Nephrol. 6, 10 (2005).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  38. Jaffe, J. A. & Kimmel, P. L. Chronic nephropathies of cocaine and heroin abuse: a critical review. Clin. J. Am. Soc. Nephrol. 1, 655–667 (2006).

    Article  CAS  PubMed  Google Scholar 

  39. Mireku-Boateng, A. O. & Tasie, B. Priapism associated with intracavernosal injection of cocaine. Urol. Int. 67, 109–110 (2001).

    Article  CAS  PubMed  Google Scholar 

  40. Khan, F. et al. Fournier's gangrene associated with intradermal injection of cocaine. J. Sex. Med. 10, 1184–1186 (2013).

    Article  PubMed  Google Scholar 

  41. Chan, J. Y., Huang, C. L. & Chan, S. H. Nitric oxide as a mediator of cocaine-induced penile erection in the rat. Br. J. Pharmacol. 118, 155–161 (1996).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  42. Munarriz, R., Hwang, J., Goldstein, I., Traish, A. M. & Kim, N. N. Cocaine and ephedrine-induced priapism: case reports and investigation of potential adrenergic mechanisms. Urology 62, 187–192 (2003).

    Article  PubMed  Google Scholar 

  43. Roberts, J. R., Price, C. & Mazzeo, T. Intracavernous epinephrine: a minimally invasive treatment for priapism in the emergency department. J. Emerg. Med. 36, 285–289 (2009).

    Article  PubMed  Google Scholar 

  44. Altman, A. L., Seftel, A. D., Brown, S. L. & Hampel, N. Cocaine associated priapism. J. Urol. 161, 1817–1818 (1999).

    Article  CAS  PubMed  Google Scholar 

  45. Fiorelli, R. L., Manfrey, S. J., Belkoff, L. H. & Finkelstein, L. H. Priapism associated with intranasal cocaine abuse. J. Urol. 143, 584–585 (1990).

    Article  CAS  PubMed  Google Scholar 

  46. Mouraviev, V. B., Pautler, S. E. & Hayman, W. P. Fournier's gangrene following penile self-injection with cocaine. Scand. J. Urol. Nephrol. 36, 317–318 (2002).

    Article  CAS  PubMed  Google Scholar 

  47. Carey, F. & Dinsmore, W. W. Cocaine-induced penile necrosis. Int. J. STD AIDS 15, 424–425 (2004).

    Article  CAS  PubMed  Google Scholar 

  48. Chen, S.-C. et al. Cocaine-related vasculitis causing scrotal gangrene. Ann. Pharmacother. 43, 375–378 (2009).

    Article  PubMed  Google Scholar 

  49. Kalant, H. The pharmacology and toxicology of “ecstasy” (MDMA) and related drugs. CMAJ 165, 917–928 (2001).

    CAS  PubMed  PubMed Central  Google Scholar 

  50. Mellemgaard, A. et al. International renal-cell cancer study. III. Role of weight, height, physical activity, and use of amphetamines. Int. J. Cancer 60, 350–354 (1995).

    Article  CAS  PubMed  Google Scholar 

  51. Lindblad, P., Wolk, A., Bergström, R., Persson, I. & Adami, H. O. The role of obesity and weight fluctuations in the etiology of renal cell cancer: a population-based case-control study. Cancer Epidemiol. Biomarkers Prev. 3, 631–639 (1994).

    CAS  PubMed  Google Scholar 

  52. Yu, M. C., Mack, T. M., Hanisch, R., Cicioni, C. & Henderson, B. E. Cigarette smoking, obesity, diuretic use, and coffee consumption as risk factors for renal cell carcinoma. J. Natl Cancer Inst. 77, 351–356 (1986).

    CAS  PubMed  Google Scholar 

  53. Yuan, J. M., Castelao, J. E., Gago-Dominguez, M., Ross, R. K. & Yu, M. C. Hypertension, obesity and their medications in relation to renal cell carcinoma. Br. J. Cancer 77, 1508–1513 (1998).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  54. Dunnick, J. K. & Eustis, S. L. Decreases in spontaneous tumors in rats and mice after treatment with amphetamine. Toxicology 67, 325–332 (1991).

    Article  CAS  PubMed  Google Scholar 

  55. Campbell, G. A. & Rosner, M. H. The agony of ecstasy: MDMA (3,4-methylenedioxymethamphetamine) and the kidney. Clin. J. Am. Soc. Nephrol. 3, 1852–1860 (2008).

    Article  CAS  PubMed  Google Scholar 

  56. Richards, J. R., Johnson, E. B., Stark, R. W. & Derlet, R. W. Methamphetamine abuse and rhabdomyolysis in the ED: a 5-year study. Am. J. Emerg. Med. 17, 681–685 (1999).

    Article  CAS  PubMed  Google Scholar 

  57. Cartledge, J. J., Chow, W. M. & Stewart, P. A. Acute renal failure after amphetamine presenting with loin pain. Br. J. Urol. 81, 160–161 (1998).

    Article  CAS  PubMed  Google Scholar 

  58. Sultana, S. R. & Byrne, D. J. 'Raver's' haematuria. J. R. Coll. Surg. Edinb. 41, 419–420 (1996).

    CAS  PubMed  Google Scholar 

  59. Shannon, M. Methylenedioxymethamphetamine (MDMA, “Ecstasy”). Pediatr. Emerg. Care 16, 377–380 (2000).

    Article  CAS  PubMed  Google Scholar 

  60. Beuerle, J. R. & Barrueto, F. J. Neurogenic bladder and chronic urinary retention associated with MDMA abuse. J. Med. Toxicol. 4, 106–108 (2008).

    Article  PubMed  PubMed Central  Google Scholar 

  61. Delgado, J. H., Caruso, M. J., Waksman, J. C., Honigman, B. & Stillman, D. Acute, transient urinary retention from combined ecstasy and methamphetamine use. J. Emerg. Med. 26, 173–175 (2004).

    Article  PubMed  Google Scholar 

  62. Bryden, A. A., Rothwell, P. J. & O'Reilly, P. H. Urinary retention with misuse of “ecstasy”. BMJ 310, 504 (1995).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  63. Inman, D. S. & Greene, D. The agony and the ecstasy: acute urinary retention after MDMA abuse. BJU Int. 91, 123 (2003).

    Article  CAS  PubMed  Google Scholar 

  64. Worsey, J., Goble, N. M., Stott, M. & Smith, P. J. Bladder outflow obstruction secondary to intravenous amphetamine abuse. Br. J. Urol. 64, 320–321 (1989).

    Article  CAS  PubMed  Google Scholar 

  65. Bennett, A. H. & Delrio, A. Idiopathic rupture of the bladder: association with methamphetamine and alcohol. J. Urol. 124, 429–430 (1980).

    Article  CAS  PubMed  Google Scholar 

  66. Schwartz, D. T. Idiopathic rupture of the bladder. J. Urol. 125, 602 (1981).

    Article  CAS  PubMed  Google Scholar 

  67. Deshpande, A. V., Caldwell, P. H. Y. & Sureshkumar, P. Drugs for nocturnal enuresis in children (other than desmopressin and tricyclics). Cochrane Database of Systematic Reviews, Issue 12. Art. No.: CD002238. http://dx.doi.org/10.1002/14651858.CD002238 (2012).

  68. Andersen, M. L. et al. Association of paradoxical sleep deprivation and ecstasy (MDMA) enhances genital reflexes in male rats. Behav. Brain Res. 170, 287–292 (2006).

    Article  CAS  PubMed  Google Scholar 

  69. Zemishlany, Z., Aizenberg, D. & Weizman, A. Subjective effects of MDMA ('Ecstasy') on human sexual function. Eur. Psychiatry 16, 127–130 (2001).

    Article  CAS  PubMed  Google Scholar 

  70. Bang-Ping, J. Sexual dysfunction in men who abuse illicit drugs: a preliminary report. J. Sex. Med. 6, 1072–1080 (2009).

    Article  PubMed  Google Scholar 

  71. Bloor, R. N. Whizz-dick: side effect, urban myth or amfetamine-related koro-like syndrome? Int. J. Clin. Pract. 58, 717–719 (2004).

    Article  CAS  PubMed  Google Scholar 

  72. Foley, C. L. & Bycroft, J. 'Street urology': beyond the formulary. BJU Int. 104, 722 (2009).

    PubMed  Google Scholar 

  73. Colfax, G. & Guzman, R. Club drugs and HIV infection: a review. Clin. Infect. Dis. 42, 1463–1469 (2006).

    Article  PubMed  Google Scholar 

  74. Freeman, P. et al. Methamphetamine use and risk for HIV among young men who have sex with men in 8 US cities. Arch. Pediatr. Adolesc. Med. 165, 736–740 (2011).

    Article  PubMed  PubMed Central  Google Scholar 

  75. Fisher, D. G., Reynolds, G. L. & Napper, L. E. Use of crystal methamphetamine, Viagra, and sexual behavior. Curr. Opin. Infect. Dis. 23, 53–56 (2010).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  76. Zule, W. A., Costenbader, E. C., Meyer, W. J. & Wechsberg, W. M. Methamphetamine use and risky sexual behaviors during heterosexual encounters. Sex. Transm. Dis. 34, 689–694 (2007).

    Article  CAS  PubMed  Google Scholar 

  77. Valencia, F., Bubar, M. J., Milligan, G., Cunningham, K. A. & Bourne, N. Influence of methamphetamine on genital herpes simplex virus type 2 infection in a mouse model. Sex. Transm. Dis. 39, 720–725 (2012).

    Article  CAS  PubMed  Google Scholar 

  78. Pennock, J. W. et al. 3,4-Methylenedioxymethamphetamine increases susceptibility to genital herpes simplex virus infection in mice. J. Infect. Dis. 200, 1247–1250 (2009).

    Article  CAS  PubMed  Google Scholar 

  79. Gahr, M., Plener, P. L., Kölle, M. A., Freudenmann, R. W. & Schönfeldt-Lecuona, C. Self-mutilation induced by psychotropic substances: a systematic review. Psychiatry Res. 200, 977–983 (2012).

    Article  PubMed  Google Scholar 

  80. Israel, J. A. & Lee, K. Amphetamine usage and genital self-mutilation. Addiction 97, 1215–1218 (2002).

    Article  PubMed  Google Scholar 

  81. Crowe, A. V., Howse, M., Bell, G. M. & Henry, J. A. Substance abuse and the kidney. QJM 93, 147–152 (2000).

    Article  CAS  PubMed  Google Scholar 

  82. Kosten, T. R. & O'Connor, P. G. Management of drug and alcohol withdrawal. N. Engl. J. Med. 348, 1786–1795 (2003).

    Article  CAS  PubMed  Google Scholar 

  83. Kleber, H. D. Methadone maintenance 4 decades later: thousands of lives saved but still controversial. JAMA 300, 2303–2305 (2008).

    Article  CAS  PubMed  Google Scholar 

  84. La Pera, G. et al. Sexual dysfunction prior to first drug use among former drug addicts and its possible causal meaning on drug addiction: preliminary results. J. Sex. Med. 5, 164–172 (2008).

    Article  PubMed  Google Scholar 

  85. Chen, W. et al. Erectile dysfunction among male heroin addicts receiving methadone maintenance treatment in Guangdong, China. J. Addict. Med. 6, 212–218 (2012).

    Article  CAS  PubMed  Google Scholar 

  86. Quaglio, G. et al. Erectile dysfunction in male heroin users, receiving methadone and buprenorphine maintenance treatment. Drug Alcohol Depend. 94, 12–18 (2008).

    Article  CAS  PubMed  Google Scholar 

  87. Hallinan, R. et al. Erectile dysfunction in men receiving methadone and buprenorphine maintenance treatment. J. Sex. Med. 5, 684–692 (2008).

    Article  CAS  PubMed  Google Scholar 

  88. Bliesener, N. et al. Plasma testosterone and sexual function in men receiving buprenorphine maintenance for opioid dependence. J. Clin. Endocrinol. Metab. 90, 203–206 (2005).

    Article  CAS  PubMed  Google Scholar 

  89. Quaglio, G. et al. Erectile dysfunction in male heroin users, receiving methadone and buprenorphine maintenance treatment. Drug Alcohol Depend. 94, 12–18 (2008).

    Article  CAS  PubMed  Google Scholar 

  90. Mirin, S. M., Meyer, R. E., Mendelson, J. H. & Ellingboe, J. Opiate use and sexual function. Am. J. Psychiatry 137, 909–915 (1980).

    Article  CAS  PubMed  Google Scholar 

  91. Wang, C., Chan, V. & Yeung, R. T. The effect of heroin addiction on pituitary-testicular function. Clin. Endocrinol. (Oxf.). 9, 455–461 (1978).

    Article  CAS  PubMed  Google Scholar 

  92. Chekuri, V., Gerber, D., Brodie, A. & Krishnadas, R. Premature ejaculation and other sexual dysfunctions in opiate dependent men receiving methadone substitution treatment. Addict. Behav. 37, 124–126 (2012).

    Article  PubMed  Google Scholar 

  93. Al-Gommer, O., George, S., Haque, S., Moselhy, H. & Saravanappa, T. Sexual dysfunctions in male opiate users: a comparative study of heroin, methadone, and buprenorphine. Addict. Disord. Their Treat. 6, 137–143 (2007).

    Article  Google Scholar 

  94. Mintz, J., O'Hare, K., O'Brien, C. P. & Goldschmidt, J. Sexual problems of heroin addicts. Arch. Gen. Psychiatry 31, 700–703 (1974).

    Article  CAS  PubMed  Google Scholar 

  95. Abdollahian, E. et al. Study of the efficacy of fluoxetine and clomipramine in the treatment of premature ejaculation after opioid detoxification. Am. J. Addict. 15, 100–104 (2006).

    Article  PubMed  Google Scholar 

  96. Somers, W. J. & Lowe, F. C. Localized gangrene of the scrotum and penis: a complication of heroin injection into the femoral vessels. J. Urol. 136, 111–113 (1986).

    Article  CAS  PubMed  Google Scholar 

  97. Alguire, P. C. Necrotizing cellulitis of the scrotum: a new complication of heroin addiction. Cutis 34, 93–95 (1984).

    CAS  PubMed  Google Scholar 

  98. Winek, C. L., Wahba, W. W. & Rozin, L. Heroin fatality due to penile injection. Am. J. Forensic Med. Pathol. 20, 90–92 (1999).

    Article  CAS  PubMed  Google Scholar 

  99. White, W. B. & Barrett, S. Penile ulcer in heroin abuse: a case report. Cutis 29, 62–69 (1982).

    CAS  PubMed  Google Scholar 

  100. Aliasgari, M. A., Kaviani, A., Gachkar, L. & Hosseini-Nassab, S. R. Is bladder cancer more common among opium addicts? Urol. J. 1, 253–255 (2004).

    CAS  PubMed  Google Scholar 

  101. Shakhssalim, N. et al. Prominent bladder cancer risk factors in Iran. Asian Pac. J. Cancer Prev. 11, 601–606 (2010).

    PubMed  Google Scholar 

  102. Hosseini, S. Y., Safarinejad, M. R., Amini, E. & Hooshyar, H. Opium consumption and risk of bladder cancer: A case–control analysis. Urol. Oncol. 28, 610–616 (2010).

    Article  CAS  PubMed  Google Scholar 

  103. Shahani, R., Streutker, C., Dickson, B. & Stewart, R. J. Ketamine-associated ulcerative cystitis: a new clinical entity. Urology 69, 810–812 (2007).

    Article  PubMed  Google Scholar 

  104. Winstock, A. R., Mitcheson, L., Gillatt, D. A. & Cottrell, A. M. The prevalence and natural history of urinary symptoms among recreational ketamine users. BJU Int. 110, 1762–1766 (2012).

    Article  PubMed  Google Scholar 

  105. Morgan, C. J. A. & Curran, H. V. Ketamine use: a review. Addiction 107, 27–38 (2012).

    Article  PubMed  Google Scholar 

  106. Jang, M.-Y. et al. Sexual dysfunction in women with ketamine cystitis: a case–control study. BJU Int. 110, 427–431 (2012).

    Article  PubMed  Google Scholar 

  107. Middela, S. & Pearce, I. Ketamine-induced vesicopathy: a literature review. Int. J. Clin. Pract. 65, 27–30 (2011).

    Article  CAS  PubMed  Google Scholar 

  108. Mak, S. K. et al. Lower urinary tract changes in young adults using ketamine. J. Urol. 186, 610–614 (2011).

    Article  CAS  PubMed  Google Scholar 

  109. Meng, E. et al. Involvement of purinergic neurotransmission in ketamine induced bladder dysfunction. J. Urol. 186, 1134–1141 (2011).

    Article  CAS  PubMed  Google Scholar 

  110. Chu, P. S.-K. et al. The destruction of the lower urinary tract by ketamine abuse: a new syndrome? BJU Int. 102, 1616–1622 (2008).

    Article  PubMed  Google Scholar 

  111. Huang, P.-W. et al. 'Walking-stick ureters' in ketamine abuse. Kidney Int. 80, 895 (2011).

    Article  PubMed  Google Scholar 

  112. Oxley, J. D., Cottrell, A. M., Adams, S. & Gillatt, D. Ketamine cystitis as a mimic of carcinoma in situ. Histopathology 55, 705–708 (2009).

    Article  PubMed  Google Scholar 

  113. Lai, Y. et al. Ketamine-associated urinary tract dysfunction: an underrecognized clinical entity. Urol. Int. 89, 93–96 (2012).

    Article  CAS  PubMed  Google Scholar 

  114. Wu, S. et al. Lower urinary tract destruction due to ketamine: a report of 4 cases and review of literature. J. Addict. Med. 6, 85–88 (2012).

    Article  PubMed  Google Scholar 

  115. Chao, J.-Y. & Shai, H.-A. Duloxetine treatment of long-term ketamine abuse-related lower urinary tract symptoms: a case report. Gen. Hosp. Psychiatry 32, 647.e5–647.e6 (2010).

    Article  Google Scholar 

  116. Chen, J.-L. et al. Renal infarction secondary to ketamine abuse. Am. J. Emerg. Med. 31, 1153.e3–1153.e5 (2013).

    Google Scholar 

  117. Evans, N. A. Current concepts in anabolic-androgenic steroids. Am. J. Sports Med. 32, 534–542 (2004).

    Article  PubMed  Google Scholar 

  118. Di Luigi, L., Romanelli, F., Sgrò, P. & Lenzi, A. Andrological aspects of physical exercise and sport medicine. Endocrine 42, 278–284 (2012).

    Article  CAS  PubMed  Google Scholar 

  119. Johnston, L., O'Malley, P., Bachman, J. & Schulenberg, J. The rise in teen marijuana use stalls, synthetic marijuana use levels, and use of 'bath salts' is very low. University of Michigan News Service [online], (2012).

    Google Scholar 

  120. Kanayama, G., Brower, K. J., Wood, R. I., Hudson, J. I. & Pope, H. G. Anabolic-androgenic steroid dependence: an emerging disorder. Addiction 104, 1966–1978 (2009).

    Article  PubMed  PubMed Central  Google Scholar 

  121. Tan, R. S. & Vasudevan, D. Use of clomiphene citrate to reverse premature andropause secondary to steroid abuse. Fertil. Steril. 79, 203–205 (2003).

    Article  PubMed  Google Scholar 

  122. Tan, R. S. & Scally, M. C. Anabolic steroid-induced hypogonadism—towards a unified hypothesis of anabolic steroid action. Med. Hypotheses 72, 723–728 (2009).

    Article  CAS  PubMed  Google Scholar 

  123. Bickelman, C., Ferries, L. & Eaton, R. P. Impotence related to anabolic steroid use in a body builder. Response to clomiphene citrate. West. J. Med. 162, 158–160 (1995).

    CAS  PubMed  PubMed Central  Google Scholar 

  124. Coward, R. M. et al. Anabolic steroid induced hypogonadism in young men. J. Urol. 190, 2200–2205 (2013).

    Article  CAS  PubMed  Google Scholar 

  125. Tan, R. S. & Vasudevan, D. Use of clomiphene citrate to reverse premature andropause secondary to steroid abuse. Fertil. Steril. 79, 203–205 (2003).

    Article  PubMed  Google Scholar 

  126. Goldberg, L. Adverse effects of anabolic steroids. JAMA 276, 257 (1996).

    Article  CAS  PubMed  Google Scholar 

  127. Roberts, J. T. & Essenhigh, D. M. Adenocarcinoma of prostate in 40-year-old body-builder. Lancet 2, 742 (1986).

    Article  CAS  PubMed  Google Scholar 

  128. Vogelzang, N. J., Arnold, J. L., Chodak, G. J. & Schoenberg, H. Androgen and germ cell testicular cancers. JAMA 255, 906 (1986).

    Article  CAS  PubMed  Google Scholar 

  129. Pinto, F. et al. Doping and urologic tumors [Italian]. Urologia 77, 92–99 (2010).

    Article  CAS  PubMed  Google Scholar 

  130. Bronson, F. H. & Matherne, C. M. Exposure to anabolic-androgenic steroids shortens life span of male mice. Med. Sci. Sports Exerc. 29, 615–619 (1997).

    Article  CAS  PubMed  Google Scholar 

  131. Martorana, G., Concetti, S., Manferrari, F. & Creti, S. Anabolic steroid abuse and renal cell carcinoma. J. Urol. 162, 2089 (1999).

    Article  CAS  PubMed  Google Scholar 

  132. Bryden, A. A., Rothwell, P. J. & O'Reilly, P. H. Anabolic steroid abuse and renal-cell carcinoma. Lancet 346, 1306–1307 (1995).

    Article  CAS  PubMed  Google Scholar 

  133. Wemyss-Holden, S. A., Hamdy, F. C. & Hastie, K. J. Steroid abuse in athletes, prostatic enlargement and bladder outflow obstruction—is there a relationship? Br. J. Urol. 74, 476–478 (1994).

    Article  CAS  PubMed  Google Scholar 

  134. Centers for Disease Control and Prevention. Adverse events associated with ephedrine-containing products--Texas, December 1993–September 1995. JAMA 276, 1711–1712 (1996).

  135. Broadley, K. J. The vascular effects of trace amines and amphetamines. Pharmacol. Ther. 125, 363–375 (2010).

    Article  CAS  PubMed  Google Scholar 

  136. Song, G. Y., Lockhart, M. E., Smith, J. K., Burns, J. R. & Kenney, P. J. Pseudoephedrine and guaifenesin urolithiasis: widening the differential diagnosis of radiolucent calculi on abdominal radiograph. Abdom. Imaging 30, 644–646 (2005).

    Article  CAS  PubMed  Google Scholar 

  137. Powell, T., Hsu, F. F., Turk, J. & Hruska, K. Ma-huang strikes again: ephedrine nephrolithiasis. Am. J. Kidney Dis. 32, 153–159 (1998).

    Article  CAS  PubMed  Google Scholar 

  138. Pickens, C. L. et al. Abuse of guaifenesin-containing medications generates an excess of a carboxylate salt of beta-(2-methoxyphenoxy)-lactic acid, a guaifenesin metabolite, and results in urolithiasis. Urology 54, 23–27 (1999).

    Article  CAS  PubMed  Google Scholar 

  139. Blau, J. J. Ephedrine nephrolithiasis associated with chronic ephedrine abuse. J. Urol. 160, 825 (1998).

    Article  CAS  PubMed  Google Scholar 

  140. Hoffman, N., McGee, S. M. & Hulbert, J. C. Resolution of ephedrine stones with dissolution therapy. Urology 61, 1035 (2003).

    Article  PubMed  Google Scholar 

  141. Whelan, C. & Schwartz, B. F. Bilateral guaifenesin ureteral calculi. Urology 63, 175–176 (2004).

    Article  PubMed  Google Scholar 

  142. Smith, C. L., Gemar, S. K. & Lewis, M. J. Pseudoephedrine urolithiasis associated with acute renal failure. Nephrol. Dial. Transplant. 19, 263–264 (2004).

    Article  PubMed  Google Scholar 

  143. Assimos, D. G. et al. Guaifenesin- and ephedrine-induced stones. J. Endourol. 13, 665–667 (1999).

    Article  CAS  PubMed  Google Scholar 

  144. Bennett, S., Hoffman, N. & Monga, M. Ephedrine- and guaifenesin-induced nephrolithiasis. J. Altern. Complement. Med. 10, 967–969 (2004).

    Article  PubMed  Google Scholar 

  145. Abedin Zadeh, M., Moslemi, M. K. & Kholaseh Zadeh, G. Comparison between imipramine and imipramine combined with pseudoephedrine in 5-12-year-old children with uncomplicated enuresis: a double-blind clinical trial. J. Pediatr. Urol. 7, 30–33 (2011).

    Article  PubMed  Google Scholar 

  146. El Hemaly, A. K. Nocturnal enuresis: pathogenesis and treatment. Int. Urogynecol. J. Pelvic Floor Dysfunct. 9, 129–131 (1998).

    Article  CAS  PubMed  Google Scholar 

  147. Glidden, R. S. & DiBona, F. J. Urinary retention associated with ephedrine. J. Pediatr. 90, 1013–1014 (1977).

    Article  CAS  PubMed  Google Scholar 

  148. Soyer, T., Göl, I. H., Erogˇlu, F. & Cetin, A. Acute urinary retention due to pseudoephedrine hydrochloride in a 3-year-old child. Turk. J. Pediatr. 50, 98–100 (2008).

    PubMed  Google Scholar 

  149. Zorgniotti, A. W., Rossman, B. & Claire, M. Possible role of chronic use of nasal vasoconstrictors in impotence. Urology 30, 594 (1987).

    Article  CAS  PubMed  Google Scholar 

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  1. Department of Urologic Sciences, University of British Columbia, Level 6, 2775 Laurel Street, Vancouver, V5Z 1M9, BC, Canada

    Sean C. Skeldon & S. Larry Goldenberg

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S.C.S. researched data for the article. Both authors contributed to discussion of content, writing and reviewing the manuscript before submission.

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Skeldon, S., Goldenberg, S. Urological complications of illicit drug use. Nat Rev Urol 11, 169–177 (2014). https://doi.org/10.1038/nrurol.2014.22

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