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Eficácia da oxigenoterapia hiperbárica no tratamento de lesões uretrais induzidas por radiação : um estudo retrospetivo
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Resumo(s)
A Oxigenoterapia Hiperbárica é utilizada no tratamento de lesões tardias da radiação, como a Proctite Rádica, Cistite Rádica e Osteorradionecrose da Mandíbula. No sistema urinário, as estruturas mais afetadas pela radiação são os ureteres, a bexiga e a uretra. As Lesões Uretrais Induzidas por Radiação, podem-se caracterizar por Uretrite Rádica, Estenose Uretral e Fístula Uretral. A radiação, ao atingir os tecidos, causa fibrose e dano vascular, com consequente hipóxia. O oxigénio hiperbárico possui características que contrariam estes fenómenos, permitindo que ocorra cicatrização do tecido irradiado.
Este estudo pretende avaliar a eficácia terapêutica da Oxigenoterapia Hiperbárica nas Lesões Uretrais Induzidas por Radiação, através da avaliação retrospetiva dos sintomas antes e depois este tratamento.
Foram analisados retrospetivamente os processos clínicos dos doentes com Lesões Uretrais Induzidas por Radiação tratados no Centro de Medicina Subaquática e Hiperbárica que, num período de sete anos, cumpriram os critérios de inclusão.
O estudo incluiu nove doentes, todos com adenocarcinoma da próstata, tratados com radioterapia. Cinco doentes obtiveram resolução total de sintomas e quatro doentes obtiveram resolução parcial. Doentes que realizaram tratamentos prévios para as suas lesões mostraram uma resposta inferior ao oxigénio hiperbárico.
Como limitações, além do facto de ser retrospetivo e ter uma amostra de pequena dimensão, informações relativas à duração e dose da radioterapia, seguimento e recidiva sintomática não constavam nos processos clínicos.
Não obstante, neste estudo, a oxigenoterapia hiperbárica mostrou uma relação positiva com a resolução sintomática destas lesões, não havendo nenhum doente a relatar manutenção ou agravamento dos sintomas.
Futuramente, é necessário realizar estudos prospetivos para comprovar a eficácia deste tratamento neste tipo de lesões, com uma análise padronizada dos sintomas e tipo de radioterapia.
Hyperbaric Oxygen Therapy is used in the treatment of late radiation-induced lesions such as Radiation Proctitis, Radiation Cystitis and Osteoradionecrosis of the Jaw. In the urological system, the structures most affected by radiation are the ureters, bladder, and urethra. Radiation-Induced Urethral Lesions can manifest as Radiation Urethritis, Urethral Stricture and Urethral Fistula. When the radiation reaches the tissues, causes fibrosis and vascular damage, leading to hypoxia. Hyperbaric oxygen, with its unique properties, counteracts these phenomena, allowing for healing of the irradiated tissue. This study aims to evaluate the therapeutic efficacy of Hyperbaric Oxygen Therapy in Radiation-Induced Urethral Lesions by retrospectively assessing symptoms before and after treatment. The clinical records of patients with Radiation-Induced Urethral Lesions treated at Centro de Medicina Subaquática e Hiperbárica were retrospectively analysed, during a seven-year period, who met the inclusion criteria. The study included nine patients, all diagnosed with prostate adenocarcinoma and treated with radiotherapy. Five patients achieved complete resolution of symptoms, while four patients achieved partial resolution. Patients who had undergone previous treatments for their injuries showed a lower response to hyperbaric oxygen therapy. However, this study has limitations, such as its retrospective nature and a small sample size. Clinical records did not provide information regarding the duration and dosage of radiotherapy, follow-up, and symptomatic relapse. Nevertheless, this study demonstrated a positive relationship between Hyperbaric Oxygen Therapy and symptomatic resolution of these injuries, with no patients reporting symptom persistence or aggravation of symptoms. Future prospective studies are needed to further establish the efficacy of this treatment for Radiation-Induced Urethral Lesions, employing standardized analysis of symptoms and radiotherapy type.
Hyperbaric Oxygen Therapy is used in the treatment of late radiation-induced lesions such as Radiation Proctitis, Radiation Cystitis and Osteoradionecrosis of the Jaw. In the urological system, the structures most affected by radiation are the ureters, bladder, and urethra. Radiation-Induced Urethral Lesions can manifest as Radiation Urethritis, Urethral Stricture and Urethral Fistula. When the radiation reaches the tissues, causes fibrosis and vascular damage, leading to hypoxia. Hyperbaric oxygen, with its unique properties, counteracts these phenomena, allowing for healing of the irradiated tissue. This study aims to evaluate the therapeutic efficacy of Hyperbaric Oxygen Therapy in Radiation-Induced Urethral Lesions by retrospectively assessing symptoms before and after treatment. The clinical records of patients with Radiation-Induced Urethral Lesions treated at Centro de Medicina Subaquática e Hiperbárica were retrospectively analysed, during a seven-year period, who met the inclusion criteria. The study included nine patients, all diagnosed with prostate adenocarcinoma and treated with radiotherapy. Five patients achieved complete resolution of symptoms, while four patients achieved partial resolution. Patients who had undergone previous treatments for their injuries showed a lower response to hyperbaric oxygen therapy. However, this study has limitations, such as its retrospective nature and a small sample size. Clinical records did not provide information regarding the duration and dosage of radiotherapy, follow-up, and symptomatic relapse. Nevertheless, this study demonstrated a positive relationship between Hyperbaric Oxygen Therapy and symptomatic resolution of these injuries, with no patients reporting symptom persistence or aggravation of symptoms. Future prospective studies are needed to further establish the efficacy of this treatment for Radiation-Induced Urethral Lesions, employing standardized analysis of symptoms and radiotherapy type.
Descrição
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2023
Palavras-chave
Oxigenoterapia hiperbárica Radioterapia Lesões uretrais Urologia