Degener S, Strelow H, Pohle A, Lazica D A, Windolf J, Zumbé J, Roth S, Brandt A S
Klinik für Urologie und Kinderurologie, Helios Klinikum Wuppertal, Universität Witten/Herdecke, Heusnerstraße 40, 42283 Wuppertal, Deutschland.
Urologe A. 2012 Dec;51(12):1735-40. doi: 10.1007/s00120-012-3036-x.
Postradiation hemorrhagic cystitis is a well known long-term complication of radiation therapy occurring in 3-6 % of patients. Hyperbaric oxygen (HBO) has been demonstrated to be an effective treatment for radiation-induced hemorrhagic cystitis not responding to conventional management. This article reviews experiences with HBO for radiogenic cystitis after prostate cancer.
All patients treated for hemorrhagic cystitis with HBO between 2006 and 2012 were retrospectively reviewed. The HBO procedure was performed for 130 min/day at 1.4 atmospheres overpressure. Patient demographics, type of radiotherapy, onset and severity of hematuria and time between first hemorrhagic episode and beginning of HBO were evaluated. The effect of HBO was defined as complete or partial (lower RTOG/EORTC grade) resolution of hematuria.
A total of 10 patients with radiogenic cystitis and a median age of 76 years were treated with a median of 30 HBO treatment sessions. Patients received primary, adjuvant, salvage and high dose rate (HDR) radiotherapy (60-78 Gy). First episodes of hematuria occurred after a median of 41 months following completion of radiotherapy and HBO was performed 11 months after the first episode of hematuria. After a median 35-month follow-up 80% experienced complete resolution, one patient suffered a one-off new hematuria and in one patient a salvage cystectomy was necessary. No adverse effects were documented.
The experiences indicate that HBO is a safe and effective therapy option in treatment-resistant radiogenic cystitis but prospective clinical trials are needed for a better evaluation.
放射性出血性膀胱炎是放射治疗一种广为人知的长期并发症，发生率为3%至6%。高压氧（HBO）已被证明是治疗对传统治疗无反应的放射性出血性膀胱炎的有效方法。本文回顾了高压氧治疗前列腺癌后放射性膀胱炎的经验。
回顾性分析2006年至2012年间所有接受高压氧治疗出血性膀胱炎的患者。高压氧治疗在1.4个大气压超压下每天进行130分钟。评估患者的人口统计学特征、放疗类型、血尿的发作和严重程度以及首次出血事件与开始高压氧治疗之间的时间。高压氧的效果定义为血尿完全或部分（RTOG/EORTC分级降低）缓解。
共有10例放射性膀胱炎患者，中位年龄76岁，接受了中位30次高压氧治疗。患者接受了根治性、辅助性、挽救性和高剂量率（HDR）放疗（60 - 78 Gy）。血尿首次发作发生在放疗结束后中位41个月，高压氧治疗在血尿首次发作后11个月进行。中位随访35个月后，80%的患者血尿完全缓解，1例患者出现一次性新的血尿，1例患者需要进行挽救性膀胱切除术。未记录到不良反应。
这些经验表明，高压氧是治疗难治性放射性膀胱炎的一种安全有效的治疗选择，但需要进行前瞻性临床试验以进行更好的评估。
