Enhancing treatment efficacy using hyperbaric oxygen therapy in managing chronic hemorrhagic cystitis post radiation therapy

Introduction. A rare but serious side effect of pelvic radiation therapy is radiation cystitis, which is characterized by persistent hematuria brought on by gradual ischaemic damage to the bladder mucosa. Bowel irrigation, intravesical therapy, and coagulation methods are examples of conventional treatments that frequently only offer short-term respite without addressing the underlying disease. By improving oxygen delivery to hypoxic areas, hyperbaric oxygen therapy (HBOT) has become a viable substitute that encourages angiogenesis and tissue repair.

Case Presentation. We describe a case of a 77-year-old man who had persistent gross hematuria lasting for two weeks and had a history of prostate cancer diagnosed in 2016, for which he received radiotherapy, with the last session administered in 2018. A flexible cystoscopy showed gradual bleeding and spotty bladder irritation. Laboratoty tests revealed anemia with hemoglobin 9.6 g/dL without renal impairment or coagulopathy. HBOT was started since the hematuria continued even after bladder irrigation. After ten HBOT sessions, the patient's hemorrhage was completely resolved. He had mild adverse effects, such as brief nausea and vomiting, which were treated with medication. The long-term effectiveness of HBOT was demonstrated by follow-up visits, which verified that there was no recurrence of hematuria.

Conclusion. This case highlights the value of HBOT as a non-invasive and safe treatment for refractory hemorrhagic cystitis, a complication of radiotherapy. For individuals who fail to respond to conventional treatments, HBOT presents a viable alternative because it treats the underlying ischaemic damage rather than just treating the symptoms. Further research is required to develop standardized treatment procedures and assess long-term results.

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