Hyperbaric Oxygen Therapy for Patients With Viral or Radiation-Induced Hemorrhagic Cystitis

TL;DR

This study shows hyperbaric oxygen therapy can improve symptoms and reduce recurrence in patients with viral or radiation-induced bladder bleeding.

Contribution

The study provides clinical evidence for HBOT effectiveness in treating hemorrhagic cystitis based on etiology and symptom severity.

Findings

HBOT improved macroscopic hematuria in 81.8% of patients.

Viral HC patients had a 57.6% recurrence-free rate after three years.

Radiation-induced HC was linked to higher hematuria severity and recurrence.

Abstract

Background: Hemorrhagic cystitis (HC) is characterized by diffuse inflammation and bleeding of the lining of the urinary bladder. This study investigated hyperbaric oxygen therapy (HBOT) in patients with viral or radiation-induced HC.

Methods: A retrospective analysis was performed involving 33 patients diagnosed with HC who received HBOT. Data analysis involved the Kruskal-Wallis test and Spearman’s correlation coefficients to determine the strength of correlations between variables.

Results: Of the 33 patients, nine (27.3%) had radiation-induced HC, and 24 (72.7%) had viral HC. Among those with viral HC, 12 (50%) tested positive for BK virus by polymerase chain reaction (PCR). HBOT was performed in a multiplace hyperbaric chamber at 2.5 absolute atmospheres (ATA) for 90 to 120 minutes, and the median number of sessions was 11. The median duration of treatment was 14 days, with 81.8% (n = 27) obtaining an improvement in macroscopic hematuria, 12.1% (n = 4) interrupting treatment, and 6.1% (n = 2) dying. HC did not recur in 57.6% of the sample (n = 19) in three years of follow-up. A significant correlation was found between the degree of hematuria and the number of sessions required (p = 0.0025). Radiation-induced HC was associated with higher degrees of hematuria (p = 0.007). A correlation was found between etiology and recurrence after the conclusion of treatment (p = 0.029).

Conclusion: Identifying the cause of HC and classifying the degree of hematuria are important to planning the number of HBOT sessions needed for an improvement in symptoms and a reduction in the rate of recurrence after treatment. The present findings suggest clinical benefits from HBOT in the treatment of HC.