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Background <p>Chronic recreational use of maras powder (minced <i>Nicotiana rustica</i> leaves), endemic in Southeastern Turkey and characterized by very high nicotine and alkaloid content, may induce bladder dysfunction analogous to ketamine-induced cystitis. This study investigates the urological impact of chronic maras powder use.</p> Methods <p>We retrospectively analyzed 400 patients with lower urinary tract symptoms (LUTS) at Osmaniye State Hospital (2024–2025). The case group included 20 chronic Maras Powder users, while 30 age-matched controls had no exposure. Evaluations included urodynamics, cystoscopy, and histopathologic examination. Maras powder exposure was quantified as pack-years (daily frequency × duration).</p> Results <p>Maras powder users demonstrated significant urodynamic impairments compared to controls: reduced cystoscopic bladder capacity (median 200&#xa0;mL vs. controls, <i>p</i> &lt; 0.001), lower voided volume (79.3&#xa0;mL vs. controls, <i>p</i> &lt; 0.001) on the initial uroflowmetry test, diminished maximum flow rate (Qmax: 5.5&#xa0;mL/s, <i>p</i> = 0.007), and decreased detrusor compliance (11&#xa0;mL/cmH₂O, <i>p</i> = 0.007). Dose-dependent correlations linked higher pack-years to reduced bladder capacity (Pearson’s <i>r</i> = − 0.45, <i>p</i> &lt; 0.05). Urge incontinence (<i>p</i> &lt; 0.05) and nocturia (<i>p</i> &lt; 0.05) were more prevalent in users. Histopathology revealed eosinophilic cystitis, lymphocytic inflammation, lamina propria edema, and vascular dilation.</p> Conclusions <p>Chronic maras powder use is associated with a ketamine-like bladder syndrome, characterized by contracture, inflammation, and impaired flow. Public health measures and clinician awareness are critical to address this emerging etiology of LUTS.</p>

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The impact of recreational maras powder use on bladder function: a ketamine-bladder-like syndrome

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年10月14日

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  • Sami Berk Ozden,
  • Burak Yılmaz,
  • Göktuğ Kalender,
  • Meral Filiz Taştekin

摘要

Background

Chronic recreational use of maras powder (minced Nicotiana rustica leaves), endemic in Southeastern Turkey and characterized by very high nicotine and alkaloid content, may induce bladder dysfunction analogous to ketamine-induced cystitis. This study investigates the urological impact of chronic maras powder use.

Methods

We retrospectively analyzed 400 patients with lower urinary tract symptoms (LUTS) at Osmaniye State Hospital (2024–2025). The case group included 20 chronic Maras Powder users, while 30 age-matched controls had no exposure. Evaluations included urodynamics, cystoscopy, and histopathologic examination. Maras powder exposure was quantified as pack-years (daily frequency × duration).

Results

Maras powder users demonstrated significant urodynamic impairments compared to controls: reduced cystoscopic bladder capacity (median 200 mL vs. controls, p < 0.001), lower voided volume (79.3 mL vs. controls, p < 0.001) on the initial uroflowmetry test, diminished maximum flow rate (Qmax: 5.5 mL/s, p = 0.007), and decreased detrusor compliance (11 mL/cmH₂O, p = 0.007). Dose-dependent correlations linked higher pack-years to reduced bladder capacity (Pearson’s r = − 0.45, p < 0.05). Urge incontinence (p < 0.05) and nocturia (p < 0.05) were more prevalent in users. Histopathology revealed eosinophilic cystitis, lymphocytic inflammation, lamina propria edema, and vascular dilation.

Conclusions

Chronic maras powder use is associated with a ketamine-like bladder syndrome, characterized by contracture, inflammation, and impaired flow. Public health measures and clinician awareness are critical to address this emerging etiology of LUTS.