The aim of the present study was to investigate the changes of the bladder epithelial barrier in the pathogenesis of ketamine-induced cystitis (KIC). A total of 60 female mice were randomly allocated into control and ketamine groups, which received daily intraperitoneal injections of saline and ketamine, respectively. Micturition behavior was recorded in 2-h intervals at the end of 4, 8 and 12 weeks, and bladders were harvested for subsequent analyses. Routine hematoxylin and eosin staining was performed on the bladders and histopathological changes were analyzed using light microscopy. The distribution of zonula occludens-1 (ZO-1) protein was determined by immunohistochemical analysis. The ultrastructure of umbrella cells was observed using a transmission electron microscope (TEM). Ketamine-addicted mice exhibited a significantly increased frequency of micturitions following 8 and 12 weeks of ketamine treatment (P<0.05 and P<0.01, respectively). Suburothelial congestion and infiltration of mononuclear cells was observed in ketamine-addicted mice following 8 and 12 weeks of treatment. Immunohistochemical examination demonstrated that there was an increased abnormal distribution of ZO-1 in the bladders of ketamine-treated mice compared with control mice. TEM analysis demonstrated that the surface of bladder urothelium became flattened, the tight junctions between umbrella cells became thinner and the endothelial cells exhibited cell body shrinkage, chromatin condensation and layer denudation in mice treated with ketamine. The present study indicated that the structural and functional changes to the bladder epithelial barrier caused by long-term use of ketamine may be key mechanisms in the development of KIC.
<b><i>Introduction:</i></b> The aim of the study was to assess the efficacy and safety of ureterolithotripsy (URS) in treating ureteral calculi with holmium-YAG laser through adding retropulsion prevention and drainage function to ureteral catheter. <b><i>Methods:</i></b> An inner wire was fixed at the top of an Fr5 ureteral catheter and run through a tee joint. The proximal catheter was split into 4 strips. When the wire was pulled, the strips become arcuate, thus trapping the stone. The end of the tee branch was connected to the suction evacuation. Continuous irrigation and negative pressure suction were delivered after the strips passed the stones. Eighty-two consecutive patients with solitary ureteral stones underwent URS with the new device. <b><i>Results:</i></b> Seventy-eight patients had no observed stone retropulsion with successful insertion of the device. Four patients failed URS owing to the stone retropulsion and excessive kink of the ureter, which was followed by flexible ureteroscopy. Patient with successful insertion of the device had an immediate stone-free rate of 88.5% and 100% in a 1-month follow-up. Complications included one fever and one minor ureteral perforation. <b><i>Conclusion:</i></b> This new device has a low stone migration and minor complications and improves visual field with a negative pressure suction. Future studies are needed to evaluate it in randomized trials.
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