Ketamine cystitis: an emerging diagnostic and therapeutic challenge.

Ketamine abuse is increasingly common in the UK. Ketamine-induced cystitis can cause serious damage to the urinary tract. This emerging problem presents a new diagnostic challenge and is very likely to increase in incidence over the coming years.

Outpatient hysteroscopy: an observational study of patient acceptability.

OBJECTIVE: To assess the patient acceptability of outpatient hysteroscopy when Prilocaine is used as analgesia and to determine if our practice of using Prilocaine only if indicated by pain is appropriate. MATERIAL AND METHODS: Prospective observational study of 100 consecutive patients undergoing outpatient hysteroscopy. RESULTS: One hundred consecutive women attending for outpatient hysteroscopy, completed questionnaires after the procedure, indicating the level of pain experienced on an analogue scale. Prilocaine hydrochloride (40 mg/ml) had been administered as an intracervical block only if a patient experienced pain or if cervical dilatation was required. Patients expressed significantly more pain during hysteroscopy than after hysteroscopy whether Prilocaine was used or not. The median pain score was significantly higher in the group that required local anesthetic. There was a greater desire to have the procedure done under general anesthesia when Prilocaine was used than when it was not used. CONCLUSION: Pain is a determining factor in patient acceptability of outpatient hysteroscopy and is a likely reason for some women to opt to have a hysteroscopy under general anesthesia. The practice of administering Prilocaine only if needed is inappropriate. Future studies should now aim to determine the optimal drug, dose, and timing of administration of analgesia in pre-selected women who are likely to experience pain and hence benefit from analgesia.