Prevention of recurrent bacterial cystitis by intravesical administration of hyaluronic acid: a pilot study

Abstract

OBJECTIVES To assess the effect of bladder instillations of hyaluronic acid (HA) on the rate of recurrence of urinary tract infection (UTI). PATIENTS AND METHODS Forty women (mean age 35 years) with a history of recurrent UTI received intravesical instillations of HA (40 mg in 50 mL phosphate‐buffered saline) once weekly for 4 weeks then once monthly for 4 months. The UTI status was assessed over a prospective follow‐up of 12.4 months and compared with the rates of UTI before instillation, determined by a retrospective review of patient charts covering 15.8 months. RESULTS After HA treatment no patients had a UTI during the 5‐month treatment phase and 28 (70%) were recurrence‐free at the end of the follow‐up. The mean (sd) rate of UTI per patient‐year was 4.3 (1.55) before treatment and 0.3 (0.55) afterward (P < 0.001). The median time to recurrence after HA treatment was 498 days, compared with 96 days beforehand (P < 0.001). The tolerability was excellent, as side‐effects were limited to nine patients who reported mild bladder irritation; no patient interrupted the treatment. CONCLUSIONS In this preliminary study, bladder instillations of HA had a significant effect on the rate of UTI in women with a history of recurrent UTIs. The bladder instillation of HA is an acceptable and promising therapeutic alternative in patients with recurrent UTI. Expanded placebo controlled clinical trials examining this application of HA are currently underway.

Intravesical treatment with highly-concentrated hyaluronic acid and chondroitin sulphate in patients with recurrent urinary tract infections: Results from a multicentre survey

“…[14][15][16][17] Considering the largest cohort of patients ever reported, our findings confirm the results of 3 previously published reports supporting the role of GAGs layer repair as a valid treatment option for bacterial recurrent UTIs.…”

“…[13][14][15][16][17] Although a positive effect was reported, a small sample was considered the main limitation of the studies supporting the use of GAGs to prevent UTI. More robust analyses of larger samples are required to corroborate positive findings from early series.…”

“…More robust analyses of larger samples are required to corroborate positive findings from early series. [14][15][16][17] This study was initiated as a collaborative effort to provide a review of clinical outcomes from centres pioneering the intravesical instillation of Ialuril (IBSA International) (HA 1.6% plus CS 2%) for prophylaxis of recurrent urinary tract infections (UTIs) in female patients.…”

Non-antibacterial alternative measures for urinary tract infection in children. Part 1. Suppression of the microbial initiation of the inflammation

“…Указанные обстоятельства явились причиной разработки с 2004 г. нового подхода к профилактике возрастных инфекций мочевой системы с применени-ем гликозаминогликанов [33]. Суммарные результаты исследования были оформлены к 2012 г. Как оказалось, препараты гиалуроновой кислоты и хондроитинсуль-фата, используемые внутрипузырно на протяжении 6 мес, приводят к 10-13 кратному снижению частоты рецидивов в год на одного пациента.…”

The Association between Chronic Inflammation and Recurrent Cystitis in Women

“…Glycosaminoglycan (GAG) is an important component of this protective lining and various coating techniques have been used to try and repair this layer with variable results. It has been postulated that a deficiency in the protective lining of the bladder epithelium is a common pathway in the development of IC/BPS, UTI, and bladder carcinoma [39][40][41]. For the protective effect, the luminal surface contains a greater concentration of sulfated (negatively charged) GAGs than the intracellular and interstitial locations [42].…”