Ureteric intestinal metaplasia in association with chronic recreational ketamine abuse

Ketamine is a phencyclidine derivative which acts as a non-competitive N-methyl-D-aspartate receptor agonist. It is used in veterinary and human anaesthesia. Ketamine's hallucinogenic and dissociative properties have lead to its exploitation as a recreational drug. This trend culminated in the identification of the phenomenon of ketamine cystitis in 2007.1 In this condition, the patient with a history of ketamine use may report frequency, dysuria, haematuria and incontinence, with cystoscopy showing an erythematous contracted bladder. Histologically there is mucosal ulceration, striking urothelial reactive atypia and lamina propria inflammation, often with eosinophils. In addition squamous metaplasia, nephrogenic metaplasia and calcification have been described.2 Although previous reports have provided radiological evidence of ureteric stricture formation with prolonged ketamine use, the effects of chronic use on the upper urinary tract have not yet been histologically documented.3 This case report highlights the unusual histological features seen in ureteric resection in a case of chronic ketamine abuse. The patient is a 39-year-old man with a history of spina bifida occulta. Spinal surgery was performed at Great Ormond Street Hospital during his childhood, with no history of further problems. There is no urological history until 2005 when, aged 34 years, he presented …