The hyperbaric chamber provides unique conditions in which the hemoglobin is fully saturated and the oxygen is dissolved in the blood plasma at the rate of 2.3 volume percentage of hyperoxemia per 1 atmosphere absolute (ata). Ischemia of the bladder wall has been proposed to be a problem in BPS/IC. Van Ophoven and colleagues from Germany theorized that reduction of ischemic conditions of the pelvic region and with the IC affected bladder wall might be beneficial.

Twenty-one patients were randomized to 90 minutes treatment in a hyperbaric chamber pressurized with 100% oxygen to 2.4 ata for 30 treatment sessions or 1.3 ata breathing normal air in the control group. Three of 14 patients on active treatment and none of the 7 control patients reported treatment response. Responders continued to have benefit at 12 months. Efficacy of treatment appeared to follow an all-or-none rule with no patient showing late improvement who did not show improvement immediately after the treatment sessions.

The low response rate and the lack of any placebo response to such an invasive therapy leads one to question how well blinded the treatments were, and whether the effect was real. The numbers were small, but did reach statistical significance. O'Leary Sant Interstitial Cystitis Symptoms Scores dropped in the active group from 25.7+5.7 to 19.9+7.0 at 3 months post-treatment. In the 3 responders, pain seemed to respond, but there was no change in frequency.

While more research on HBO would be valuable, the therapy presently looks like an expensive "long run for a short slide" and does not seem ready for the treatment of BPS/IC outside of the research setting.

Arndt van Ophoven, Gordon Rossbach, Frank Pajonk, Lothar Hertle

J Urol, 176(4):1442-1446 October 2006

Written by Philip M. Hanno, MD, a Contributing Editor with UroToday.

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