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Cottrell AM, Ayres R, Weinstock P, Warren K, Gillatt D.. 
“Urinary tract disease associated with chronic ketamine use”. 
BMJ. 2008 May 3;336:973.
[Partial text of letter] Regarding the case study by Dhillon et al,1 we have seen an alarming increase in people presenting to urological services in South West England with bladder symptoms associated with chronic ketamine use. Two case series in Hong Kong and Canada have been published, but ketamine associated bladder pathology has not been reported in the UK.2 3

Over the past two years, nine patients have presented to local urologists with symptoms of severe urinary frequency, urgency, macroscopic haematuria, and suprapubic pain. They all had a history of chronic ketamine use, either recreationally or therapeutically for chronic pain. Urine culture results were negative and cystoscopy showed a contracted shrunken bladder with erythema and contact bleeding. Histological examination showed ulcerative cystitis and a severely denuded urothelium.

They were given analgesics and encouraged not to use ketamine. Complications included hydronephrosis and renal impairment. They were treated by nephrostomy and insertion of a suprapubic catheter [...]
Notes # : Correction by BMJ: "In this letter by Angela M Cottrell and colleagues, we somehow managed to mangle the second author's name, which is in fact Rachel Ayres (not Athreeres)."
Further correspondence from BMJ's "Rapid Response" online: Ketamine-associated Cystitis in a Palliative Setting
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