A combined intravesical therapy with hyaluronic acid and chondroitin for refractory painful bladder syndrome/interstitial cystitis

Abstract

The aims of this study were to evaluate the efficacy and tolerability of intravesical instillations of high-molecular-weight hyaluronic acid (HA) 1.6% and chondroitin sulfate (CS) 2.0% in patients with refractory painful bladder syndrome/interstitial cystitis (PBS/IC) and to observe their impact on Quality of Life. Twenty-three women were enrolled. They received bladder instillations with HA and CS weekly for 20 weeks and then monthly for 3 months. Mean follow-up after completion of therapy was 5 months. We observed a significant improvement in urinary symptoms on voiding diaries and Visual Analogue Scale for frequency (p = 0.045), urgency (p = 0.005), and pain (p = 0.001). The O'Leary-Sant Interstitial Cystitis Symptom Index and Interstitial Cystitis Problem Index resulted in a significant improvement in both scores (p = 0.004 and 0.01, respectively). The Pelvic Pain and Urgency/Frequency Symptom Scale only showed significant improvement in the symptom score (p = 0.001). This promising experience seems to offer an additional therapeutic option in patients with refractory PBS/IC.

Systematic Review and Meta-Analysis of Intravesical Hyaluronic Acid and Hyaluronic Acid/Chondroitin Sulfate Instillation for Interstitial Cystitis/Painful Bladder Syndrome

“…Steinhoff et al found a 45% response rate after initial 3 months with instillation of 40 ml CS 0.2%, and Nickel et al reported that instillation of CS 2% produced a 60% response rate at 6 months [27,29]. Furthermore, several studies also reported a significant effect with the combination of HA and CS, Porru et al assumed that HA/CS may give better longer-lasting therapeutic effects than the individual compounds [17,23,30]. In the present study, although mean difference of VAS in the pure HA subgroup was higher than that in the subgroup with combination of HA and CS, there was no significant difference between subgroups (P = 0.722).…”

Morphological Changes of Bladder Mucosa in Patients Who Underwent Instillation with Combined Sodium Hyaluronic Acid-Chondroitin Sulphate (Ialuril®)

“…Single agent intravesical therapy with CS also provided encouraging results [22,23,24]. To maximize the potential for urothelial restoration, and to elucidate the optimal dose and schedule, HA 1.6% and CS 2.0% were combined for intravesical instillation therapy [25,26] with promising results and recently Cervigni et al [27] reported a sustained improvement in symptoms, still apparent at 3-year follow-up, in patients affected by BPS/IC who had been unresponsive to previous treatments.…”

Treatment of bladder pain syndrome and interstitial cystitis: a systematic review

“…Porru et al [21], Cervigni et al [52], and Giberti et al [53] used an intravesical injection of 1.6 % hyaluronic acid and 2.0 % chondroitin sulfate as a treatment for BPS/IC, and observed a decrease of 35-50.76 % in pain, a decrease of 26-57.14 % in voiding frequency, and an increase of 24.90-41 % in voided volume [21; 52]. The study had many limitations; however, they reported an improvement in BPS/ IC symptoms [53].…”