Nerve hyperplasia: a unique feature of ketamine cystitis
نویسندگان
چکیده
BACKGROUND There is an emerging association between ketamine abuse and the development of urological symptoms including dysuria, frequency and urgency, which have a neurological component. In addition, extreme cases are associated with severe unresolving bladder pain in conjunction with a thickened, contracted bladder and an ulcerated/absent urothelium. Here we report on unusual neuropathological features seen by immunohistology in ketamine cystitis. RESULTS In all cases, the lamina propria was replete with fine neurofilament protein (NFP+) nerve fibres and in most patients (20/21), there was prominent peripheral nerve fascicle hyperplasia that showed particular resemblance to Morton's neuroma. The nerve fascicles, which were positive for NFP, S100 and the p75 low-affinity nerve growth factor receptor (NGFR), were generally associated with a well-developed and in places, prominent, epithelial membrane antigen+/NGFR+ perineurium. This peripheral nerve fascicle hyperplasia is likely to account for the extreme pain experienced by ketamine cystitis patients. Urothelial damage was a notable feature of all ketamine cystitis specimens and where urothelium remained, increased NGFR expression was observed, with expansion from a basal-restricted normal pattern of expression into the suprabasal urothelium. CONCLUSIONS The histological findings were distinguishing features of ketamine cystitis and were not present in other painful bladder conditions. Ketamine cystitis afflicts predominantly young patients, with unknown long-term consequences, and requires a strategy to control severe bladder pain in order to remove a dependency on the causative agent. Our study indicates that the development of pain in ketamine cystitis is mediated through a specific neurogenic mechanism that may also implicate the urothelium.
منابع مشابه
Interstitial cystitis symptoms associated with ketamine abuse: the first Japanese case.
Ketamine, an N-methyl-D-aspartate receptor antagonist, is used for general anesthesia in medical and veterinary procedures. Abuse of ketamine as a recreational drug has become more and more popular among youngsters. This is not only a social problem, but also a urological one; ketamine abusers are known to develop lower urinary tract symptoms (LUTS) that resemble interstitial cystitis/ hypersen...
متن کاملBiological effect of ketamine in urothelial cell lines and global gene expression analysis in the bladders of ketamine-injected mice
Ketamine is used clinically for anesthesia but is also abused as a recreational drug. Previously, it has been established that ketamine‑induced bladder interstitial cystitis is a common syndrome in ketamine‑abusing individuals. As the mechanisms underlying ketamine‑induced cystitis have yet to be revealed, the present study investigated the effect of ketamine on human urothelial cell lines and ...
متن کاملLetter to the editor: "Urothelial barrier dysfunction: cause or outcome of ketamine-induced voiding dysfunction".
TO THE EDITOR: Ketamine-induced cystitis was first reported by Shahani et al. in 2007 (6). Clinical presentations of this entity is characterized by lower urinary tract symptoms (LUTS), such as frequency, urgency, gross hematuria, and bladder pain (2, 6). The underlying mechanisms are still unelucidated in ketamine-induced cystitis, and the approaches to therapy include cessation of ketamine, m...
متن کاملReply to "Letter to the editor: 'Urothelial barrier dysfunction: cause or outcome of ketamine-induced voiding dysfunction'".
REPLY: We would like to thank Wang et al. (3) for their interest in and comment on our article. Since the first report of ketamine cystitis by Shahani et al. (2) 10 years ago, the mechanism of this new urinary dysfunction is still a mystery. Ketamine is accumulated in urine, and urothelial ulceration is commonly observed in severe ketamine cystitis patients, which might be the major reason for ...
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