Department of Urology, Buddhist Tzu Chi General Hospital, Tzu Chi University, Hualien, Taiwan.
Department of Pathology, Buddhist Tzu Chi General Hospital, Tzu Chi University, Hualien, Taiwan.
Neurourol Urodyn. 2018 Jun;37(5):1764-1772. doi: 10.1002/nau.23514. Epub 2018 Feb 14.
To investigate the histopathological findings in ketamine-associated uropathy (KU) and their clinical association.
Thirty-eight KU patients had received history investigation and video urodynamic study. Twelve of them were clinically mild KU who were admitted for cystoscopic hydrodistention. The other 26 patients were severe KU who were admitted for enterocystoplasty with or without ureter reimplantation. Bladder and ureter specimens were harvested during operation, and a single pathologist reviewed all specimens under hematoxylin and eosin stain. The severity of histopathological findings was graded with a 4-point scale (0: none, 1: mild, 2: moderate, and 3: severe) RESULTS: Inflammatory cells infiltrations and nerve hyperplasia were found in the mucosa, muscle, and subserosal layers of KU bladders and ureter. In the mild KU bladder mucosa, the predominant component of the infiltrating inflammatory cells was lymphocytes. In contrast, neutrophils, eosinophils, lymphocytes, and plasma cells infiltration were noted in the mucosa of almost all severe KU bladders. Clinical severe KU was significantly correlated with severe to moderate lymphocytes, plasma cells, neutrophils, eosinophils infiltration, and nerve hyperplasia in bladder mucosa. KU patients with moderate or severe neutrophils or lymphocytes infiltration in bladder mucosa had significantly more severe bladder pain and smaller bladder capacity.
The histological findings of KU showed whole-layer inflammation and nerve hyperplasia in bladder mucosa. The severity of inflammatory cell infiltration in the bladder mucosa is associated with clinical symptoms. A histopathological examination might be a useful tool to discriminate the KU severity in patients.
探讨氯胺酮相关性尿路病（KU）的组织病理学表现及其与临床的关系。
38 例 KU 患者接受了病史调查和视频尿动力学研究。其中 12 例为临床轻度 KU，行膀胱镜下注水扩张；26 例为重度 KU，行肠膀胱扩大术，伴或不伴输尿管再植术。术中采集膀胱和输尿管标本，由同一位病理学家在苏木精和伊红染色下进行检查。采用 4 分制对组织病理学发现的严重程度进行分级（0：无，1：轻度，2：中度，3：重度）。
KU 膀胱和输尿管的黏膜、肌肉和黏膜下层均可见炎症细胞浸润和神经增生。在轻度 KU 膀胱黏膜中，浸润性炎症细胞的主要成分是淋巴细胞。相比之下，几乎所有重度 KU 膀胱黏膜中均可见中性粒细胞、嗜酸性粒细胞、淋巴细胞和浆细胞浸润。临床重度 KU 与膀胱黏膜重度至中度淋巴细胞、浆细胞、中性粒细胞、嗜酸性粒细胞浸润和神经增生显著相关。膀胱黏膜中中性粒细胞或淋巴细胞浸润程度为中度或重度的 KU 患者，膀胱疼痛明显更严重，膀胱容量更小。
KU 的组织病理学表现为膀胱黏膜全层炎症和神经增生。膀胱黏膜炎症细胞浸润的严重程度与临床症状相关。组织病理学检查可能是鉴别 KU 严重程度的有用工具。
