, International Journal of PharmTech Research, Volume 9, Issue 12, p.1015-1022, (2016)
Urologic surgeries concerns the surgical treatment disorders that affect urologic pelvic structures as
cancer of the prostate, adrenal glands, bladder, kidneys, ureters, testicles, and penis1.
Compartment syndrome is a condition in which increased pressure within a limited space which
compromises the circulation and function of the tissues within that space. There are numerous causes of acute
compartment syndrome, including fractures, soft tissue trauma, and prolonged limb compression following drug
overdose, burns, and reperfusion of ischemic tissue, however the most common precipitating factor is traumatic
injury 2.
Well leg compartment syndrome (WLCS)is being increasingly recognized after urological,
gynaecologic, orthopedic or general surgical procedures with the common denominator of patient positioning in
the lithotomy or hemilithotomy position3.The lithotomy position is commonly used to access the pelvis and
perineum during urological, colorectal, and gynecologicalsurgery. Lower limb compartment syndrome is
caused by abnormal increases in intracompartmental pressures within a non-expansile fascial space and has
been recognized after prolonged elevation of the lower limbs during surgical procedures in the lithotomy
position. Commonly compartment syndrome involves ischaemia, hypoxia and oedema4. If prolonged urological
procedure is necessary patient should be monitored post operatively for early and prompt treatment of this
complication. Early diagnosis and proper treatment is the main-stay of the treatment in cases of acute
compartment syndrome following unavoidable prolonged urological procedures in lithotomy position5.
Hyperbaric oxygenation (HBO) therapy is defined as a treatment in which the patient breathes 100%
oxygen at pressures greater than atmospheric; this causes the P02 to increase in proportion to the increase in
ambient pressure. True HBO therapy only refers to the systemic delivery of oxygen via the lungs and is not
related to “topical oxygen therapy, in which only a specific body part is subjected to locally delivered oxygen
under pressure6.
A further form of conservative treatment for compartment syndrome is hyperbaric oxygenation. This
specifically reduces oedema and floods the tissues with oxygen dissolved in the extracellular fluid. This oxygen
is available to the compromised cells without the energy expenditure otherwise required for its transfer from
haemoglobin. In a series of patients with compartment syndrome who were treated with hyperbaric oxygen, that
none progressed and none required a fasciotomy7.
