Introduction
Radiation-induced severe hemorrhagic cystitis is one of the most difficult-to-treat conditions resulting from prolonged radiation exposure. The latter is a specific type of iatrogenic injury that occurs at the bladder wall after a cancer patient receives pelvic radiation therapy. Most forms of treatment used to treat hemorrhagic cystitis have very little efficiency in dealing with the condition. Radiation-induced severe hemorrhagic cystitis mostly occurs as a result of radiation therapy on different types of pelvic cancers. The long-term effect of radiation exposure could occur 20 years after initial radiation exposure. It is mostly characterized by obliterative endarteritis of the small blood vessels thereby causing cellular hypoxia. Increased inflammation of the cells results in occasional clot formation and blockage of the small and medium-sized blood vessels. The blood vessels at the edges are the most affected. Reduced blood flow to the pelvic regions results in gradual tissue damage. When not attended to promptly, the condition could be fatal. Some of the treatments and corrective remedies for severe hemorrhagic radiation-induced cystitis include blood transfusion, hyperbaric oxygen therapy (HBOT), radiation cystectomy, coagulation, and selective embolization among others. The condition is more severe in relatively elderly individuals as well as those predisposed by other factors/conditions e.g. diabetes mellitus, smoking, and atherosclerosis, among other vascular insufficiencies.
Mechanism of Action of Hyperbaric Oxygen Therapy (HBOT)
Introduction of high-pressure oxygen to the tissues reverses cellular hypoxia that arises after radiation therapy. Oxygen is able to diffuse better within the tissues around the bladder thus optimizing cell metabolism and functioning. Subscribing to HBOT also deals with bladder irritability, pelvic pain, urgency, and pain while urinating. The aforementioned are some of the most prevalent symptoms associated with radiation-induced severe hemorrhagic cystitis. Hyperbaric oxygen therapy (HBOT) is preferred and highly recommended for the treatment of the condition since it takes care of both hematuria and radiocystitis thus addressing the condition fully. Hematuria refers to the presence of blood in urine. Elevating oxygen partial pressure promotes recovery in the affected tissues around the bladder wall. The recovery includes neovascularization, angiogenesis, and improvement in immunity. The replenished blood vessels also lead to increased nutrient influx to the recovering tissues.
HBOT is non-invasive and has fewer side effects compared to some of the common forms of treatment used to treat the condition e.g. formalin and phenol. Also, HBOT reduces the need to undergo regular blood transfusions by increasing oxygenated blood reaching all parts of the body. Also, the need for irreversible processes such as cystectomy is reversed or eliminated immediately. HBOT is also quite effective with the main consideration being the value that the patients derive in terms of improvement of quality of life. They no longer have to subscribe to the high costs associated with rehabilitation and high acute care. It also increases the efficacy of other forms of treatment when used side by side.
References
Degener, S., Pohle, A., Strelow, H., Mathers, M., Zumbé, J., Roth, S., & Brandt, A. S. (2015). Long-term experience of hyperbaric oxygen therapy for refractory radio- or chemotherapy-induced haemorrhagic cystitis. BMC Urology, 15(1). https://doi.org/10.1186/s12894-015-0035-4
Dellis, A., Papatsoris, A., Kalentzos, V., Deliveliotis, C., & Skolarikos, A. (2017). Hyberbaric oxygen as sole treatment for severe radiation - induced haemorrhagic cystitis. International Braz J Urol, 43(3), 489–495. https://doi.org/10.1590/s1677-5538.ibju.2016.0451
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