Hyaluronan treatment of interstitial cystitis/painful bladder syndrome

Abstract

The aim of this study is to evaluate the efficacy of intravesical hyaluronan therapy in interstitial cystitis/painful bladder syndrome (IC/PBS). One hundred twenty-six patients with IC/PBS and an average disease duration of 6.1 years were treated with weekly instillations of a 50-cm3 phosphate-buffered saline solution containing 40 mg sodium hyaluronate. To be eligible for hyaluronan treatment, a positive modified potassium test was requested as a sign of a urine-tissue barrier disorder. Data were obtained by a visual analogue scale (VAS) questionnaire rating from 0 to 10 that asked for global bladder symptoms before and after therapy. Additional questions evaluated the therapeutic impact on quality of life. A positive and durable impact of hyaluronan therapy on IC/PBS symptoms was observed--103 (85%) of the patients reported symptom improvement (> or =2 VAS units). The mean initial VAS score of 8.5 decreased to 3.5 after therapy (p < 0.0001). Out of 121 patients, 67 (55%) remained with no or minimal bladder symptoms after therapy (VAS 0-2). The majority (101, 84%) reported significant improvement of their quality of life. Intravesical therapy had to be initiated again with good success in 43 patients (34.5%) as symptoms recurred after discontinuation of treatment, while the rest stayed free of symptoms for up to 5 years. In general, hyaluronan therapy was well tolerated and, with the exception of mild irritative symptoms, no adverse reactions were reported for a total of 1,521 instillations. Timely hyaluronan instillation therapy may lead to complete symptom remission or even cure in part of the IC/PBS patients, while some responders need continuous intravesical therapy. The present results suggest that selection of patients for hyaluronan therapy by potassium testing improves the outcome of intravesical therapy with a response rate of >80%.

A Systematic Review and Meta-analysis on the Efficacy of Intravesical Therapy for Bladder Pain Syndrome/Interstitial Cystitis

“…The largest ES in all CT studies was observed for HMW-HA in the study by Shao et al (Fig. 2) [34], with similar findings in two UCT studies with HMW-HA [16,40] by a superior Bd^for average VAS difference. Closest to this VAS reduction were the results obtained using 300 mg of intravesical PPS [47].…”

“…By far the largest effect sizes (d>2) for symptom reduction were found in 3 studies performed with HMW-HA [16,34,40].…”

“…In the absence of an explicitly cited definition for RR, and according previous publications [16,17], a reduction of ≥2 on a visual analogue scale (VAS) was considered to be a response to treatment; the percentage of responders was inferred by calculating the z value, defined as the proportion of responders within confidence intervals at 95 % (CI 95 %).…”

Protective Effect of Intravesical Platelet-Rich Plasma on Cyclophosphamide-Induced Hemorrhagic Cystitis

“…The most accepted theory is the disruption of bladder lining glycosaminoglycan (GAG) layer [18]. There are many treatment modalities, although there is no cure [19]. The current treatment modalities give only a relief of symptoms.…”

Clinical comparision of intravesical hyaluronic acid and hyaluronic acid-chondroitin sulphate therapy for patients with bladder pain syndrome/interstitital cystitis

“…12 HA is widely studied and has shown a wide range of symptom improvement, from 30% to 85%. 3,13,14 Recently, Engelhardt and colleagues reported their long-term results of intravesical HA therapy and they observed a 50% complete bladder symptom remission at the 5-year follow-up without any additional therapy, while 41.7% with symptom recurrence improved with HA maintenance therapy. 15 On the other hand, in a double-blind, placebo-controlled, multicentre clinical study of different hyaluronic acid preparations (40 or 200 mg/cc), no significant efficacy of sodium hyaluronate compared to placebo was found for IC patients; however, further details, including patient selection, inclusion/exclusion criteria, definition of improvement/success, are not available.…”