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

Abstract

Introduction: Patients with a history of bladder pain syndrome/interstitial cystitis (BPS/IC) and who responded poorly or unsatisfactorily with previous treatment were compared taking intravesical hyaluronic acid (HA) or hyaluronic acid-chondroitin sulphate (HA-CS).Methods: Patients were treated with intravesical instillation with 50 mL sterile sodium hyalurinic acid (Hyacyst, Syner-Med, Surrey, UK) (n = 32) and sodium hyaluronate 1.6% sodium chondroitin sulphate 2% (Ialuril, Aspire Pharma, UK) (n = 33). Intravesical instillations were performed weekly in first month, every 15 days in the second month and monthly in third and fourth months, for a total of 8 doses. Patients were evaluated using a visual analog pain scale (VAS), interstitial cystitis symptom index (ICSI), interstitial cystitis problem index (ICPI), voiding diary for frequency/nocturia, cystometric bladder capacity and voided volume at the beginning and at 6 months. All patients had a potassium sensitivity test (PST) initially. Wilcoxon and Mann-Whitney U tests were used for statistical analysis.Results: In total, 53 patients met the study criteria. There were 30 patients in the HA-CS group (mean age: 48.47) and 23 patients in the HA group (mean age: 49.61) (p > 0.05). The initial PST was positive in 71.7% patients (38/53) overall with no difference between groups (p > 0.05). Responses for VAS, ICCS, ICPS, 24-hour frequency/nocturia statistically improved in both groups at 6 months. There was no significant difference in symptomatic improvement (p > 0.05). Eight patients had mild adverse events.Conclusion: HA and HA/CS instillation can be effective in BPS/IC patients who do not respond to conservative treatment. An important limitation of our study is that the HA dosage of the 2 treatment arms were different. It would be more appropriate with same HA dosage in both groups; however, there was no commercially available glycosaminoglycan (GAG) substance with same HA dosage for single and combination therapy. Large, long-term randomized studies are required to determine if there is a difference between these treatments.

CUA guideline: Diagnosis and treatment of interstitial cystitis/ bladder pain syndrome

“…39,[126][127][128][129][130][131][132][133][134] Combination therapy with HA and chondroitin sulfate has also shown encouraging results up to three years in small cohorts of patients. [135][136][137] However, the efficacy of intravesical HA has been questioned in three reported, but unpublished RCTs, which found no significant symptom improvement compared to placebo. [138][139][140] Few adverse reactions have been reported except for mild irritative symptoms.…”

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

“…The final systematic review and meta-analysis included 10 eligible articles and 8 subsets with HA and 4 subsets with HA/CS. However, analyzed studies numbered 12 in the current metaanalysis because Gulpinar et al [18] reported the results of Hyacyst ® (120 mg HA in 50 ml) and Ialuril ® (1.6% HA and 2.0% CS), and Lai et al [20] reported the separate results of HA instillation for IC/PBS with 2 different regimens: 4 weekly intravesical instillations of 40 mg HA followed by 5 monthly HA instillations (HA-9 group), and 12 intravesical instillations of 40 mg HA every 2 weeks (HA-12 group). Therefore, we counted these as 4 studies in the data extraction process (Table 1) after searching the articles (Fig.…”

Complete response to acupuncture therapy in female patients with refractory interstitial cystitis/bladder pain syndrome

“…It is seen 10 times more frequent in females than males. The disease occurs generally between third and fifth decades [3,4]. Although the etiology is not completely known, autoimmune mechanisms, previous infections, stress, mast cell activation, neuropathic changes and toxic materials in urine are blamed.…”

“…In studies with different intravesical GAG replacement treatments (hyaluronic acid, chondroitin sulphate, hepatin) aiming the renewal of glycosaminoglycan layer, it was shown that they were successful in removing the pain by 48-71%, increasing bladder capacity and recovery of sexual functions and it was observed that the symptoms were acutely relieved. But a high ratio of recurrence was reported in symptoms [3][4][5][6][7]. It was demonstrated that interventional applications such as bladder dilatation, Botulinum toxin A (BTX-A) application, Electromotive drug administration (EMDA), Hyperbaric oxygen, Neuromodulation application, coagulation and Transurethral resection (TUR) in patients with Hunner ulcer were useful in different levels in the treatment [1].…”

“…Although the etiology is not completely known, autoimmune mechanisms, previous infections, stress, mast cell activation, neuropathic changes and toxic materials in urine are blamed. Disruption of the barrier and permeability in bladder mucosa due to the defects in glycosaminoglycan (GAG) layer in urothelium and exposure to toxic components of the submucosal tissue plays a role in pathogenesis [1,3].…”