UroToday- In a case report of two patients with refractory ulcerative interstitial cystitis hyperbaric oxygen proved to be an effective therapy with long-lasting positive results. Tanaka and co-workers used therapy consisting of 20 sessions of 100% oxygen inhalation (2.0 atmosphere absolute for 60 minutes/day X 5 days/week for 4 weeks).

The first patient was a 79 year old woman with severe glomerulations and ulceration and a functional bladder capacity of only 30cc. At 1 month and 9 months of follow-up, her pain had diminished by over 50%, her frequency dropped from 25 to 9 times per 24 hours, and her functional bladder capacity increased to 150cc. Dramatic results were also realized in a 61 year old woman treated in a similar fashion.

The biological mechanisms of hyperbaric oxygen (HBO) originated from hypersaturating oxygen dissolved in plasma due to treatment. This phenomenon results in an increased diffusion gradient between the circulation and surrounding tissues, forcing oxygen into the damaged hypoxic urothelial tissues. Subsequently, HBO treatment stimulates leukocyte function characterized by phagocytosis producing growth factors that enhance angiogenesis. Finally, healthy granulation tissue grows at the local sites.

The authors review the limited literature available and conclude that a larger randomized clinical trial will be needed to define criteria of HBO for BPS/IC patients. I myself have had problems getting insurance coverage for HBO in refractory patients, and articles like this one help to make a case for getting coverage for desperate patients. A large-scale multicenter trial is certainly needed.

Tomoaki T, Hidenori K, Tetsuya M, Sadanori K, Noboru K, Tatsuya N

International Journal of Urology. 14(6): 563-565, June 2007
DOI: 10.1111/j.1442-2042.2007.01599.x

Reported by UroToday Contributing Editor Philip M Hanno, M.D

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