Ketamine-abuse uropathy is a rather newly recognized entity that begins to draw the attention of urologists in countries where recreational use of ketamine has become popular. Keeping in mind that ketamine users are increasing in numbers, a higher degree of alertness may be mandatory in the future when treating patients with "unexplained" LUTS and painful bladder symptoms. In this context the review by Venyo and Benatar would be more than welcome... However, there are several points that in my opinion prevent the reader from obtaining an overview of the subject. The presentation of the literature review is unnecessarily extensive and written in a "narrative" style that often distracts the reader's attention from the main points of interest. Moreover, extensive reference in details of history and lab tests for every patient described in published case reports is pointless. The main point for a comprehensive review is exactly to summarize findings and present key information based on the existing literature.

I believe that a thorough review on ketamine-abuse -uropathy should address a few vital questions: Is there a causative role for ketamine in the "uropathy" described? What are the proposed mechanisms? Are there tissue or animal models to support the damaging theory? What are the typical (or less typical) symptoms that should alert a physician? What lab tests or examinations should be employed and why? Are there any treatment options available? Is cessation of ketamine use mandatory for these patients? I would like to invite the authors to improve their extensive review by abridging the literature review section and focus on answering the aforementioned questions in a way that is more reader-friendly.

The following reference should also be taken into consideration: Recreational ketamine: from pleasure to pain. Wood et al. BJU Int. 2011 Jun;107(12):1881-4.

Ass. Professor of Anatomy, Urologic Surgeon, Head of Urology Dept. in a private hospital and rehabilitation center. No particular experience with ketamine abuse.