A Prospective Study of Hyperbaric Oxygen as a Treatment Option for Radiation-induced Hemorrhagic Cystitis

Abstract

Abstract Introduction and Objective: Hemorrhagic cystitis (HC) is a diffuse bladder inflammation that causes hematuria and other urinary tract complaints. Noninfectious hemorrhagic cystitis most commonly occurs in patients who have undergone pelvic radiation. In cases with refractory disease and persistent hematuria, the bladder can be irrigated with a variety of agents. Hyperbaric oxygen (HBO) therapy has been used with some success in difficult cases. In the present article, the safety and efficacy of HBO was examined as the primary treatment choice for radiation-induced HC. Evidence Acquisition: Prospective data were collected among patients with HC and previous radiotherapy. HBO was applied as a primary treatment. The primary endpoint of our study was the incidence of complete and partial response to treatment, whereas a variety of secondary endpoints were examined including the duration of response, blood transfusion rate, the avoidance of surgery, and the overall survival. Moreover, the correlation between the interval between the onset of hematuria and initiation of therapy and the success of treatment was recorded. Evidence Synthesis: A total of 20 patients participated in the study. The complete and partial response rate was 85% and 15%, respectively. All patients completed therapy while the median number of sessions needed was 31. No complications were recorded during treatment. Patients with complete response received therapy within 3 months of the hematuria onset. One patient needed cystectomy, whereas 19 patients were alive at the end of follow-up. Conclusions: HBO consists of an effective and safe treatment option in the management of radiation-induced severe HC. Further prospective studies should be undergone in order to validate its efficacy and safety profile.