title: Severe cyclophosphamide-induced haemorrhagic cystitis treated with hyperbaric oxygen.
abstract: OBJECTIVE
  Cyclophosphamide-induced haemorrhagic cystitis (CHC) is an uncommon but well-recognised condition caused by a metabolite, acrolein, which is toxic to the urothelium. Based on similarities in the histopathology of radiation- and chemotherapy-induced haemorrhagic cystitis, benefit from hyperbaric oxygen therapy (HBOT) has been proposed. HBOT produces an increased oxygen partial pressure diffusion gradient between the circulation and surrounding tissues, which enhances neutrophil function and fibroblast and macrophage migration into damaged hypoxic soft tissue, promoting collagen formation, fibroblast growth, angiogenesis and white-cell bacterial killing. There are only isolated case reports of HBOT for CHC, in the literature so we reviewed the New Zealand experience with HBOT in CHC.
  
  
  METHODS
  The case records of all patients with CHC referred to the three hyperbaric medicine units in New Zealand between 2000 and 2007 were reviewed retrospectively.
  
  
  RESULTS
  Six patients, with life-threatening haemorrhage at the time of referral for HBOT weeks or months after initial presentation with CHC, were identified. Cessation of bleeding occurred in all six patients after 14 to 40 HBOT, without complications. All patients remained clear of haematuria at 11 to 36 months follow-up.
  
  
  CONCLUSIONS
  We recommend the use of HBOT in the management of intractable cyclophosphamide-induced haemorrhagic cystitis as an effective and low-risk therapy.
authors.affiliation: Hyperbaric Medicine Unit, Christchurch Hospital, Private Bag 4710, Christchurch, New Zealand. mike.davis@cdhb.govt.nz
authors.forename: Michael
authors.initials: M
authors.lastname: Davis
authors.forename: Heather
authors.initials: H
authors.lastname: MacDonald
authors.forename: Christopher
authors.initials: C
authors.lastname: Sames
authors.forename: Kushma
authors.initials: K
authors.lastname: Nand
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D003520:Cyclophosphamide / Q000009:adverse effects* / Q000627:therapeutic use; D003556:Cystitis / Q000139:chemically induced* / Q000503:physiopathology / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006417:Hematuria / Q000139:chemically induced* / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D006931:Hyperbaric Oxygenation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009520:New Zealand; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D016896:Treatment Outcome; D016482:Urinalysis; D055815:Young Adult
chemical_list: D003520:Cyclophosphamide