Children aged 13 treated for ketamine bladder damage at Alder Hey

What happened

Children aged 13 are receiving specialist NHS treatment in Liverpool for urinary damage linked to ketamine use, with some affected youngsters needing incontinence pads or keeping a bucket beside their bed because of their symptoms.

Researchers from Alder Hey Children's NHS Foundation Trust and Lancaster University examined the first 60 patients at a service created to treat young people with ketamine-related urinary problems. Their average age was 14, and all were between 13 and 15.

The findings, published in the medical journal Archives of Disease in Childhood, describe children who had typically been using the drug for between one and two years before reaching the clinic. For some, ketamine use began at 13.

The condition, ketamine-induced uropathy, is often called ketamine bladder. That name describes only part of the potential injury: the drug can also damage the tubes through which urine passes and the kidneys. The condition can cause substantial pain and lasting disability.

The background

Alder Hey opened the UK's first specialist ketamine clinic for young people in May 2025. The service followed an increase in children being referred with urinary symptoms associated with taking ketamine outside medical care.

The injury develops as ketamine and the substances produced when the body breaks it down remain in contact with the bladder. With excessive use, that exposure can harm both its inner lining and its muscle tissue, affecting an organ whose job is to hold urine before it leaves the body.

Damage to the bladder wall can include ulceration and fibrosis. Ulceration involves sores in the tissue, while fibrosis is the formation of scar tissue. These are physical changes to the organ, rather than simply discomfort experienced while someone is taking the drug.

Symptoms include needing to urinate frequently, losing control of the bladder and passing blood in urine. Persistent bladder pain can accompany those problems. Together, they can make an ordinary bodily function painful and difficult to manage throughout the day and overnight.

Some damage is irreversible. In the most serious cases, patients may eventually need major surgery or dialysis, a treatment that takes over some of the kidneys' work when they cannot adequately filter waste from the blood. Those are potential consequences of severe disease, rather than treatments required by every person with ketamine-related symptoms.

Who is affected

Girls accounted for about two-thirds of the clinic's first patients. Roughly two-thirds also lived in the most deprived areas. These figures describe the children reaching this specialist service; they are not a measure of ketamine use among all teenagers in Liverpool or across the UK.

Childhood emotional trauma was recorded for 72% of the group. This places difficult earlier experiences alongside the children's current physical illness in the clinical picture, giving the team information relevant to support beyond treatment of the urinary tract.

One in five patients had experience of the care system. That is a separate part of the assessment from where a child lives or the symptoms bringing them to hospital, and helps describe the circumstances in which clinicians are working with young people.

Sixteen of the 60 patients had autism, attention deficit hyperactivity disorder, or both. These findings identify additional needs within the group; they do not establish that either condition caused the children's drug use or their bladder injury.

Ketamine was not the only substance involved. Half the patients reported taking other drugs as well. Alcohol use was reported by 27%, while 48% said they used vapes. The categories can overlap, so they should not be added together as though they represent separate groups of children.

What people are saying

Harriet Corbett, a consultant paediatric urologist at Alder Hey, said referrals involving children with ketamine-related bladder symptoms had been increasing over several years. Her account places the clinic's opening within a longer change in the work facing specialists who treat children's urinary conditions.

Corbett said the first-year analysis would help clinicians tailor support by examining patients' ages, neighbourhoods, backgrounds and experiences. The purpose is to understand the circumstances of individual children, rather than allowing the medical diagnosis alone to determine how they are helped.

She also emphasised prevention. Her warning about potentially permanent injury makes preventing additional harm a central aim of care, alongside managing the pain and loss of bladder function that have already brought a child to hospital.

Professor Rachel Isba, a consultant in paediatric public health medicine at Alder Hey and professor emerita of children and young people's health at Lancaster University's Medical School, said the work examined the wider circumstances surrounding ketamine use. The researchers are exploring factors associated with serious health problems, rather than treating drug use as something detached from children's lives.

Isba said the findings raised questions about reaching young people earlier and designing appropriate services. Her focus extends beyond the hospital consultation to how healthcare and community support can respond before a child develops further injury.

What happens next

At the clinic, staff aim to provide a setting in which young people can discuss their lives without being judged. Isba described an approach based on working with patients to draw up a plan to stop taking ketamine and limit additional damage.

That work combines a physical-health objective with a change in drug use. Treating urinary symptoms addresses the illness that prompted referral, while supporting a child to stop ketamine tackles continued exposure to the substance responsible for the injury. Neither task makes the child's wider circumstances irrelevant.

The first year's findings will inform consideration of further action within healthcare and in the community. The work is intended to help identify opportunities for earlier intervention and to shape services around the characteristics and experiences of the young people attending.

As an analysis of patients already referred for specialist care, the study answers a particular question: who is arriving at this clinic with ketamine-related urinary harm? Its figures describe that clinical group. They should not be read as national prevalence estimates or as proof that any one background characteristic determines who will develop the condition.

Why this matters

For UK families, the practical issue is that a teenager's urinary symptoms can be a sign of drug-related physical injury. Frequent trips to the toilet, incontinence and blood in urine belong to a medical problem, not simply a question of behaviour or discipline.

For health services, the combination of addiction, urinary damage and wider support needs means care reaches across clinical specialisms. Alder Hey's experience brings children's urology and paediatric public health into the same response, with preventing further injury as the shared aim.