title: Long-term experience of hyperbaric oxygen therapy for refractory radio- or chemotherapy-induced haemorrhagic cystitis.
abstract: BACKGROUND
  Radiotherapy and cyclophosphamide-induced haemorrhagic cystitis are rare but severe complications occurring in 3-6% of patients. Hyperbaric oxygen treatment (HBOT) has been demonstrated to be an effective treatment for haematuria not responding to conventional management. Only very few data exist for long-term follow-up after HBOT.
  
  
  METHODS
  We retrospectively reviewed 15 patients referred for HBOT for haemorrhagic cystitis (HC). HBOT was performed for 130 min/day at a pressure of 2.4 atmospheres. We evaluated patient demographics, type of radio- and chemotherapy and characteristics of haematuria. The effect of HBOT was defined as complete or partial resolution of hematuria according to the RTOG/EORTC grade and Gray score.
  
  
  RESULTS
  A total of 15 patients (12 after radiotherapy, two after chemotherapy and one patient with a combination of both) were treated with a median of 34 HBO treatments. Radiotherapy patients received primary, adjuvant, salvage and HDR radiotherapy (60 - 78 Gy) for prostate, colon or cervical cancer. The patient with combination therapy and both of the chemotherapy patients were treated with cyclophosphamide. First episodes of haematuria occurred at a median of 48 months after completion of initial therapy. The first HBOT was performed at a median of 11 months after the first episode of hematuria. After a median of a 68-month follow-up after HBOT, 80% experienced a complete resolution and two patients suffered a singular new minor haematuria (p < 0.00001). A salvage-cystectomy was necessary in one patient. No adverse effects were documented.
  
  
  CONCLUSIONS
  Our experience indicate that HBOT is a safe and effective therapeutic option for treatment-resistant radiogenic and chemotherapy-induced haemorrhagic cystitis. For a better evaluation prospective clinical trials are required.
authors.affiliation: Department of Urology, HELIOS Medical Center Wuppertal, University of Witten/Herdecke, Heusnerstrasse 40, 42283, Wuppertal, Germany. stephan.degener@helios-kliniken.de.
authors.forename: Stephan
authors.initials: S
authors.lastname: Degener
authors.affiliation: Department of Urology, Medical Center Leverkusen, Am Gesundheitspark 11, 51375, Leverkusen, Germany. alexander.pohle@klinikum-lev.de.
authors.forename: Alexander
authors.initials: A
authors.lastname: Pohle
authors.affiliation: Institute of Hyperbaric Oxygen (HBO), University Hospital Düsseldorf, Moorenstrasse 5, 40225, Düsseldorf, Germany. strelow@med.uni-duesseldorf.de.
authors.forename: Hartmut
authors.initials: H
authors.lastname: Strelow
authors.affiliation: Urological Ambulatory PandaMED, Alleestrasse 105-107, 42853, Remscheid, Germany. irtima@t-online.de.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Mathers
authors.affiliation: Department of Urology, Medical Center Leverkusen, Am Gesundheitspark 11, 51375, Leverkusen, Germany. juergen.zumbe@klinikum-lev.de.
authors.forename: Jürgen
authors.initials: J
authors.lastname: Zumbé
authors.affiliation: Department of Urology, HELIOS Medical Center Wuppertal, University of Witten/Herdecke, Heusnerstrasse 40, 42283, Wuppertal, Germany. stephan.roth@helios-kliniken.de.
authors.forename: Stephan
authors.initials: S
authors.lastname: Roth
authors.affiliation: Department of Urology, HELIOS Medical Center Wuppertal, University of Witten/Herdecke, Heusnerstrasse 40, 42283, Wuppertal, Germany. alexander-sascha.brandt@helios-kliniken.de.
authors.forename: Alexander S
authors.initials: AS
authors.lastname: Brandt
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D059248:Chemoradiotherapy / Q000009:adverse effects*; D015331:Cohort Studies; D003520:Cyclophosphamide / Q000009:adverse effects / Q000627:therapeutic use; D003556:Cystitis / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006417:Hematuria / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D006931:Hyperbaric Oxygenation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D012737:Sex Factors; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D003520:Cyclophosphamide