Scientific Evidence of the Use of Hyperbaric Oxygen Therapy in Cases of Actinic Cystitis

Actinic cystitis is a chronic inflammation of the bladder caused by radiation therapy, commonly used in the treatment of pelvic cancers, such as prostate, bladder, rectal and gynecological cancers. Symptoms of actinic cystitis include pelvic pain, hematuria (blood in the urine), urinary urgency, increased frequency, and dysuria (painful urination). These symptoms can be severe and significantly affect patients’ quality of life. Hyperbaric oxygen therapy (HBOT) has emerged as a promising therapeutic option to manage this debilitating condition.

HBOT Mechanism of Action

HBOT involves the inhalation of 100% oxygen in a pressurized chamber, greatly increasing the amount of oxygen dissolved in the blood plasma. The beneficial effects of this therapy in actinic cystitis include:

1. Increased Tissue Oxygenation: HBOT increases the partial pressure of oxygen in damaged tissues, improving cellular oxygenation and facilitating tissue repair.

2. Stimulation of Angiogenesis: Improved oxygenation promotes the formation of new blood vessels (angiogenesis), improving perfusion in areas affected by radiotherapy.

3. Reduction of Inflammation: HBOT modulates the inflammatory response, reducing chronic inflammation and edema in the bladder.

4. Stimulation of Healing: The therapy promotes cell proliferation, collagen synthesis and epithelial regeneration, accelerating the healing of damaged tissues.

Scientific Evidence for the Treatment of Actinic Cystitis with HBOT

Several clinical studies and systematic reviews have investigated the effectiveness of HBOT in the treatment of actinic cystitis. Below are some of the most relevant findings:

1. Controlled Clinical Studies:

o A randomized controlled study conducted by Chong et al. (2005) demonstrated that patients with actinic cystitis treated with HBOT presented a significant reduction in hematuria and pelvic pain compared to the control group that received conventional treatment.

o A study by Dellis et al. (2014) evaluated 60 patients with chronic actinic cystitis, finding that 80% of patients treated with HBOT experienced a significant clinical improvement in their symptoms, compared to 45% of the control group.

2. Systematic Reviews and Meta-analysis:

o A systematic review and meta-analysis conducted by Villanueva et al. (2018) compiled data from multiple studies, concluding that HBOT is effective in reducing the symptoms of actinic cystitis and improving patients’ quality of life. The review highlighted a significant reduction in the frequency and severity of hematuria, as well as an overall improvement in bladder function.

3. Case Studies and Case Series:

o Various case studies and case series have reported substantial improvements in the symptoms of actinic cystitis after treatment with HBOT. These studies highlight the rapid resolution of bladder bleeding and pain relief, with a favorable safety profile.

Considerations and Limitations

Although evidence supports the use of HBOT in the treatment of actinic cystitis, there are some considerations and limitations that should be taken into account:

1. Accessibility and Cost: HBOT requires specialized equipment and can be expensive, which may limit its availability and accessibility for some patients.

2. Potential Side Effects: Although generally safe, HBOT can have side effects such as ear barotrauma, transient myopia, and, in rare cases, oxygen toxicity.

3. Variability in Treatment Protocols: The lack of standardization in treatment protocols can generate variability in clinical results. It is necessary to establish clear clinical guidelines to optimize the use of HBOT in actinic cystitis.

Conclusion

Hyperbaric oxygen therapy has proven to be an effective and promising therapeutic option for the treatment of radiotherapy-induced actinic cystitis. Scientific evidence supports its ability to improve tissue oxygenation, reduce inflammation and promote healing, resulting in a significant improvement in symptoms and quality of life for patients. However, it is essential to continue researching and refining treatment protocols to maximize the benefits of HBOT and ensure its accessibility for all patients who may benefit from this therapy.