Pretreatment Features to Influence Effectiveness of Intravesical Hyaluronic Acid Instillation in Refractory Interstitial Cystitis/Painful Bladder Syndrome

Abstract

PurposeTo determine the efficacy of intravesical hyaluronic acid (HA) instillation in treating patients with refractory interstitial cystitis/painful bladder syndrome (IC/PBS) and to identify any related factors that influence its therapeutic effect.MethodsThirty-three female IC/PBS patients who demonstrated poor or unsatisfactory responses to previous treatments between December 2010 and October 2012 were enrolled. Despite previous treatments, the enrolled patients had visual analogue scale (VAS) pain scores ≥4 and total scores (symptom and bother scores) ≥13 on the pelvic pain and urgency/frequency (PUF) questionnaire and ≥12 on the O'Leary-Sant interstitial cystitis symptoms index (ICSI)/problems index (ICPI). All patients received once weekly intravesical instillations of 40-mg HA diluted in 50-mL saline for 4 weeks. The efficacy of the HA instillation was evaluated by comparing the mean changes in the scores of the VAS and questionnaires from baseline to 4 weeks after treatment. Improvement was defined as a ≥2 decrease in the VAS. Moreover, we investigated the effects of the presence of Hunner's ulcer and previous treatment modalities on the therapeutic outcome of HA instillation.ResultsThe mean age was 57.0±1.8 years (range, 28-75 years). The VAS score significantly decreased from baseline to 4 weeks after treatment (-2.5, P<0.001). The mean changes in the PUF, ICSI, and ICPI from baseline to 4 weeks after the treatment were -3.8 (P<0.001), -2.3 (P<0.001), and -2.7 (P<0.001), respectively. Twenty patients (61%) showed improvements. Previous treatment modalities did not affect the efficacy of HA instillation and the presence of Hunner's ulcer was unrelated to outcomes. No complications were observed.ConclusionsThese results show that intravesical HA instillation is an effective and safe treatment for patients with refractory IC/PBS. Previous treatment modalities and presence of Hunner's ulcer do not affect the efficacy of HA instillation.

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

“…Several observational studies have reported a wide range of response rates, from 30-87%. 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.…”

From bladder to systemic syndrome: concept and&nbsp;treatment evolution of interstitial cystitis

“… 87 Intravesical hyaluronic acid instillation was an effective and safe treatment for 33 patients with refractory IC/PBS, with no influence of previous treatment modalities and presence of Hunner’s ulcer being observed to affect its efficacy. 88 Along with the reduction of BPS/IC symptoms, intravesical hyaluronic acid also seemed to improved sexual function. 89 …”

Evaluation of the incidence and risk factors associated with persistent frequency in interstitial cystitis/bladder pain syndrome and the efficacy of antimuscarinic treatment

“…All treatments were performed according to the guidelines published by the American Urological Association [ 1 6 ]. Conventional treatments included amitriptyline, pentosan polysulfate (PPS), intravesical hyaluronic acid instillation, hydrodistension (HD), or transurethral resection and cauterization (TUR-C), according to the severity of symptoms and presence of Hunner lesions [ 7 8 ].…”