Submited on: 18 Feb 2012 03:13:45 AM GMT
Published on: 18 Feb 2012 09:37:23 AM GMT
Response from Author
Posted by Mr. Anthony Kodzo - Grey Venyo on 02 Mar 2012 10:45:52 PM GMT

Author’s reply to review statements made on:  A review of the literature on Ketamine-Abuse-Uropathy. 

(Reply by Anthony Kodzo-Grey Venyo)

There is no need to modify or shorten the paper. In view of the fact that Ketamine-Abuse-Uropathy is a new clinical entity it is important to have a repository of almost all the cases so far reported to include the clinical presentation, investigation and management of the clinical entity.  Even though the paper is long, readers would be encouraged to read the document carefully in order to retain all the detailed information provided.

  1. Answers to some of the questions asked by the reviewer include:

Postulates regarding the mechanism of Ketamine-Abuse-Uropathy

- The mechanism by which ketamine might cause the various symptoms of urinary dysfunction has not been concretely established.

- Postulates from published case reports include  the theory that ketamine and / or its metabolites, carried in the urine, exert a direct irritating effect on the bladder cells and kidney / upper urinary tract, resulting in inflammation.

- Another postulate proposed the possibility that ketamine / its metabolites compromise circulation in the bladder and possibly the kidney or decrease micro-vascular density.

See the following references.

[ Shahani R, Streutker C, Dickson B. et al. “Ketamine-Associated Ulcerative cystitis: A new clinical entity”. Urology 2007, 69(5): 810 - 812]

[Ho CC,  Pezhman H, Praveen s.  et al. “Ketamine-Associated ulcerative cystitis: A case report and Literature review.” Malaysian J Med SCi. 2010 Apr-Jun; 17(2): 61 – 65]

 

The symptoms of Ketamine-Abuse-Uropathy are non-specific and these symptoms are usually irritating lower urinary tract symptoms which patients with other conditions experience. Some of the symptoms include: Diurnal urinary frequency, urgency, nocturia , dysuria, urge incontinence and at times haematuria. The patients may void at intervals which may be as short as 15 minutes intervals.

With regard to investigations, urine culture is usually negative for significant growth of an organism. Cystoscopy usually reveals an inflamed urinary bladder and histology of bladder biopsy specimens tends to reveal non-specific inflammation. The bladder capacity at cystoscopy is usually small. Hydro-uretero-nephrosis tends to develop with further progress of the disease.  Ketamine and its metabolites has been found in nephrostomy urine  of a patients who developed renal failure and hydronephrosis as a result of ureteric obstruction requiring insertion of nephrostomy. 

A history of Ketamine Abuse is crucial to the establishment of a diagnosis of Ketamine Abuse Uropathy.

 

There is evidence as stated in the paper that cessation of Ketamine Abuse before irreversible damage to the urinary tract occurs leads to resolution or improvement of the symptoms of Ketamine Abuse. Patients’ symptoms would not resolve unless they stop ketamine abuse.

With regard to patho-physiology and the mechanism of Ketamine-Abuse-Uropathy, there is a great opportunity for researchers with enquiring minds to undertake animal experiments in order to investigate further the mechanism of Ketamine-Abuse-Uropathy.        

 

Author's response to review
Posted by Mr. Anthony Kodzo - Grey Venyo on 02 Mar 2012 10:44:30 PM GMT

Author’s reply to review statements made on:  A review of the literature on Ketamine-Abuse-Uropathy. 

(Reply by Anthony Kodzo-Grey Venyo)

There is no need to modify or shorten the paper. In view of the fact that Ketamine-Abuse-Uropathy is a new clinical entity it is important to have a repository of almost all the cases so far reported to include the clinical presentation, investigation and management of the clinical entity.  Even though the paper is long, readers would be encouraged to read the document carefully in order to retain all the detailed information provided.

  1. 1.       Answers to some of the questions asked by the reviewer include:

Postulates regarding the mechanism of Ketamine-Abuse-Uropathy

- The mechanism by which ketamine might cause the various symptoms of urinary dysfunction has not been concretely established.

- Postulates from published case reports include  the theory that ketamine and / or its metabolites, carried in the urine, exert a direct irritating effect on the bladder cells and kidney / upper urinary tract, resulting in inflammation.

- Another postulate proposed the possibility that ketamine / its metabolites compromise circulation in the bladder and possibly the kidney or decrease micro-vascular density.

See the following references.

[ Shahani R, Streutker C, Dickson B. et al. “Ketamine-Associated Ulcerative cystitis: A new clinical entity”. Urology 2007, 69(5): 810 - 812]

[Ho CC,  Pezhman H, Praveen s.  et al. “Ketamine-Associated ulcerative cystitis: A case report and Literature review.” Malaysian J Med SCi. 2010 Apr-Jun; 17(2): 61 – 65]

 

The symptoms of Ketamine-Abuse-Uropathy are non-specific and these symptoms are usually irritating lower urinary tract symptoms which patients with other conditions experience. Some of the symptoms include: Diurnal urinary frequency, urgency, nocturia , dysuria, urge incontinence and at times haematuria. The patients may void at intervals which may be as short as 15 minutes intervals.

With regard to investigations, urine culture is usually negative for significant growth of an organism. Cystoscopy usually reveals an inflamed urinary bladder and histology of bladder biopsy specimens tends to reveal non-specific inflammation. The bladder capacity at cystoscopy is usually small. Hydro-uretero-nephrosis tends to develop with further progress of the disease.  Ketamine and its metabolites has been found in nephrostomy urine  of a patients who developed renal failure and hydronephrosis as a result of ureteric obstruction requiring insertion of nephrostomy. 

A history of Ketamine Abuse is crucial to the establishment of a diagnosis of Ketamine Abuse Uropathy.

 

There is evidence as stated in the paper that cessation of Ketamine Abuse before irreversible damage to the urinary tract occurs leads to resolution or improvement of the symptoms of Ketamine Abuse. Patients’ symptoms would not resolve unless they stop ketamine abuse.

With regard to patho-physiology and the mechanism of Ketamine-Abuse-Uropathy, there is a great opportunity for researchers with enquiring minds to undertake animal experiments in order to investigate further the mechanism of Ketamine-Abuse-Uropathy.        

Author’s reply to review statements made on:  A review of the literature on Ketamine-Abuse-Uropathy. 

(Reply by Anthony Kodzo-Grey Venyo)

There is no need to modify or shorten the paper. In view of the fact that Ketamine-Abuse-Uropathy is a new clinical entity it is important to have a repository of almost all the cases so far reported to include the clinical presentation, investigation and management of the clinical entity.  Even though the paper is long, readers would be encouraged to read the document carefully in order to retain all the detailed information provided.

  1. 1.       Answers to some of the questions asked by the reviewer include:

Postulates regarding the mechanism of Ketamine-Abuse-Uropathy

- The mechanism by which ketamine might cause the various symptoms of urinary dysfunction has not been concretely established.

- Postulates from published case reports include  the theory that ketamine and / or its metabolites, carried in the urine, exert a direct irritating effect on the bladder cells and kidney / upper urinary tract, resulting in inflammation.

- Another postulate proposed the possibility that ketamine / its metabolites compromise circulation in the bladder and possibly the kidney or decrease micro-vascular density.

See the following references.

[ Shahani R, Streutker C, Dickson B. et al. “Ketamine-Associated Ulcerative cystitis: A new clinical entity”. Urology 2007, 69(5): 810 - 812]

[Ho CC,  Pezhman H, Praveen s.  et al. “Ketamine-Associated ulcerative cystitis: A case report and Literature review.” Malaysian J Med SCi. 2010 Apr-Jun; 17(2): 61 – 65]

 

The symptoms of Ketamine-Abuse-Uropathy are non-specific and these symptoms are usually irritating lower urinary tract symptoms which patients with other conditions experience. Some of the symptoms include: Diurnal urinary frequency, urgency, nocturia , dysuria, urge incontinence and at times haematuria. The patients may void at intervals which may be as short as 15 minutes intervals.

With regard to investigations, urine culture is usually negative for significant growth of an organism. Cystoscopy usually reveals an inflamed urinary bladder and histology of bladder biopsy specimens tends to reveal non-specific inflammation. The bladder capacity at cystoscopy is usually small. Hydro-uretero-nephrosis tends to develop with further progress of the disease.  Ketamine and its metabolites has been found in nephrostomy urine  of a patients who developed renal failure and hydronephrosis as a result of ureteric obstruction requiring insertion of nephrostomy. 

A history of Ketamine Abuse is crucial to the establishment of a diagnosis of Ketamine Abuse Uropathy.

 

There is evidence as stated in the paper that cessation of Ketamine Abuse before irreversible damage to the urinary tract occurs leads to resolution or improvement of the symptoms of Ketamine Abuse. Patients’ symptoms would not resolve unless they stop ketamine abuse.

With regard to patho-physiology and the mechanism of Ketamine-Abuse-Uropathy, there is a great opportunity for researchers with enquiring minds to undertake animal experiments in order to investigate further the mechanism of Ketamine-Abuse-Uropathy.        

 

 

Author’s reply to review statements made on:  A review of the literature on Ketamine-Abuse-Uropathy. 

(Reply by Anthony Kodzo-Grey Venyo)

There is no need to modify or shorten the paper. In view of the fact that Ketamine-Abuse-Uropathy is a new clinical entity it is important to have a repository of almost all the cases so far reported to include the clinical presentation, investigation and management of the clinical entity.  Even though the paper is long, readers would be encouraged to read the document carefully in order to retain all the detailed information provided.

  1. Answers to some of the questions asked by the reviewer include:

Postulates regarding the mechanism of Ketamine-Abuse-Uropathy

- The mechanism by which ketamine might cause the various symptoms of urinary dysfunction has not been concretely established.

- Postulates from published case reports include  the theory that ketamine and / or its metabolites, carried in the urine, exert a direct irritating effect on the bladder cells and kidney / upper urinary tract, resulting in inflammation.

- Another postulate proposed the possibility that ketamine / its metabolites compromise circulation in the bladder and possibly the kidney or decrease micro-vascular density.

See the following references.

[ Shahani R, Streutker C, Dickson B. et al. “Ketamine-Associated Ulcerative cystitis: A new clinical entity”. Urology 2007, 69(5): 810 - 812]

[Ho CC,  Pezhman H, Praveen s.  et al. “Ketamine-Associated ulcerative cystitis: A case report and Literature review.” Malaysian J Med SCi. 2010 Apr-Jun; 17(2): 61 – 65]

 

The symptoms of Ketamine-Abuse-Uropathy are non-specific and these symptoms are usually irritating lower urinary tract symptoms which patients with other conditions experience. Some of the symptoms include: Diurnal urinary frequency, urgency, nocturia , dysuria, urge incontinence and at times haematuria. The patients may void at intervals which may be as short as 15 minutes intervals.

With regard to investigations, urine culture is usually negative for significant growth of an organism. Cystoscopy usually reveals an inflamed urinary bladder and histology of bladder biopsy specimens tends to reveal non-specific inflammation. The bladder capacity at cystoscopy is usually small. Hydro-uretero-nephrosis tends to develop with further progress of the disease.  Ketamine and its metabolites has been found in nephrostomy urine  of a patients who developed renal failure and hydronephrosis as a result of ureteric obstruction requiring insertion of nephrostomy. 

A history of Ketamine Abuse is crucial to the establishment of a diagnosis of Ketamine Abuse Uropathy.

 

There is evidence as stated in the paper that cessation of Ketamine Abuse before irreversible damage to the urinary tract occurs leads to resolution or improvement of the symptoms of Ketamine Abuse. Patients’ symptoms would not resolve unless they stop ketamine abuse.

With regard to patho-physiology and the mechanism of Ketamine-Abuse-Uropathy, there is a great opportunity for researchers with enquiring minds to undertake animal experiments in order to investigate further the mechanism of Ketamine-Abuse-Uropathy.        

 

Author’s reply to review statements made on:  A review of the literature on Ketamine-Abuse-Uropathy. 

(Reply by Anthony Kodzo-Grey Venyo)

There is no need to modify or shorten the paper. In view of the fact that Ketamine-Abuse-Uropathy is a new clinical entity it is important to have a repository of almost all the cases so far reported to include the clinical presentation, investigation and management of the clinical entity.  Even though the paper is long, readers would be encouraged to read the document carefully in order to retain all the detailed information provided.

  1. Answers to some of the questions asked by the reviewer include:

Postulates regarding the mechanism of Ketamine-Abuse-Uropathy

- The mechanism by which ketamine might cause the various symptoms of urinary dysfunction has not been concretely established.

- Postulates from published case reports include  the theory that ketamine and / or its metabolites, carried in the urine, exert a direct irritating effect on the bladder cells and kidney / upper urinary tract, resulting in inflammation.

- Another postulate proposed the possibility that ketamine / its metabolites compromise circulation in the bladder and possibly the kidney or decrease micro-vascular density.

See the following references.

[ Shahani R, Streutker C, Dickson B. et al. “Ketamine-Associated Ulcerative cystitis: A new clinical entity”. Urology 2007, 69(5): 810 - 812]

[Ho CC,  Pezhman H, Praveen s.  et al. “Ketamine-Associated ulcerative cystitis: A case report and Literature review.” Malaysian J Med SCi. 2010 Apr-Jun; 17(2): 61 – 65]

 

The symptoms of Ketamine-Abuse-Uropathy are non-specific and these symptoms are usually irritating lower urinary tract symptoms which patients with other conditions experience. Some of the symptoms include: Diurnal urinary frequency, urgency, nocturia , dysuria, urge incontinence and at times haematuria. The patients may void at intervals which may be as short as 15 minutes intervals.

With regard to investigations, urine culture is usually negative for significant growth of an organism. Cystoscopy usually reveals an inflamed urinary bladder and histology of bladder biopsy specimens tends to reveal non-specific inflammation. The bladder capacity at cystoscopy is usually small. Hydro-uretero-nephrosis tends to develop with further progress of the disease.  Ketamine and its metabolites has been found in nephrostomy urine  of a patients who developed renal failure and hydronephrosis as a result of ureteric obstruction requiring insertion of nephrostomy. 

A history of Ketamine Abuse is crucial to the establishment of a diagnosis of Ketamine Abuse Uropathy.

 

There is evidence as stated in the paper that cessation of Ketamine Abuse before irreversible damage to the urinary tract occurs leads to resolution or improvement of the symptoms of Ketamine Abuse. Patients’ symptoms would not resolve unless they stop ketamine abuse.

With regard to patho-physiology and the mechanism of Ketamine-Abuse-Uropathy, there is a great opportunity for researchers with enquiring minds to undertake animal experiments in order to investigate further the mechanism of Ketamine-Abuse-Uropathy.