Inadvertent placement of a urethral catheter into the ureter is a rare but documented complication of catheterisation. Management becomes more challenging when the catheter cannot be removed using conservative techniques. We present the case of an 85-year-old male with a history of bladder cancer treated with intravesical Bacillus Calmette–Guérin (BCG) therapy who was found to have a urethral catheter stuck in his left ureter on computerized tomography scan after a routine catheter change. The catheter balloon was punctured using ureteroscopy and Holmium laser. Our literature review identified five other cases where a misguided urethral catheter required surgical intervention for removal from the ureter and the different techniques used are discussed. Risk factors appear to be pregnancy and structural changes to the bladder resulting in widened ureteric orifices including BCG therapy. We suggest that laser puncture of an inflated catheter balloon is a safe and effective method for facilitating removal. Level of evidence: 4

ObjectivesKetamine uropathy causes inflammatory changes to the urothelium, manifesting as significant lower urinary tract symptoms, small bladder capacity, and pelvic pain. Upper tract involvement and hydronephrosis can occur. Data from UK centers are limited, and no formal treatment guidelines exist.Patients and MethodsAll patients with ketamine uropathy presenting to our unit over an 11‐year period were identified through operative and clinic lists, emergency presentations, and a prospectively collected local database. Demographic data, biochemical findings, imaging techniques, and both medical and surgical management were recorded.ResultsA total of 81 patients with ketamine uropathy were identified from 2011 to 2022; however, a large proportion presented from 2018 onwards. The average age at presentation was 26 years (interquartile range [IQR]: 27–34), 72.8% were male, and average follow‐up time was 34 months (IQR: 8–46). Therapeutic interventions included anticholinergic medication, cystodistension, and intravesical sodium hyaluronate. Hydronephrosis was present in 20 (24.7%) patients and nephrostomy insertion was required in six. One patient underwent bladder augmentation surgery. Serum gamma‐glutamyl transferase and length of follow‐up were significantly higher in patients with hydronephrosis. Adherence to follow‐up was poor.ConclusionsWe present a large cohort of patients with ketamine uropathy from a small town in the UK which is unusual. The incidence appears to be rising, in‐keeping with increasing recreational ketamine use and should be of concern to urologists. Abstinence is a key aspect of management, and a multi‐disciplinary approach works best particularly as many patients are lost to follow‐up. The development of formal guidance would be helpful.

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