Bladder Instillation Therapy With Hyaluronic Acid and Chondroitin Sulfate Improves Symptoms of Postradiation Cystitis: Prospective Pilot Study

Gacci, Mauro; Saleh, Omar M. Abu; Giannessi, Claudia; Chini, T.; Camera, P. Della; Detti, Beatrice; Livi, Lorenzo; Agrò, Enrico Finazzi; Marzi, Vincenzo Li; Minervini, Andrea; Carini, Marco; Oelke, Matthias; Gravas, Stavros; Serni, Sergio

doi:10.1016/j.clgc.2016.01.016

Cited by 28 publications

(22 citation statements)

References 20 publications

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“…146 Positive effects on bleeding as well as frequency, urgency, and pain have been reported. 147,148 Hyaluronic acid and hyperbaric oxygen had similar effects on hematuria in one study, with a response rate of 88-75%. 149 However, only 45-50% of the patients were free of symptoms at follow-up 18 months post treatment.…”

Section: Treatment Optionsmentioning

confidence: 94%

Radiation-induced cystitis treated with hyperbaric oxygen therapy (RICH-ART): a randomised, controlled, phase 2–3 trial

Oscarsson

Müller

Rosén

et al. 2019

The Lancet Oncology

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Introduction Cancer is affecting a growing number of persons. Still, the treatment and survival of cancer is improving. Radiation therapy is used in the treatment of cancer. Late radiation-induced injuries afflict 5-15% of irradiated patients. The urinary bladder and bowel may be affected after irradiation of cancer in the pelvic region. Symptoms can be severe, with impaired health related quality of life (HRQoL). Hyperbaric oxygen therapy (HBOT) involves breathing oxygen at high ambient pressure. HBOT can reverse radiation-induced injuries, alleviate patient-perceived symptoms, and improve HRQoL. We aimed to clarify the effects of HBOT on late radiation-induced injuries in the urinary bladder and bowel, and to clarify some of the underlying mechanisms through which HBOT exerts its effects. Methods A prospective cohort study assessed effects of HBOT on patient-perceived symptoms (Paper I). A rat study assessed reversal of radiation-induced stress with HBOT (Paper II). A methodological experiment assessed reversal of HBOT on cellular death induced by radiation (Paper III). A multi-center, randomized, controlled trial assessed patient-perceived symptoms, HRQoL, and objective clinical outcomes (Paper IV). Result HBOT can alleviate patient-perceived symptoms, reduce objective findings, and improve HRQoL in patients affected by late radiation-induced injuries (Paper I, IV). Oxidative stress and downstream effects, induced by the irradiation, can be reversed by HBOT (Paper II). Paper III outlines a method for studies on urothelial cells exposed to radiation and HBOT. Conclusion HBOT can reduce radiation-induced oxidative stress and inflammatory response. HBOT can reverse injuries induced by radiation therapy to the pelvic region, alleviate patient-perceived symptoms and lead to improved HRQoL.

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Section: Treatment Optionsmentioning

confidence: 94%

Radiation-induced cystitis treated with hyperbaric oxygen therapy (RICH-ART): a randomised, controlled, phase 2–3 trial

Oscarsson

Müller

Rosén

et al. 2019

The Lancet Oncology

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“…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.…”

Section: Discussionmentioning

confidence: 99%

Improving the barrier function of damaged cultured urothelium using chondroitin sulfate

Rozenberg

Janssen

Jansen

et al. 2019

Neurourology and Urodynamics

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Aims: To determine whether glycosaminoglycan (GAG) replenishment is able to improve recovery of a deficient urothelial barrier, chondroitin sulfate (CS) instillations were tested using an in vitro model. Porcine urothelial cells (Ucells) were terminally differentiated in culture conditions to construct a urothelial layer with a functional barrier. This layer was damaged to compromise barrier function to simulate a key characteristic of bladder pain syndrome/interstitial cystitis. The functional effect of subsequent treatment with CS was evaluated.Methods: Primary porcine Ucells were isolated and cultured on inserts. Differentiation of cells was evaluated with immunohistochemical analysis for the presence of umbrella cells, tight junctions and CS. Transepithelial electrical resistance (TEER) measurements were performed to evaluate barrier function. Protamine was used to simulate mild urothelial damage. CS 0.2% (vol/vol), a GAG, was subsequently instilled in the treatment group. The recovery of barrier function was further evaluated with TEER measurements. The Student t test was used for the analysis of results.

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“…Gacci et al. 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 .…”

Section: Discussionmentioning

confidence: 99%

“…Moreover, the study by Raymond et al [22] and a metaanalysis showed that high-molecular-weight HA instillation effectively reduces the symptoms of women with IC/BPS or UTIs and improves their QoL. Table 3 shows the recent studies of intravesical instillations of HA and CS [15,18,21,[23][24][25][26].…”

Section: Discussionmentioning

confidence: 99%

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

Kim

et al. 2018

BJU International

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Bladder Instillation Therapy With Hyaluronic Acid and Chondroitin Sulfate Improves Symptoms of Postradiation Cystitis: Prospective Pilot Study

Cited by 28 publications

References 20 publications

Radiation-induced cystitis treated with hyperbaric oxygen therapy (RICH-ART): a randomised, controlled, phase 2–3 trial

Radiation-induced cystitis treated with hyperbaric oxygen therapy (RICH-ART): a randomised, controlled, phase 2–3 trial

Improving the barrier function of damaged cultured urothelium using chondroitin sulfate

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

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