Ketamine consumption in on the increase as a recreational abuse substance. It is reported to cause lower urinary tract symptoms (LUTS), and published accounts of its deleterious effects are increasing. We reviewed the available literature regarding the urological impact of ketamine abuse and its management. Twenty-two publications were found in total after a search of all databases including Pubmed, Medline and Google Scholar using the words ‘ketamine’, ‘bladder’ and ‘cystitis’ with no limits imposed. There are approximately 110 cases reported in the literature in the form of case series, case reports and letters. The effect of ketamine abuse on the bladder is universally similar; however, there is no uniform method adopted in reporting the symptoms, diagnosis and management. Very little is known regarding the pathogenesis of its effects on the urinary tract. Patients with severe irritative LUTS, a positive history of ketamine abuse and the absence of any other aetiology should be considered to have ketamine-induced vesicopathy. Effort must be made to elicit the history of drug abuse in those with no found cause of LUTS, especially in the young. Presently, ketamine cessation is the only effective treatment modality to prevent deterioration of the renal function and indeed offer the possibility of symptom resolution. Management akin to that formulated for interstitial cystitis patients would appear to offer the greatest opportunity for effective treatment.