張嘉峰、郭漢崇

花蓮慈濟醫院 泌尿部

Jia-Fong Jhang, Hann-Chorng Kuo

Department of Urology, Haulien Tzu Chi Hospital.

 

Purpose: Early studies had revealed some electron microscopic (EM) characteristics of interstitial cystitis (IC) and ketamine cystitis (KC). However, the clinical association is still lacking. The EM urothelium difference between ulcer and non-ulcer IC was also unknown. The aim of current study is to investigate the human IC and KC urothelium characteristics in EM, and further analyze the association between the EM urothelium findings and clinical symptoms severity.

Materials and Methods:  IC and KC patients who were admission for hydrodistention were enrolled. The IC patients were classified to ulcer and non-ulcer IC according to the cystoscopic finding of Hunner’s lesion. The cold-cup biopsy bladder specimens were taken during hydrodistention for transmission EM (TEM) and scanning EM (SEM). In TEM, the urothelium cell layers number, integrity of umbrella cells and tight junction complexes were investigated. In the SEM, the umbrella cell intact, uniform and deep folding were evaluated. All of these EM findings were grading with a 4 point scale (0: normal, 1: mild defect, 2: moderate defect, 3: severe defect). Visual Analogue Scale (VAS) pain score, cystometric bladder capacity (CBC) and maximal bladder capacity under general anesthesia (MBC) in these patients were recorded. Chi-square test was used to evaluate the association between symptoms severity and EM findings. Bladder biopsies were also taken from the patients with stress urinary incontinence and were considered as normal control.

Results: IC and KC patients who were admission for hydrodistention were enrolled. The IC patients were classified to ulcer and non-ulcer IC according to the cystoscopic finding of Hunner’s lesion. The cold-cup biopsy bladder specimens were taken during hydrodistention for transmission EM (TEM) and scanning EM (SEM). In TEM, the urothelium cell layers number, integrity of umbrella cells and tight junction complexes were investigated. In the SEM, the umbrella cell intact, uniform and deep folding were evaluated. All of these EM findings were grading with a 4 point scale (0: normal, 1: mild defect, 2: moderate defect, 3: severe defect). Visual Analogue Scale (VAS) pain score, cystometric bladder capacity (CBC) and maximal bladder capacity under general anesthesia (MBC) in these patients were recorded. Chi-square test was used to evaluate the association between symptoms severity and EM findings. Bladder biopsies were also taken from the patients with stress urinary incontinence and were considered as normal control.

Conclusions: In EM, the urothelium defects were found in KC and IC bladders. In comparison the non-ulcer IC, the urothelium defects and inflammation were more severe in ulcer IC. Urothelium defect in TEM may be associated with bladder pain severity in KC and IC patients.