Continuous bladder irrigation in the monoplace hyperbaric chamber: Two case reports

Introduction: Radiation-induced hemorrhagic cystitis is a serious side effect of radiation therapy. Anemia requiring transfusion can ensue. Treatment methods include bladder irrigation, fulguration, and hyperbaric oxygen (HBO₂) therapy. Failure of treatment leads to cystectomy associated with a high risk of severe complications (42%) and mortality (16%). Continuous bladder irrigation (CBI) is often required to prevent further clot formation. HBO₂ supports the healing process of radiation cystitis. In patients requiring CBI, the time in HBO₂ can help cause clot accumulation and obstruction. We describe a method of providing CBI in a monoplace hyperbaric chamber. Materials and methods: An IV to catheter adapter is used, allowing an IV pump to control CBI flow into the chamber. Drainage is collected in an extra-large (2- to 5-liter) bag. The rate is set so the volume does not exceed the bag's capacity. The bag is placed in a manner that precludes spilling and allows monitoring of outflow. Results: CBI was successfully maintained. Brief cases are presented and issues discussed. Summary/Conclusions: CBI is easily maintained in a monoplace hyperbaric chamber, with readily available equipment allowing for uninterrupted CBI of hemorrhagic cystitis. HBO₂ helps mitigate the potential side effects of other interventions in a previously irradiated area.