K他命膀胱炎在病理組織的嚴重程度及臨床症狀的相關性
張嘉峰、郭漢崇
花蓮慈濟醫院 泌尿部
Histopathological characteristics of ketamine-associated uropathy and their clinical association
Jia-Fong Jhang, Hann-Chorng Kuo
Department of Urology, Haulien Tzu Chi Hospital.
Purpose: Previous studies revealed some bladder histopathologic characteristics in patients with ketamine associated uropathy (KU). However, comprehensive studies of the histopathological findings in KU and their association with the clinical disorder are lacking.
Materials and Methods: Thirty-eight patients with KU who had provided detailed clinical histories and had undergone video urodynamic studies were examined. Of them, 13 had clinically mild KU and underwent cystoscopic hydrodistention. The other 25 patients had severe KU and underwent enterocystoplasty with or without ureter reimplantation. Bladder and ureter specimens were obtained and stained with hematoxylin and eosin for histological examination. The mucosa, muscle and subseroal layers of bladder and ureter were examined respectively. The severity of the histopathological findings was graded on a 4-point scale (0: none, 1: mild, 2: mild, and 3: severe). The histopathology findings and grading were correlated with clinical parameters, including visual analogue scale for pain (VAS), cystometric bladder capacity (CBC) and maximal bladder capacity (MBC) under general anesthesia
Results: Inflammatory cells infiltration and nerve hyperplasia were found in the mucosa, muscle, and subserosal layers of the bladder and ureters in patients with KU. In mild KU, lymphocyte infiltration predominated. In contrast, significant neutrophil, eosinophil, lymphocyte and plasma cell infiltrations were found in almost all severe KU bladders mucosa. Clinical severe KU was significantly correlated with severe to moderate lymphocytes, plasma cells, neutrophils, eosinophils infiltration and nerve hyperplasia in bladder mucosa. The chi-square test showed statistically significant association between severe bladder pain (VAS≧6) and moderate to severe histopathological findings. On the other aspect, independent T test revealed KU patients with moderate to severe neutrophils or lymphocytes infiltration in the bladder mucosa had significantly higher VAS pain score, smaller CBC and MBC.
Conclusions: In patients with KU, the histological findings showed whole-layer inflammation and nerve hyperplasia in the bladder and ureter. The severity of inflammatory cell infiltration in the bladder mucosa is associated with clinical symptoms. A histopathological examination is a useful tool to evaluate KU severity