Hyperbaric oxygen therapy for the management of hemorrhagic radio-induced cystitis.

OBJECTIVES: Radio-induced cystitis (RADC) is an inflammatory bladder disease that presents as anemic-hematuria in its most serious form. Classic treatments can not control the disease in the mid-to-long term because they don't treat the pathogenesis of the disease. Thus, we evaluated the effectiveness of hyperbaric oxygen (HBO) therapy as a potential treatment for patients with RADC. METHODS: This prospective study included 38 patients, 21 men and 17 women, mean age of 66.5 years(46-75), who had been subjected to pelvic radiotherapy (RT), with the diagnosis of RADC with or without radio-induced proctitis (RADP), gross hematuria and lower urinary tract symptoms. HBO treatment was applied in a multiplace chamber; patients breathed pure oxygen (100%) at 2-2.5 atmospheres of pressure (ATAs). Patients received an average of 31.2 sessions (10-48 sessions) and the median follow-up period was 56 months (4-72 months). RESULTS: Hematuria was completely resolved in 34 of the 38 patients. After HBO 6 patients required readmission, 5 for anemic hematuria and 1 for acute obstructive pyelonephritis. In general, patients tolerated treatment well; however, one patient experienced barotrauma requiring myringotomy. CONCLUSIONS: HBO can be used to satisfactorily treat RADC, leading to clinical improvements that begin during the initial sessions in the majority of cases, and with a more than acceptable level of patient tolerance.

Large cell neuroendocrine carcinoma of the urinary bladder. Bibliographic review.

OBJECTIVES: Large cell neuroendocrine carcinoma (LCNEC) of the urinary bladder is very rare. We intend to update diagnostic criteria, pathologic and immunohistochemical characteristics, prognosis and treatment options. All published articles related with LCNEC of the urinary bladder have been reviewed and a descriptive study has been done. RESULTS: A total of 17 LCNEC of the bladder has been found. The 50% of all LCNEC of the bladder are mixed histological variant. This variant implies a better prognosis than the pure variant. The 70% of LCNEC of the bladder were ≥T3 at the time of diagnosis and the survival rate was 25%, whereas T2 tumors showed a survival rate of 100%. Radical cystectomy with lymphadenectomy combined with chemotherapy can sometimes reduce local and distant recurrence and improve survival of LCNEC of the bladder. CONCLUSIONS: LCNEC of the bladder is a tumor with high rate of local and distant recurrence, as well as low survival, requiring early diagnosis and aggressive combined treatment.