Sodium hyaluronate and chondroitin sulfate replenishment therapy can improve nocturia in men with post-radiation cystitis: results of a prospective pilot study

Abstract

BackgroundRadiotherapy is one of the treatment options for prostate cancer (PCa) but up to 25 % of men report about severe nocturia (nocturnal voiding). The combination of hyaluronic acid (HA) and chondroitin sulfate (CS) resembles glycosaminoglycan (GAG) replenishment therapy. The aim of our study was to evaluate the impact of HA and CS on nocturia, in men with nocturia after PCa radiotherapy.MethodsTwenty-three consecutive patients with symptomatic cystitis after external radiotherapy for PCa were enrolled. Patients underwent bladder instillation therapy with HA and CS weekly for the first month and, afterwards, on week 6, 8 and 12. Nocturnal voiding frequency was assessed by item 3 (Q3) of the Interstitial Cystitis Symptoms Index (ICSI) and item 2 (Q2) of the Interstitial Cystitis Problem Index (ICPI). Data were analyzed with paired-samples T-test and adjusted for age.ResultsEighteen patients (78 %) reported about nocturia. Pre- and post-treatment ICSI-Q3 was 2.13 ± 0.28 and 1.61 ± 0.21 (−24.4 %, p = 0.001). With logistic regression analysis, both age and baseline ICSI-Q3 had a significant impact on nocturnal voiding frequency (r = 0.293, p = 0.011 and r = 0.970, p < 0.001). Pre- and post-treatment ICPI-Q2 was 1.87 ± 0.26 and 1.30 ± 0.25 (−30.5 %, p = 0.016); logistic regression analysis was without significant findings.ConclusionBladder instillation treatment with a combination of HA and CS was effective in reducing nocturnal voiding frequency in men with post-radiation bladder pain for PCa. Randomized, controlled trials with sham treatment are needed to confirm our result.

Effect of highly concentrated hyaluronic acid/chondroitin sulphate instillation on ureteric stent‐induced discomfort after ureteroscopic lithotripsy: a multicentre randomised controlled pilot study

“…The present study is also consistent with several studies that showed that highly concentrated HA/CS instillation is useful for radiation‐induced cystitis . Gacci et al.…”

“…The present study is also consistent with several studies that showed that highly concentrated HA/CS instillation is useful for radiation-induced cystitis [28]. Gacci et al [26] reported that radiation therapy worsens LUTS and bother, and that instilling highly concentrated HA/CS reduces both of these clinical problems.…”

“…Gacci et al [26] reported that radiation therapy worsens LUTS and bother, and that instilling highly concentrated HA/CS reduces both of these clinical problems. In another study, they also showed that, when patients with post-radiation cystitis were treated with highly concentrated HA/CS, their Interstitial Cystitis Symptom Index and Problem Index indices dropped [28]. In addition, Sommariva et al [29] showed that highly concentrated HA/CS instillation improved bladder capacity, symptoms, and QoL in patients with late radiation tissue cystitis.…”

Improving the barrier function of damaged cultured urothelium using chondroitin sulfate

“…In addition to BPS/IC, there is evidence that GAGreplenishment with sodium hyaluronate and CS has a positive effect on symptoms in other chronic forms of cystitis including recurrent urinary tract infections and postradiation cystitis. 14,15 Studies have shown a decreased frequency of UTI with GAG-replenishment. 13,16,17 Therefore, improving the GAG-layer could possibly decrease bacterial adherence to the urothelium and reduce UTI recurrence.…”

“…13 In addition to BPS/IC, other indications for GAG-replenishment therapy are being investigated, such as chronic forms of cystitis including postradiation cystitis and recurrent urinary tract infections could possibly benefit from this therapy. [13][14][15][16][17] For GAG-replenishment, a variety of products are available that contain CS, hyaluronic acid, heparin, or pentosan polysulfate. The mouse study by Hurst et al 5 showed that exogenous CS can bind to the damaged bladder wall.…”