Narrative review of hyperbaric oxygen therapy for radiation induced hemorrhagic cystitis

To evaluate the benefits of hyperbaric oxygen in the treatment of radiation-induced hemorrhagic cystitis (HC). Hyperbaric oxygen has been shown to be an effective long-term treatment for early and late radiationand chemotherapy-induced HC. It has been proven safe for adult and pediatric patients. Treatment typically required 10–40 “dives” for 60–120 min, making it very time intensive for patients. Complete response has been reported in up to 87% of patients with recurrence ranging from 0–35% in most studies. It works both as an initial treatment and after less time-intensive therapies have failed. Better responses have been seen with initiation within 6-month of presentation. Additional risk factors for treatment failure include: higher radiation doses, more severe hematuria, incomplete treatment, and blood thinner use. In addition to being effective for hematuria, it has also been shown to improve the lower urinary tract symptoms associated with radiation cystitis. Repeat treatments are effective for some patients, but if hematuria fails to resolve after hyperbaric oxygen therapy (HBOT), patients must be reassessed for malignancy as a source of their hematuria. The overall complication rate is low, and these tend to be self-limited with the most common adverse effects being blurred vision and ear pain which resolve after treatment. While expensive and time intensive, it may prove to be cheaper in the long run and offer a better alternative to patients otherwise facing bladder embolization or cystectomy.