ABSTRACT
Ketamine-associated cystitis is a well-recognised syndrome; yet upper urinary tract involvement remains poorly understood. We present the case of a 33-year-old man who developed ketamine-associated cystitis and ureteritis. The patient's severe bladder symptoms required subtotal cystectomy and orthotopic reconstruction. However, the associated ureteritis led to bilateral ureteric obstruction and renal failure. Bilateral autotransplantation with pyelovesicostomy was performed. This first case of autotransplantation for ketamine uropathy helps to demonstrate the potentially devastating effects of ketamine on the urinary tract.
Subject(s)
Cystitis/chemically induced , Cystitis/surgery , Ketamine/adverse effects , Ureter/transplantation , Ureteral Diseases/chemically induced , Ureteral Diseases/surgery , Urinary Tract Infections/chemically induced , Adult , Biopsy/methods , Cystectomy , Cystitis/pathology , Cystoscopy/methods , Humans , Male , Transplantation, Autologous , Ureteral Diseases/pathology , Urinary Tract Infections/etiology , Urinary Tract Infections/pathologyABSTRACT
BACKGROUND: Acute low back pain is a common cause for presentation to the emergency department (ED). Since benign etiologies account for 95% of cases, red flags are used to identify sinister causes that require prompt management. OBJECTIVES: We assessed the effectiveness of red flag signs used in the ED to identify spinal cord and cauda equine compression. PATIENTS AND METHODS: It was a retrospective cohort study of 206 patients with acute back pain admitted from the ED. The presence or absence of the red flag symptoms was assessed against evidence of spinal cord or cauda equina compression on magnetic resonance imaging (MRI). RESULTS: Overall, 32 (15.5%) patients had compression on MRI. Profound lower limb neurologic examination did not demonstrate a statistically significant association with this finding. The likelihood ratio (LR) for bowel and bladder dysfunction (sensitivity of 0.65 and specificity of 0.73) was 2.45. Saddle sensory disturbance (sensitivity of 0.27 and specificity of 0.87) had a LR of 2.11. When both symptoms were taken together (sensitivity of 0.27 and specificity of 0.92), they gave a LR of 3.46. CONCLUSIONS: The predictive value of the two statistically significant red flags only marginally raises the clinical suspicion of spinal cord or cauda equina compression. Effective risk stratification of patients presenting to the ED with acute back pain is crucial; however, this study did not support the use of these red flags in their current form.
