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Nerve hyperplasia: a unique feature of ketamine cystitis

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...

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Autores principales: Baker, Simon C, Stahlschmidt, Jens, Oxley, Jon, Hinley, Jennifer, Eardley, Ian, Marsh, Fiona, Gillatt, David, Fulford, Simon, Southgate, Jennifer
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2013
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3893507/
https://www.ncbi.nlm.nih.gov/pubmed/24252413
http://dx.doi.org/10.1186/2051-5960-1-64
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author Baker, Simon C
Stahlschmidt, Jens
Oxley, Jon
Hinley, Jennifer
Eardley, Ian
Marsh, Fiona
Gillatt, David
Fulford, Simon
Southgate, Jennifer
author_facet Baker, Simon C
Stahlschmidt, Jens
Oxley, Jon
Hinley, Jennifer
Eardley, Ian
Marsh, Fiona
Gillatt, David
Fulford, Simon
Southgate, Jennifer
author_sort Baker, Simon C
collection PubMed
description 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.
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spelling pubmed-38935072014-01-17 Nerve hyperplasia: a unique feature of ketamine cystitis Baker, Simon C Stahlschmidt, Jens Oxley, Jon Hinley, Jennifer Eardley, Ian Marsh, Fiona Gillatt, David Fulford, Simon Southgate, Jennifer Acta Neuropathol Commun Research 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. BioMed Central 2013-10-08 /pmc/articles/PMC3893507/ /pubmed/24252413 http://dx.doi.org/10.1186/2051-5960-1-64 Text en Copyright © 2013 Baker et al.; licensee BioMed Central Ltd. http://creativecommons.org/licenses/by/2.0 This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Research
Baker, Simon C
Stahlschmidt, Jens
Oxley, Jon
Hinley, Jennifer
Eardley, Ian
Marsh, Fiona
Gillatt, David
Fulford, Simon
Southgate, Jennifer
Nerve hyperplasia: a unique feature of ketamine cystitis
title Nerve hyperplasia: a unique feature of ketamine cystitis
title_full Nerve hyperplasia: a unique feature of ketamine cystitis
title_fullStr Nerve hyperplasia: a unique feature of ketamine cystitis
title_full_unstemmed Nerve hyperplasia: a unique feature of ketamine cystitis
title_short Nerve hyperplasia: a unique feature of ketamine cystitis
title_sort nerve hyperplasia: a unique feature of ketamine cystitis
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3893507/
https://www.ncbi.nlm.nih.gov/pubmed/24252413
http://dx.doi.org/10.1186/2051-5960-1-64
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