Intravesical treatment with highly-concentrated hyaluronic acid and chondroitin sulphate in patients with recurrent urinary tract infections: Results from a multicentre survey

Abstract

Introduction: We assess the effectiveness of intravesical instillation of hyaluronic acid (HA) and chondroitin sulphate (CS) as a non-antibiotic treatment option for prophylaxis of recurrent urinary tract infections (UTIs) in female patients. Methods: This was a retrospective cohort study involving 7 European institutions. We included patients with recurrent UTIs who received intravesical instillations of Ialuril (IBSA International) (50 mL HA 1.6% and CS 2% solution) between January 2010 and March 2012. Medication schedule, length of follow-up, recurrence infection time, number of UTIs/patients/year, patient quality of life, subjective symptoms score, and treatment-emergent side effects were recorded and analyzed. Results: In total, 157 women (mean age: 54.2 ± 4.1 years) were included in the analysis. All patients had at least 12 months followup. After 4 weekly and 5 monthly HA-CS bladder instillations, UTI episodes decreased from 4.13 ± 1.14 to 0.44 ± 0.50 (p = 0.01) at 12 months, while recurrent UTI time prolonged from 94.8 ± 25.1 days to 178.4 ± 37.3 days (p = 0.01) at 12 months. An improvement in symptoms and quality of life was achieved. A medium-depth pain after medication instillation was the most reported side effect. Regression model analysis showed significant risk factors in developing new UTI episodes: being more than 50 years old and having more than 4 UTI episodes per year (OR 3.41; CI 95%; p = 0.003 and OR 3.31;; p = 0.003, respectively). Retrospective design and lack of a control group represent two main limitations of the study. Conclusions: Restoring glycosaminoglycans bladder layer therapy is a promising non-antibiotic therapy to prevent recurrent UTIs.

Intravesical sodium hyaluronate reduces severity, frequency and improves quality of life in recurrent UTI

“…Some of these studies have been more extensive and have included two randomised trials as well. All these studies have demonstrated a reduction in the mean number of UTI recurrences and an increase in the recurrence-free interval [19][20][21][22]. Thus, our results have been congruent with the outcomes reported in the literature.…”

High molecular weight hyaluronic acid: a two‐pronged protectant against infection of the urogenital tract?

“…Glycosaminoglycan instillations when compared clinically to placebo and antibiotics have been found to be linked to fewer episodes of UTI recurrence in women and longer periods between infections 28, 29, 30. Hence, these agents appear protective against UTIs.…”

Managing chronic bladder diseases with the administration of exogenous glycosaminoglycans: an update on the evidence

“…As in the Damiano study, tolerability of the Ialuril formulation was good, with no serious adverse events reported. Recently Cicione and colleagues [Cicione et al 2014] assessed the effectiveness of intravesical instillation of HA and CS as a nonantibiotic treatment option for the prophylaxis of recurrent UTIs in female patients at seven European institutions. They used intravesical instillations of 50 ml HA 1.6% and CS 2% solution in 157 women with recurrent UTIs.…”