6 UROLOGY, URO-ONCOLOGY AND SEXOLOGY UPDATE The application of Hyperbaric Oxygen Therapy as an Adjunct Treatment in the Management of Radiation Injuries The exact causes of radiation injuries are complex and still only partially understood. Vascular changes characterised by obliterative endarteritis are however observed in virtually all organs which (1) demonstrate radiation damage . Though there might be no immediate outward signs of tissue destruction, it is agreed that the onset of damage (2) induced by radiation exposure is immediate . While numerous studies on the link between cytokines and radiation injuries have been conducted in animal models, the practical application of these observed associations is difcult with no single marker able to (1,3) reliably estimate future radiation damage . Radiation damage/injury may be accurately predicted based on the source and length of exposure to radiation, and the type of tissue that was exposed to radiation. Although predictable, the multiple sources and dosages involved in radiation treatment results in difculty in selecting one specic treatment option for these patients resulting in signicant variation in treatment (2) recommendations . The Nature of Radiation Injury Radiation injuries are all complex. Radiation injuries can be classied as acute, sub-acute or delayed (4) complications . Acute radiation injuries are due to direct and almost immediate cellular toxicity. This cellular toxicity directly affects the mitotic/reproductive health of the cells, caused by free radical mediated damage to cellular DNA. Acute injuries are usually self-limiting but may cause debilitating symptoms and are usually managed symptomatically. Sub-acute injuries are typically identiable in only a small number of organ systems (i.e: radiation pneumonitis post- lung cancer treatment). While sub-acute injuries are typically selflimiting and managed symptomatically, they may persist for several months, evolve, and become delayed complication injuries. Delayed radiation complications are typically only noted after a latent period of six months or more and may only develop years post-radiation exposure. Delayed injuries are often precipitated by additional tissue insult such as surgery within the radiation eld. While classication of injuries may assist in the management thereof this is not to say that acute radiation injuries may not resolve or evolve to become chronic injuries (5) indistinguishable from delayed radiation injuries . Cystitis Cystitis is any inammatory condition of the urinary bladder usually presenting with mild discomfort in the lower abdomen, which may result in a wide range of clinical manifestations from asymptomatic to life-threatening. Two types of cystitis are most common etiologically: infectious cystitis (more common - caused by bacteria) and sterile (or noninfectious) cystitis, often secondary to irritation by (6,7) chemical agents or the result of radiation injury . Radiotherapy-induced haemorrhagic cystitis (RHC), while rare (occurring in approximately 3–6.5% of patients), can arise from 6 months to 20 years after (8,9,10) radiation therapy , while chemotherapy-induced haemorrhagic cystitis (CHC) has also been proven to cause chemotherapy-limiting haematuria (cyclophosphamide or others (11,12,13) oxazaphosphorines) . The treatment of CHC, traditionally through the introduction of Mesna (2mercaptoethanesulfonic acid), has decreased the (12) incidence of CHC to less than 5% . Causal factors aside, haemorrhagic cystitis (HC) is a signicant impairment of a patients' quality of life often resulting in multiple, mostly emergency, admissions to hospitals. Bladder irrigation while Fundamentals of Hyperbaric Medicine (Simon Frasier University) Daniel M Botha Biokinetics (Hons) (U.J.) Daniel qualied with a post-graduate degree in Biokinetics in 2013 following studies in psychology, biomedical Science and health sciences and completed Fundamentals of Hyperbaric Medicine through Simon Frasier University in 2022. Daniel is currently completing his master's degree in public health with a research dissertation on prostate cancer. Daniel's primary focus is medical screenings and chronic disease rehabilitation. He is the clinical director of Dr Botha and Associates, the clinical Manager of Lyra wellbeing's executive medical programmes and he is a member of the Prostate Cancer Foundation's Medical and Scientic Advisory Board. He has a passion for men's health and competes in triathlons.
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