Hyperbaric oxygen therapy for the management of hemorrhagic radio-induced cystitis.

Objectives: Radio-induced cystitis (RADC) is an inflammatory bladder disease that presents as anemic-hematuria in its most serious form. Classic treatments can not control the disease in the mid-to-long term because they don't treat the pathogenesis of the disease. Thus, we evaluated the effectiveness of hyperbaric oxygen (HBO) therapy as a potential treatment for patients with RADC.

Methods: This prospective study included 38 patients, 21 men and 17 women, mean age of 66.5 years(46-75), who had been subjected to pelvic radiotherapy (RT), with the diagnosis of RADC with or without radio-induced proctitis (RADP), gross hematuria and lower urinary tract symptoms. HBO treatment was applied in a multiplace chamber; patients breathed pure oxygen (100%) at 2-2.5 atmospheres of pressure (ATAs). Patients received an average of 31.2 sessions (10-48 sessions) and the median follow-up period was 56 months (4-72 months).

Results: Hematuria was completely resolved in 34 of the 38 patients. After HBO 6 patients required readmission, 5 for anemic hematuria and 1 for acute obstructive pyelonephritis. In general, patients tolerated treatment well; however, one patient experienced barotrauma requiring myringotomy.

Conclusions: HBO can be used to satisfactorily treat RADC, leading to clinical improvements that begin during the initial sessions in the majority of cases, and with a more than acceptable level of patient tolerance.