Although effective in improving renal function, PCN is a procedure not without associated morbidity and does not always prolong survival. Therefore, the decision to decompress an obstructed kidney with advanced pelvic malignancy should not be taken lightly. We recommend that such cases be discussed in a multidisciplinary setting, and a decision is taken only after a full informed discussion involving patients and their relatives.

Ketamine cystitis is a complex problem whose exact pathological mechanism and natural history remain unknown. The only known effective treatment is to abstain from the drug. Urologists need to recognize the condition early and work together with the local substance misuse service, focusing on drug cessation therapy to reduce complications.

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