10 normal capillary density. Hyperbaric oxygen therapy causes anti-oedematous vasoconstriction (30) without secondary ischaemia . Resolution of haematuria has been measured at rates of as high as 75-96% in RHC research groups in both prospective and retrospective study (26,30,31,32,33) designs . These results are maintained even after a median long-term follow-up period of 68 months, conrming excellent long-term results of the application of HBOT(34). In CHC reported case reports a complete resolution of haematuria was described to have occurred for 11–36 months post- (35,36,37,38) HBOT treatment . It was noted in further studies that HBOT demonstrated more success in patients exposed to lower radiation doses (62Gy) versus patients with high dosage radiotherapy (39,40) (76Gy) . It was however noted that some papers indicate that success rate in RHC would be (35,36,37,38) dependent on the number of HBOT sessions . HBOT Protocols Although different treatment protocols reduce the comparability of treatment outcomes, standardised protocols (modied US Navy Recompression Treatment Tables) have, for the most part been applied in the South African setting. For the most part, treatment recommendations presented by the U.S. Navy Diving Manual, U.S. (41) Navy Recompression Treatment tables, (1999) should be followed as closely as possible, unless it becomes evident that these treatment guidelines are not being effective for a specic condition. Only a Diving Medical Ofcer (DMO)/Hyperbaric trained specialist (HBOT Specialist) may recommend changes to treatment protocols other than those described in the tables set out for HBOT by the U.S. Navy Diving Manual. Treatment “Table 9” (Figure 1) is the shortest of the ofcial HBOT treatment tables providing 90minutes of oxygen breathing at 2.4 ATA. This table is used based only on the recommendation of a DMO/HBOT Specialist cognisant of the patient's (41) medical condition and preferred outcomes . individuals suffering from cyanide poisoning, carbon monoxide poisoning, gas gangrene, smoke inhalation, necrotizing soft-tissue infections, severe injuries, arterial gas embolism arising from surgery or diagnostic procedures, thoracic trauma or those whose requiring accelerated healing for whatever reasons. All HBOT treatments shall be done under (41,47) the cognisance of a DMO/HBOT Specialist . “Table 1” is an example of treatment protocols for some of the approved Indications for HBOT, taken from the Undersea and Hyperbaric Medical Society's Hyperbaric Oxygen Therapy Committee (42,47) Report-2003 . These guidelines include not only the approved conditions but eludes to the frequency of treatment, and the advised minimum and maximum number of treatments (subject to (41,47) the DMO/HBOT Specialist's clinical opinion) . Figure 1: Treatment Table 9. Hyperbaric oxygen treatment (41) table Taken from: U.S. Navy Diving Manual, (1999)(41) • 90minutes of oxygen breathing at 2.4 ATA (45 feet/13-15msw). • Descent rate – 6 Meters/Min. (2.15minutes) • The total treatment time (60/90min) begins on arrival at 2.4 ATA or 13-15msw • Ascent rate – 6 Meters/Min (2.15minutes) – This rate may be slowed to 0.3048 m/min depending upon the patient's medical condition. • The patient may breathe air or oxygen during ascent. • If patient cannot tolerate oxygen at 13-15msw, this table can be modied UROLOGY, URO-ONCOLOGY AND SEXOLOGY UPDATE
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