International Urogynecology Journal

, Volume 19, Issue 4, pp 543–546 | Cite as

Sequential hydrodistension and intravesical instillation of hyaluronic acid under general anaesthesia for treatment of refractory interstitial cystitis: a pilot study

  • Imran Ahmad
  • Nalagatla Sarath Krishna
  • Robert N. Meddings
Original Article


Pilot study looking at the combination of general anaesthetic hydrodistension and intravesical hyaluronic acid for treatment of refractory interstitial cystitis. Twenty-three treatment refractory patients were recruited with an average age 53.4 years. All underwent general anaesthetic cystoscopy, hydrodistension and instillation of hyaluronic acid (40 mg/50 ml). The bladder was then subsequently drained with the patient awake. Two initial treatments were carried out a month apart and duration between treatments increased depending upon symptom response. In the responders, the average number of treatments was 6.6 (median 4.5), duration between treatments was 3.1 months (median 2.6) and follow-up 15.8 months (median 16). Seventeen patients (74%) responded with immediate improvement in symptoms. In all responders, healing of ulceration and resolution of inflammation occurred. Average anaesthetic bladder capacity increased in the responder group from an average of 492 ml (median 500 ml) to an average of 776 ml (median 700 ml). Our pilot data suggests sequential hydrodistension and hyaluronic acid treatment under general anaesthesia may be considered for resistant cases of interstitial cystitis, especially those that cannot tolerate the instillation procedure under local anaesthesia. Further prospective trials are required.


Interstital cystitis Hyaluronic acid Hydrodistension 


  1. 1.
    Parsons CL (1994) The therapeutic role of sulphated polysaccharides in the urinary bladder. Urol Clin North Am 21:93–100PubMedGoogle Scholar
  2. 2.
    Sant GR, Ucci A Jr, Alroy J (1986) Bladder surface glycosaminoglycans (GAGs) in interstitial cystitis. J Urol 135:175A, abstract 287Google Scholar
  3. 3.
    Ratliff TL, Klutke CG, McDougall EM (1994) The etiology of interstitial cystitis. Urol Clin North Am 21:21PubMedGoogle Scholar
  4. 4.
    Morales A, Emerson L, Nickel JC, Ludie M (1996) Intravesical hyaluronic acid in the treatment of refractory interstitial cystitis. J Urol 156:45–48PubMedCrossRefGoogle Scholar
  5. 5.
    O’Leary MP, Sant GR, Fowler FJ Jr, Whitmore KE, Spolarich-Kroll J (1997) The interstitial cystitis symptom index and problem index. Urology 49(S 5A):58–63PubMedCrossRefGoogle Scholar
  6. 6.
    Monson FC, Wein AJ, McKenna BA, Whitmore K, Levin RM (1991) Indigocarmine as a quantitative indicator of urothelial integrity. J Urol 145:842–845PubMedGoogle Scholar
  7. 7.
    Johansson SL, Fall M (1990) Clinical features and spectrum of light microscopic changes in interstitial cystitis. J Urol 143:1118–1124PubMedGoogle Scholar
  8. 8.
    Sato H, Takahashi T, Ide H, Fukushima T, Tabata M, Sekine F, Kobayashi K, Negishi M, Niwa Y (1988) Antioxidant activity of synovial fluid, hyaluronic acid and two sub-components of hyaluronic acid. Synovial fluid scavenging effect is enhanced in rheumatoid arthritis patients. Arth Rheum 31:63CrossRefGoogle Scholar
  9. 9.
    Balasz EA, Denlinger JL (1984) The role of hyaluronic acid in arthritis and its therapeutic use. In: Peyron JG (eds) Osteoarthritis: current clinical and fundamental problems. Geigy, Basel pp 165, 174Google Scholar
  10. 10.
    Goldberg RL, Toole BP (1987) Hyaluronate inhibition of cell proliferation. Arth Rheum 30:769CrossRefGoogle Scholar
  11. 11.
    Abatangelo G, Martelli M, Vecchia P (1983) Healing of hyaluronic acid-enriched wounds: histological observations. J Surg Res 35:410PubMedCrossRefGoogle Scholar
  12. 12.
    Hadler NM, Napier MA (1997) Structure of hyaluronic acid in synovial fluid and its influence on the movement of solutes. Sem Arth Rheum 7:141CrossRefGoogle Scholar
  13. 13.
    Houpt JB, Aviad A (1990) Osteoarthritis of the knee: effect of intra-articular sodium hyaluronate. Clin Exp Rheumatol 4:80Google Scholar
  14. 14.
    Lokeshwar VB, Selzer MG, Unwala DJ, Estrella V, Gomez M-FL, Golshani R, Kester RR, Klumpp DJ, Gousse AE (2006) Uronate peaks and urinary hyaluronic acid levels correlate with interstitial cystitis severity. J Urol 176:1001–1007PubMedCrossRefGoogle Scholar

Copyright information

© International Urogynecology Journal 2007

Authors and Affiliations

  • Imran Ahmad
    • 1
  • Nalagatla Sarath Krishna
    • 1
  • Robert N. Meddings
    • 2
  1. 1.Department of UrologySouthern General HospitalGlasgowUK
  2. 2.Department of UrologyAyr HospitalAyrUK

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