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

Abstract 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.