Intravesical Hyaluronic Acid in the Treatment of Refractory Interstitial Cystitis

Abstract

The response of patients with refractory interstitial cystitis to the intravesical administration of hyaluronic acid was gratifying. In the past many therapies for interstitial cystitis which were initially considered promising failed the test of a controlled study. Such a study to determine the activity of hyaluronic acid in patients with interstitial cystitis is currently under way.

Treatment of post-hematopoietic stem cell transplantation hemorrhagic cystitis with intravesicular sodium hyaluronate

“…It has been used in the treatment of patients with interstitial cystitis with beneficial results. 6 The mechanisms of action of sodium hyaluronate in this setting are not well understood. Sodium hyaluronate has many biological activities, which include inhibition of immune complexes, adherence to polymorphonuclear cells, inhibition of leukocyte migration, regulation of fibroblast and endothelial cell proliferation, enhancement of connective tissue healing, etc.…”

“…Sodium hyaluronate is a glycosaminoglycan present on the bladder mucosa, which serves as an important protective substance against uroepithelial damage. Preparations of this component have been shown to be effective in the treatment of interstitial cystitis 6,7 including post-chemoradiotherapy induced interstitial cystitis. 8 In this study, we tested the efficacy and safety of sodium hyaluronate in a cohort of seven patients with posttransplant HC.…”

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

“…Data were extracted from each publication by two independent reviewers (CLL and AMG) and included: type of study according to the presence of a control arm (controlled or uncontrolled clinical trials), randomisation (randomised or nonrandomised controlled trials) and observational studies (prospective or retrospective), type of intravesical solution, total of patients at baseline (intention-to-treat analysis), total patients treated (per protocol analysis), number of patients lost to follow-up, therapy regimen (total number of instillations/ frequency of application), instruments/scales used for evaluation of symptoms before and after treatment, and response rates (RR), considered as the percentage of patients with symptom reduction after therapy out of the total study sample [15]. In the absence of an explicitly cited definition for RR, and according previous publications [16,17], a reduction of ≥2 on a visual analogue scale (VAS) was considered to be a response to treatment; the percentage of responders was inferred by calculating the z value, defined as the proportion of responders within confidence intervals at 95 % (CI 95 %).…”

“…The final sample of 19 trials corresponds to a total of 801 patients, with 228 patients evaluated in a CT. Only 4 trials included male and female patients [15,35,44,45], while the rest of the studies exclusively included women.…”

“…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].…”