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

Pyo, Jung‐Soo; Cho, Won Jin

doi:10.1159/000447863

Cited by 57 publications

(40 citation statements)

References 32 publications

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“…Intravesical instillation of sodium hyaluronate or sodium chondroitin sulfate alone has demonstrated short-term therapeutic effects, although long-term efficacy was limited. 19 In a study of postoperative adjuvant instillation, additional instillation decreased symptom recurrence, but not HLs recurrence. 20 Future studies should, therefore, focus on approaches to the restoration of the damaged bladder using, for example, stem cell injection, which has demonstrated therapeutic efficacy in IC rat models.…”

Section: Discussionmentioning

confidence: 98%

“…Removal of HLs with sufficient safety margins may serve as the primary treatment for Hunner‐type IC, but refractory cases may require approaches that restore the entire bladder wall. Intravesical instillation of sodium hyaluronate or sodium chondroitin sulfate alone has demonstrated short‐term therapeutic effects, although long‐term efficacy was limited . In a study of postoperative adjuvant instillation, additional instillation decreased symptom recurrence, but not HLs recurrence .…”

Section: Discussionmentioning

confidence: 99%

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Patterns and predictors of Hunner lesion recurrence in patients with interstitial cystitis

Han

Shin

Choo

2019

Neurourology and Urodynamics

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Aims To evaluate the patterns and predictive factors associated with Hunner lesions (HLs) recurrence in patients with interstitial cystitis (IC). Methods This study was a retrospective analysis of data from patients with IC who underwent transurethral resection and cauterization (TUR‐C) of HLs between October 2011 and December 2017. Symptoms were evaluated using the Pelvic Pain and Urgency/Frequency Patient Symptom Scale (PUF), O'Leary‐Sant Interstitial Cystitis Symptom Index, and Visual Analogue Scale (VAS). Patients attended follow‐up visits every 3 months; cystoscopy was performed immediately in patients with aggravated symptoms. Recurrence was defined as a VAS score greater than or equal to 4 and HLs recurrence on cystoscopy. Results A total of 91 patients were enrolled (25 male, 66 female): median follow‐up was 30.6 months. HLs recurrence occurred in 101 sites (53 patients), 21.8% in the previous TUR‐C site, 18.8% de novo, and 59.4% at both previous and de novo sites. The recurrence rate was approximately 12.7%, 40%, and 55.2% at 6, 12, and 18 months, respectively. A higher PUF bother score was the only predictive factor of recurrence (odds ratio: 1.142, 95% confidence interval: 1.016‐1.284, P = 0.026), with a cut‐off value of 7.5 (sensitivity: 67.9%, specificity: 62.5%). In case of late recurrence (>18 months), there was no predictive factor. Conclusions The HLs recurrence pattern was unpredictable, involving both previous TUR‐C and de novo areas. More accurately defining the HLs resection margin may lead to better surgical outcomes but this remains to be proven.

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Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

Patterns and predictors of Hunner lesion recurrence in patients with interstitial cystitis

Han

Shin

Choo

2019

Neurourology and Urodynamics

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“…Presently, there are many drugs that can relieve the bladder symptoms [4, 10]. However, their effects on bladder structure and function have rarely been investigated.…”

Section: Discussionmentioning

confidence: 99%

Protective Effects of Antimuscarinics on the Bladder Remodeling After Bladder Outlet Obstruction

Liu

Luo

Yang

et al. 2017

Cell Physiol Biochem

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Background/Aims: Overactive bladder associated with bladder outlet obstruction (BOO) is a highly prevalent condition, which is usually treated with antimuscarinics. However, the potential effects of antimuscarinics on the structure and function of bladder have not been investigated thus far. Methods: Sprague-Dawley(R) rats accepted bladder neck obstruction surgery or sham surgery, and then received treatment of three different antimuscarinics (Solifenacin, Darifenacin, and Tolterodine) or vehicle. After 3, 6 and 12 weeks, the bladder function and structure were measured. The effect of antimuscarinics on cellular alteration in vitro was observed under mechanical stimulation. Bladder morphology were examined by immunohistochemistry, and the bladder function were investigated by cystometry and strip contractility test. The expression of muscarinic receptors and inflammatory cytokines were measured by PCR and Western blotting. Results: Here we demonstrate, both in vitro and in vivo, that antimuscarinics are protective regulators for the bladder structure and function. Antimuscarinics decrease the weight of bladders with BOO. Antimuscarinics improve the voiding parameter and enhance the contraction of bladder smooth muscle. The results also show that antimuscarinics inhibit the proliferation of bladder smooth muscle cells both in vivo and in vitro, it can reduce the collagen deposition and inflammatory cytokines in bladders with BOO. During this process, the expression of M2 and M3 receptors was altered by antimuscarinics. Conclusion: Antimuscarinics could reverse the structural and functional changes of BOO bladder wall at cellular and tissue level, and the alteration of M2 and M3 receptors may be involved in this biological process.

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“…26 In another recent meta-analysis, hyaluronic acid, alone or in combination with chondroitin sulfate, was shown to be effective in reducing pain and symptoms, and improving QoL, although it was also noted that data from placebo-controlled trials and long-term studies were limited. 46 Available data support the efficacy and safety of intravesical hyaluronic acid, chondroitin sulfate, or the combination, in BPS/IC patients. A summary of efficacy results from representative studies of intravesical GAG replenishment therapy with chondroitin sulfate and hyaluronic acid is shown in Table 1.…”

Section: Replenishment Therapymentioning

confidence: 97%

“…However, the largest effects size for response rate was shown for high molecular weight hyaluronic acid, followed by PPS . In another recent meta‐analysis, hyaluronic acid, alone or in combination with chondroitin sulfate, was shown to be effective in reducing pain and symptoms, and improving QoL, although it was also noted that data from placebo‐controlled trials and long‐term studies were limited …”

Section: Clinical Evidence For Gag Replenishment Therapymentioning

confidence: 99%

GAG replenishment therapy for bladder pain syndrome/interstitial cystitis

Wyndaele

Riedl²,

Taneja

et al. 2018

Neurourology and Urodynamics

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Aims To present a rationale for the inclusion of urothelial coating dysfunction in the etipathogenesis of bladder pain syndrome/interstitial cystitis (BPS/IC) and the preclinical and clinical evidence in support of glycosaminoglycan (GAG) replenishment therapy in the treatment of BPS/IC, supplemented by the clinical experience of medical experts in the field and patient advocates attending a symposium on GAG replenishment at ESSIC’17, the annual Meeting of the International Society for the Study of Bladder Pain Syndrome, held in Budapest, Hungary in 2017. Results The urothelial GAG layer has a primary role in providing a permeability barrier to prevent penetration of urinary toxins and pathogens into the bladder wall. Disruption of the GAG layer contributes to the development of BPS/IC. The evidence shows that replenishment of GAGs can restore the GAG layer in BPS/IC, reducing inflammation, pain, and other symptoms. Conclusions Although data from large randomized controlled studies are limited, long clinical observation and the experience of clinicians and patients support the beneficial effects of intravesical GAG replenishment therapy for providing symptomatic relief for patients with BPS/IC.

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

Cited by 57 publications

References 32 publications

Patterns and predictors of Hunner lesion recurrence in patients with interstitial cystitis

Patterns and predictors of Hunner lesion recurrence in patients with interstitial cystitis

Protective Effects of Antimuscarinics on the Bladder Remodeling After Bladder Outlet Obstruction

GAG replenishment therapy for bladder pain syndrome/interstitial cystitis

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