Improvements in patients’ quality of life following treatment with intravesical hyaluronic acid (Cystistat 40 mg) for bladder pain syndrome and recurrent UTIs

Introduction: Intravesical hyaluronic acid (Cystistat) is indicated for a variety of chronic cystitis conditions including bladder pain syndrome, recurrent bacterial urinary tract infections and radiation or chemical cystitis. Previously published studies have predominantly assessed the outcome in terms of bladder symptoms (frequency/urgency/nocturia/pain) or in the case of recurrent bacterial urinary tract infection, by microbiological response. The aim of this study was to assess improvement in patients’ quality of life following treatment with intravesical Cystistat. Materials and methods: Patients’ referred for treatment with intravesical Cystistat for either bladder pain syndrome or recurrent bacterial urinary tract infection completed the King’s health questionnaire. Patients were treated with a 6-week course of Cystistat by one of two specialist urology nurses. If treatment was effective further instillations were given every 2–4 weeks for up to 6 months. King’s health questionnaire scores were repeated after 6 weeks and 6 months and were analysed. Results: Twenty patients (18 women, 2 men) were included: 8 bladder pain syndrome, 12 recurrent bacterial urinary tract infections. There were four treatment failures within 6 weeks, of whom three were being treated for recurrent bacterial urinary tract infections. Of the 16 patients who continued with treatment beyond 6 weeks, 12 have 6-month scores available. The average initial King’s health questionnaire score was 500.8 (534.1 for the recurrent bacterial urinary tract infection group, 450.8 for the bladder pain syndrome group). After six treatments average King’s health questionnaire scores improved to 426.3 (457.7 for recurrent bacterial urinary tract infections, 372.4 for bladder pain syndrome). After 6 months, average scores significantly improved to 278 overall (303.2 ( P<0.05) for the recurrent bacterial urinary tract infections group, 252.8 ( P>0.05) for the bladder pain syndrome group). Conclusion: Intravesical Cystistat should be considered in all patients with bladder pain syndrome and recurrent bacterial urinary tract infections. We have shown a significant, clinically important, improvement in patients’ quality of life in refractory bladder pain syndrome and recurrent bacterial urinary tract infections. In future Cystistat could be considered as an alternative to long-term low-dose antibiotic prophylaxis. Level of evidence: 4