Hydrostatic pressure treatment for carcinoma of the bladder. A clinical and urodynamic evaluation of the effect on bladder hemorrhage and fibrosis in irradiated patients.

Hydrostatic pressure treatment as described by Helmstein was given to 12 patients with hematuria secondary at irradiation for carcinoma of the bladder. The bladder function was evaluated on the basis of urodynamic examinations before and after the treatment. The study includes examination of the effect on the renal function. In 6 patients, hemostasis was obtained for a period averaging 10 months. No serious complications occurred. Following irradiation, the patients showed a characteristic micturition pattern with a small bladder capacity and a marked increase in pressure during the filling phase. The micturition took place partly by use of the abdominal musculature; the detrusor pressure was falling during the whole voiding time. The voiding was almost complete, and the flow values were slightly reduced. The hydrostatic pressure treatment resulted in no demonstrable changes in this micturition pattern. Evaluated from the creatinine clearance, the renal function was unchanged after the treatment, and neither polyuria nor an increased excretion of sodium was demonstrated during the first hours after the treatment. We conclude that before major surgery is decided on, hydrostatic pressure treatment should be given to patients with hemorrhage following irradiation for carcinoma of the bladder. No improvement can be expected in patients where the often pronounced pollakiuria is due to fibrosis of the bladder secondary to irradiation.