Ketamine associated bladder dysfunction:

1. No. 105 Ketamine associated bladder dysfunction: A histological comparison with painful bladder syndrome/interstitial cystitis. Chris White, Alex Freeman, Dan Wood University College London Hospitals, United Kingdom Posters Proudly Supported by: • Results • Nine patients with ketamine associated bladder dysfunction were seen over a 2 year period. All patients described similar symptoms of haematuria, pain, urinary frequency, and small capacity bladders. • . • Three patients required cystectomy to palliate intractable urinary symptoms. • The ketamine group showed a larger eosinophil count per high field (phf) in both the lamina propria and muscularispropria compared to the PBS/IC group (1.6 v. 0.08phf (p=0.022) and 3.7 v. 0phf (p=0.028) respectively). The PBS/IC group showed a higher mast cell count in the muscularispropria layer (2.6phf v. 12.4phf (p=0.028)). T lymphocyte mediated localized immune response was seen in both groups. Introduction Ketamine is an N-methyl-D-aspartic acid receptor antagonist which was first synthesised in the 1960s and has been used extensively as an anaesthetic and analgesic agent in medical and veterinary practice. More recently, there has been a surge in its use in the club/party drug “scene” in the UK due to its dissociative and hallucinogenic properties. In the last few years there have been a number of reports of urinary symptoms which have been attributed to ketamine abuse 1-2. Cystoscopic appearance of ketamine bladder Aim The aim of this study was to compare tissue specimens from patients known to have abused ketamine and those who had previously suffered with painful bladder syndrome/interstitial cystitis (PBS/IC). Methods A retrospective audit identified all patients who had presented to a tertiary referral centre with urological symptoms associated with ketamine abuse between 2008 and 2010. Histological comparison was made between 6 of the ketamine patients and 5 patients with bladder pain syndrome/interstitial cystitis using biopsy or cystectomy samples taken from these two groups. Haematoxylin/Eosin staining was performed to assess eosinophil count. Azure A staining was performed to assess mast cell count. An average of number of eosinophils and mast cells seen per field under 400X magnification was noted. Immunohistochemistry staining was also performed using different antibodies to label the CD4, CD8, CD3, CD20 and CD68 markers on the lymphocytes in the tissue samples. The Mann-Whitney U non-parametric statistical test was performed to assess significance. HE stain of ketamine bladder lamina propria showing eosinophils (encircled) Azure A staining of ketamine bladder muscularispropria showing 4 mast cells (encircled) Conclusions The documented rise in recreational ketamine abuse will inevitably result in more presentations of “ketamine bladder”. This study has demonstrated the significant damage that ketamine abuse inflicts on the urinary tract. It also shows a difference in the inflammatory infiltrate seen in the ketamine bladder when compared with PBS/IC. This may provide further information about the mechanism of damage and help direct potential treatment options. Immunochemistry staining of ketamine bladder showing CD3 content in lamina propria References 1.Volpe, M. A., Shah, S., Cooper, K., & Kaplan, S. A. 2003, "Illicit ketamine abuse (special K) causing eosinophilic cystitis", J.Urol., vol. 169, no. 4 (supplement 1), p. 9 2.Chu, P. S., Ma, W. K., Wong, S. C., Chu, R. W., Cheng, C. H., Wong, S., Tse, J. M., Lau, F. L., Yiu, M. K., & Man, C. W. 2008, "The destruction of the lower urinary tract by ketamine abuse: a new syndrome?", BJU.Int., vol. 102, no. 11, pp. 1616-1622. Acknowledgements I would like to thank the staff in the urology and histopathology departments at University College London Hospitals for their generous support with this project.