Intravesical administration of combined hyaluronic acid (HA) and chondroitin sulfate (CS) for the treatment of female recurrent urinary tract infections: a European multicentre nested case–control study

Abstract

ObjectivesTo compare the clinical effectiveness of the intravesical administration of combined hyaluronic acid and chondroitin sulfate (HA+CS) versus current standard management in adult women with recurrent urinary tract infections (RUTIs).SettingA European Union-based multicentre, retrospective nested case–control study.Participants276 adult women treated for RUTIs starting from 2009 to 2013.InterventionsPatients treated with either intravesical administration of HA+CS or standard of care (antimicrobial/immunoactive prophylaxis/probiotics/cranberry).Primary and secondary outcome measuresThe primary outcome was occurrence of bacteriologically confirmed recurrence within 12 months. Secondary outcomes were time to recurrence, total number of recurrences, health-related quality of life and healthcare resource consumption. Crude and adjusted results for unbalanced characteristics are presented.Results181 patients treated with HA+CS and 95 patients treated with standard of care from 7 centres were included. The crude and adjusted ORs (95% CI) for the primary end point were 0.77 (0.46 to 1.28) and 0.51 (0.27 to 0.96), respectively. However, no evidence of improvement in terms of total number of recurrences (incidence rate ratio (95% CI), 0.99 (0.69 to 1.43)) or time to first recurrence was seen (HR (95% CI), 0.99 (0.61 to 1.61)). The benefit of intravesical HA+CS therapy improves when the number of instillations is ≥5.ConclusionsOur results show that bladder instillations of combined HA+CS reduce the risk of bacteriologically confirmed recurrences compared with the current standard management of RUTIs. Total incidence rates and hazard rates were instead non-significantly different between the 2 groups after adjusting for unbalanced factors. In contrast to what happens with antibiotic prophylaxis, the effectiveness of the HA+CS reinstatement therapy improves over time.Trial registration numberNCT02016118.

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

“…Recently, a case‐control study showed that intravesical instillation of a HA/CS mixture significantly reduced the recurrence rate in women with recurrent UTIs . Moreover, the study by Raymond et al.…”

How can we improve investigation, prevention and treatment for recurrent urinary tract infections – ICI‐RS 2018

“…Although widely used for the prevention of rUTIs, the clinical evidence for the use of exogenous GAG‐layer analogs in this population is predominantly limited to retrospective series with heterogeneity in terms of the intravesical formulation used and the frequency and duration of therapy. Despite reporting promising results in terms of reduction in rUTI rates compared with antibiotic prophylaxis, limitations exist regarding the method of defining and diagnosing infections and the retrospective nature of these studies limits their applicability . However, two RCTs have reported promising results.…”

“…Despite reporting promising results in terms of reduction in rUTI rates compared with antibiotic prophylaxis, limitations exist regarding the method of defining and diagnosing infections and the retrospective nature of these studies limits their applicability. [47][48][49] However, two RCTs have reported promising results. In one study, intravesical hyaluronic acid plus chondroitin sulfate was compared with placebo (normal saline), in 57 women with rUTI.…”

Non-surgical management of recurrent urinary tract infections in women

“…A total of 276 women with rUTIs were treated with intravesical hyaluronic acid and chondroitin sulfate and achieved significantly reduced rates of recurrence and increased symptomatic relief, quality of life and bladder capacity compared to standard therapy only (98). Standard therapy in this study consisted of an antimicrobial, immunoactive prophylaxis, probiotics and cranberry.…”