Intravesical hyaluronic acid and chondroitin sulphate for bladder pain syndrome/interstitial cystitis: long-term treatment results

Aims: The role of urodynamic studies in the diagnosis and prognosis of interstitial cystitis/bladder pain syndrome (IC/BPS) remains controversial. We evaluated the correlation of baseline voiding dysfunctions with long-term treatment outcome in a large cohort of patients with IC/BPS. Methods: We studied 211 patients with nonulcerative IC/BPS. All patients underwent video urodynamic examination at baseline to identify their voiding conditions and they received subsequent treatments. The primary endpoint was the global response assessment (GRA) at the current interview. Secondary endpoints included O’Leary-Sant score (OSS), Visual Analog Scale (VAS) for pain, and the rate of IC symptom flare-up. Results: Mean patient age was 56.8 ± 12.8 years and mean IC symptom duration was 16.0 ± 9.9 years. At baseline, 83 (39.3%) patients had a voiding problem and 62.7% had one to three comorbidities. The duration, comorbidity, treatments, changes in OSS and VAS, maximum bladder capacity (MBC), glomerulations, GRA, and flare-up rate were not significantly different among the different voiding subtypes. When we divided the patients by their voiding conditions of normal (n = 32) and hypersensitive bladder with (n = 76) and without (n = 103) voiding dysfunctions, only MBC (P = 0.002) and glomerulation (P = 0.021) demonstrated a significant difference. When we analyzed subgroups by GRA, patients with a GRA ≥ 2 had a significantly shorter disease duration. There also were significant associations between GRA and the changes in OSS and VAS (P < 0.001). Conclusions: Voiding dysfunctions in patients with non-Hunner IC/BPS do not affect long-term treatment outcome.

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

Canadian Urological Association Journal ◽

10.5489/cuaj.2036 ◽

2014 ◽

Vol 8 (9-10) ◽

pp. 610 ◽

Cited By ~ 15

Author(s):

Ömer Gülpınar ◽

Aytaç Kayış ◽

Evren Süer ◽

Mehmet İlker Gökçe ◽

Adil Güçal Güçlü ◽

...

Keyword(s):

Hyaluronic Acid ◽

Interstitial Cystitis ◽

Chondroitin Sulphate ◽

Sodium Hyaluronate ◽

Previous Treatment ◽

Pain Syndrome ◽

Bladder Pain Syndrome ◽

Symptom Index ◽

Bladder Pain ◽

Significant Difference

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.

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