Resonance metallic ureteric stent in a case of ketamine bladder induced bilateral ureteric obstruction with one year follow up

Abstract

IntroductionUpper urinary tract occlusion is well recognized in patients with chronic ketamine abuse. The mechanism is generally unknown, but the ulcerative cystitis contracture may be responsible for obstruction. We present the first reported use of the Resonance metallic ureteric stent in the management ureteric obstruction caused by ketamine-induced uropathy.Presentation of caseA 31-year-old lady with one-year history of recreational ketamine abuse presented with symptoms related to drug-induced ulcerative cystitis over twelve-months. She presented with acute renal failure with bilateral pyonephrosis and sepsis, and was initially treated with bilateral nephrostomy insertions and antegrade stenting. The J stents recovered the renal function, but the patient suffered from recurrent urinary tract infections (UTI’s) with the prosthesis in-situ. The patient successfully underwent bilateral insertion of 12 cm 6.0 French Cook Resonance metallic ureteric stents. One year following the placement of the metallic stents, the patient maintained optimal renal function with no episode of UTI.DiscussionKetamine induced uropathy is a well documented complication of chronic drug-induced ulcerative cystitis. The mechanical strength and inert property of metallic ureteric stents make it an ideal device to manage this problematic benign cause of ureteric obstruction.ConclusionThis is the first reported case of therapeutic bilateral metallic ureteric stents in the management of patients with ketamine induced uropathy with one year follow up.

Ketamine‐induced upper urinary tract lesions deserve more attention

“…Urologists focus on lower urinary symptoms because of several uncomfortable to the abusers, potential upper urinary lesions may be neglected by doctors. Recently, some serious upper urinary cases had been reported, and a separate attention should be paid on upper urinary tract including ketamine‐induced cystitis . We would like to update recent evidences on ketamine‐induced upper urinary tract lesions, and emphasis more attention on upper urinary tract system.…”

“…Recently, some serious upper urinary cases had been reported, and a separate attention should be paid on upper urinary tract including ketamine-induced cystitis. [5][6][7] We would like to update recent evidences on ketamine-induced upper urinary tract lesions, and emphasis more attention on upper urinary tract system.According to clinical prospective researches and retrospective cases summaries, the incidence of hydronephrosis (bilateral or unilateral) ranged from 6% to 64.3% in different centers. 7-10 Upper urinary tract lesions may be caused by these reasons 7,8 : (i) contracted, overactive bladder, and decreased compliant bladder; (ii) vesicoureteric reflux; (iii) ureteric wall thickness or obstruction; (iv) abnormal ureter peristalsis; and (v) acute papillary necrosis.…”

“…Recently, some serious upper urinary cases had been reported, and a separate attention should be paid on upper urinary tract including ketamine-induced cystitis. [5][6][7] We would like to update recent evidences on ketamine-induced upper urinary tract lesions, and emphasis more attention on upper urinary tract system.…”