Intravesical hyaluronic acid for interstitial cystitis/painful bladder syndrome: A comparative randomized assessment of different regimens

Abstract

Abbreviations & AcronymsObjectives: To compare the clinical effectiveness of different regimens of intravesical hyaluronic acid instillation for patients with interstitial cystitis/painful bladder syndrome. Methods: A total of 60 patients (age 16-77 years) diagnosed with interstitial cystitis/ painful bladder syndrome were enrolled in this prospective, randomized study. A total of 30 patients were assigned to receive four weekly intravesical instillations of 40 mg of hyaluronic acid followed by five monthly instillations (hyaluronic acid-9 group). Another 30 patients received 12 intravesical instillations of 40 mg hyaluronic acid every 2 weeks (hyaluronic acid-12 group). Symptomatic changes after hyaluronic acid treatments were assessed using Interstitial Cystitis Symptom and Problem Indexes, pain visual analog scale, functional bladder capacity, frequency and nocturia in voiding diary, maximum flow rate, voided volume, postvoid residual volume, and Quality of Life Index at 1, 3 and 6 months. Results: Of the 60 patients, 59 were evaluable at the end of the study. The Interstitial Cystitis Symptom Index, Interstitial Cystitis Problem Index and total score, pain visual analog scale, functional bladder capacity, maximum flow rate, and Quality of Life Index improved significantly after 6 months in both groups. The frequency and voided volume improved significantly only in the hyaluronic acid-12 group. However, patients with moderate and marked improvement were clinically similar in both groups. The measured variables did not differ between the two groups over the course of the study. Conclusion: No significant difference was noted in the therapeutic effect between two hyaluronic acid instillation regimens for treatment of interstitial cystitis/painful bladder syndrome patients. Both groups showed significant improvement in symptom scores and Quality of Life Index.

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.…”

“…Lai et al compared the clinical effectiveness of two different intravesical HA instillation regimen (HA-9: 4 weekly intravesical instillations of 40 mg HA followed by 5 monthly HA instillations HA-12: 12 intravesical instillations of 40 mg HA every 2 weeks) [20]. However, most studies adopted a treatment strategy consisting of weekly treatment for several weeks followed by maintenance treatment (Table 1).…”

Stress and Chronic Pelvic Pain

“…140,141 Intravesicular replenishment of GAG as a treatment for IC/PBS has yielded mixed results. [142][143][144][145][146] Additionally, the clinical relevance of urothelial permeability in IC/PBS remains controversial. [147][148] Finally, the role of mast cells in IC/PBS has been investigated for several decades.…”

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

“…The final set of 19 articles on intravesical BPS/IC therapy was further qualitatively and quantitatively analysed: 5 studies were prospective controlled trials [34][35][36][37][38], 1 compared different intravesical products [39], 1 paper was designed as a retrospective study [40], and another 1 compared two different regimens of the same product [41]. The rest of the trials were classified as uncontrolled clinical studies (Table 2).…”

“…Other relevant differences were also detected: six of the studies included Btreatment-refractory patients^, considered to be cases with an inadequate response to previous BPS/IC treatments such as intravesical DMSO [15], heparin and/or PPS [15,41] and/or oral drug therapy [24,43,47]. One study only included Bnaïve patients^(no previous disease-specific treatment) with a positive PST and a reduction of≥2 points in symptom score after the first instillation of ChS 0.2 % [44].…”