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

Tomoaki Tanaka, Yujiro Nitta, Kazuya Morimoto, Noriaki Nishikawa, Chikako Nishihara, Satoshi Tamada, Hidenori Kawashima, Tatsuya Nakatani, Tomoaki Tanaka, Yujiro Nitta, Kazuya Morimoto, Noriaki Nishikawa, Chikako Nishihara, Satoshi Tamada, Hidenori Kawashima, Tatsuya Nakatani

Abstract

Background: There 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.

Methods: HBO 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.

Results: Seven 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.

Conclusions: HBO 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.

Figures

Figure 1
Figure 1
Changes in evaluated parameters (the total score of ICSI, the scale of pain and urgency on VAS, 24-hour voiding frequency and maximum bladder volume) from the baseline in seven responders after three, six, nine, and 12 months follow-up after HBO treatment. The bottom and top of the box are the lower and upper quartiles, respectively, and the ends of whiskers represent the minima and maxima of the samples.
Figure 2
Figure 2
Granulation of an ulcer in the bladder mucosa of an HBO-responder; the arrows indicate the lesions.

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