Hyperbaric oxygen therapy for painful bladder syndrome/interstitial cystitis resistant to conventional treatments: long-term results of a case series in Japan

Abstract

BackgroundThere is no confirmed strategy for treating painful bladder syndrome/interstitial cystitis (PBS/IC) with unclear etiology. Therefore, a pilot study was carried out to evaluate the efficacy and safety of hyperbaric oxygen (HBO) therapy in treatment-resistant PBS/IC patients.MethodsHBO treatment (2.0 ATA for 60 minutes/day × 5 days/week for 2 or 4 weeks) was performed on 11 patients with severe symptoms that had not been improved by previous therapy regimens between December 2004 and July 2009.ResultsSeven of the 11 patients demonstrated persistent improvement in symptoms during the 12 months after HBO treatment. These responders demonstrated a decrease in the pelvic pain scale and urgency scale from 7.7 ± 1.0 and, 6.6 ± 0.9 to 3.4 ± 2.5 and 4.3 ± 2.4 after 12 months, respectively (p < 0.05). The total score of the interstitial cystitis symptom index and 24-hour urinary frequency demonstrated a significant sustained decrease from the baseline. Two responders, who received an additional course of HBO 12 and 13 months after initial treatment, respectively, did not suffer impairment for more than two years. There was one case of transient eustachian tube dysfunction and three cases of reversible exudative otitis media as a consequence of HBO treatment.ConclusionsHBO is a potent treatment for PBS/IC patients resistant to conventional therapy. It was well tolerated and provided maintained amelioration of pain, urgency and urinary frequency for at least 12 months.

CUA guideline: Diagnosis and treatment of interstitial cystitis/ bladder pain syndrome

“…Tanaka et al 202 reported successful outcomes in 7/11 patients treated with HBO over 2-4 weeks. Improvements in pain, urgency, frequency, capacity, and symptom scores were maintained for up to 12 months (p<0.05 compared to baseline).…”

Effect of Supplementation With Hydrogen-rich Water in Patients With Interstitial Cystitis/Painful Bladder Syndrome

“…3 Recently, Hyperbaric oxygen therapy has been reported to be effective in patients with IC/PBS resistant to conventional treatments. 4,5 Hyperbaric oxygen treatment has clinical effects in different pathological ischemic conditions, eg impaired oxygen delivery or impaired oxygen metabolism. 17 Oxidative stress represents an imbalance between the production of reactive oxygen species (ROS) and the activity of antioxidant defense systems.…”

“…[1][2][3] Indeed, hyperbaric oxygen therapy has been reported to be effective in patients with IC/PBS resistant to conventional treatments. 4,5 Oxidative stress due to free radicals, which are formed by reperfusion after bladder ischemia, can cause bladder damage. Reperfusion injury is more harmful than the damage caused by ischemia alone.…”

Hyperbaric Oxygen Therapy and Applications in Urology: Review

“…Tedaviye dirençli bu tür hastalarda ağrı semptom skorunun bir yıl içinde gerilediği ve HBOT'nin iyi tolere edilebilmesine rağmen bir hastada kulak ös-taki tüp disfonksiyonu, 3 hastada ise geri dönüşlü eksüdatif otitis media geliştiğinden söz edilmiştir. 40 van Ophoven ve ark. yapmış oldukları çalış-mada interstisyel sistitli hastalarda HBOT'nin etkinliği ve güvenilirliğini ortaya koymaya çalışmış; 21 hasta ile yaptıkları çift-kör ve "sham" gruplu bir çalışma sonrasında HBOT'nin interstisyel sistitli hastalarda etkin, güvenli ve uygulanabilir olduğunu, semptomlarda azalmayla beraber kontrol grubuna göre önemli iyileşmeler görüldüğünü belirlemişler-dir.…”