Chi-Wai Man

The destruction of the lower urinary tract by ketamine abuse: a new syndrome?

To report the clinical spectrum seen in young abusers of street‐ketamine (regular recreational abusers of street‐ketamine, for its hallucinogenic effects) in Hong Kong, presenting with significant lower urinary tract symptoms (LUTS) but with no evidence of bacterial infection.

Augmentation cystoplasty: Urodynamic and metabolic outcomes at 10-year follow-up.

To review the urodynamic outcomes, renal function and metabolic complications after augmentation cystoplasty with at least 10 years of follow‐up.

Hepatic haematoma after shockwave lithotripsy for renal stones

Extracorporeal shock wave lithotripsy (SWL) is a non-invasive procedure for urolithiasis. Only a very small portion of patients suffer from post-SWL haematoma and most of them have perinephric haematoma formation. We present two patients who developed subcapsular hepatic haematomas after SWL, followed by a review of the literature on the condition.

Destruction of the urinary tract by ketamine abuse: Hong Kong local experience

Aim:  To report and analyze the disastrous effects of ketamine abuse on the urinary system seen in young Hong Kong patients.

Cystoscopic and video-urodynamic features of a ketamine abuser

Ketamine is the most common psychotropic substance being abused by people younger than 21 years in Hong Kong since 2000. Reports had shown that ketamine abusers can present as dysuria, frequency, urgency, urge incontinence, nocturia and painful haematuria. Usually they will be diagnosed as bacterial cystitis and prescribed multiple courses of oral antibiotics with no response. However these patients had different cystoscopic and urodynamic findings with that of ordinary bacterial cystitis and we would like to present that with a case: A 21 year old female patient who had been a daily ketamine abuser for 4 years presented to us in 2007 with dysuria, painful haemturia, suprapubic pain and was diaper dependent. Her daily consumption of ketamine was 1–4 g. Numerous white and red blood cells were detected in the urine microscopy but no bacteria was cultured. Her blood creatinine level was 110 umol/L and there were bilateral hydronephrosis detected on ultrasound. Only ketamine but no other psychotropic substance was detected in the patient’s urine. Cystoscopy was performed for her under general anaesthesia and there was marked telangiectasia with erythematous mucosa. The bladder was also markedly contracted and was difficult to be distended despite that the cystoscopy was performed under general anaesthesia. Moreover there was some whitish precipitate extruding from left ureteric orifice which is suggestive of ketamine or its metabolite. (video 1) Videourodyamic study was also performed for her which revealed a poor compliance bladder with detrusor overactivity. The functional capacity of the patient was around 50 ml only. Bilateral vesicoureteric reflux up to both kidneys was also detected. (video 2) The patient was then prescribed antimuscarinic drug, scheduled for augmentation cystoplasty and was referred to the hospital authority’s substance abuse clinic for detoxification. However she died one month later for multiple injuries from falling out from height after ketamine overdose.