Treatment of radiation induced hemorrhagic cystitis with hyperbaric oxygen: long-term followup

Hemorrhagic cystitis is a recognized possible side effect of therapeutic radiation administered for a variety of pelvic malignancies. Patients may experience pain, bleeding and clot retention. Various palliative treatments, including instillation of alum, silver nitrate and formalin, may be unsuccessful in alleviating patient symptoms. Hyperbaric oxygen therapy is often used to treat poorly healing wounds. We assess the long-term efficacy of hyperbaric oxygen therapy in treating the manifestations of radiation induced injury to the bladder.

A total of 11 patients with radiation induced hemorrhagic cystitis, confirmed by cystoscopy and biopsy, were treated with hyperbaric oxygen therapy. Symptoms included intractable hematuria in all 11 patients, and some also had other voiding symptoms, including persistent suprapubic pain and urinary urgency. In all patients most other types of management had failed and there was no evidence of active infection or recurrent malignancy. Patients received 100% oxygen in a hyperbaric chamber at 2.0 atmospheres for 90 minutes 5 days a week. Average number of treatments was 40 and median followup was 5.1 years.

Of these 11 patients 3 (27%) experienced complete and durable resolution of symptoms, 3 had persistent symptoms despite hyperbaric treatments and required supravesical urinary diversion, and 5 initially responded to hyperbaric oxygen therapy but experienced long-term recurrent symptoms necessitating urinary diversion as definitive therapy.

Hyperbaric oxygen offers a noninvasive therapeutic alternative in the management of radiation cystitis. It appears to produce good short-term benefits but it often does not produce definitive long-term cure of the disease process.