International Urogynecology Journal

, Volume 22, Issue 4, pp 401–405 | Cite as

Long-term results of intravesical hyaluronan therapy in bladder pain syndrome/interstitial cystitis

  • Paul F. Engelhardt
  • Nike Morakis
  • Lukas K. Daha
  • Britta Esterbauer
  • Claus R. Riedl
Original Article


Introduction and hypothesis

While the short-term efficacy of intravesical hyaluronan for bladder pain syndrome/interstitial cystitis (BPS/IC) has been demonstrated, no data exist on the long-term outcome of this therapy.


Seventy BPS/IC patients treated with intravesical hyaluronan therapy from 2001 to 2003 were asked to rate their present status of bladder symptoms on a visual analog scale.


Forty-eight of 70 patients responded after a mean follow-up of 4.9 years. The average initial VAS score of 8.15 had been reduced to 2.71 after therapy and further to 2.14 5 years later. Fifty percent of patients (24/48) reported complete bladder symptom remission at 5 years follow-up without any additional therapy; 41.7% (20/48) with symptom recurrence was improved with hyaluronan maintenance therapy. No improvement was reported by four patients.


Besides a high rate of acute symptom remission, intravesical hyaluronan also shows long-term efficacy in a considerable number of BPS/IC patients.


Bladder pain syndrome GAG substitution Hyaluronan Hyaluronic acid Instillation therapy Interstitial cystitis 


Conflicts of interest

Claus R. Riedl is the principal investigator for controlled study on Hyaluronan in BPS/IC (CISTIC).


  1. 1.
    Toft BR, Nordling J (2006) Recent developments of intravesical therapy of painful bladder syndrome/interstitial cystitis: a review. Curr Opin Urol 16:268–272PubMedCrossRefGoogle Scholar
  2. 2.
    Morales A, Emerson L, Nickel JC, Lundie M (1996) Intravesical hyaluronic acid in the treatment of refractory interstitial cystitis. J Urol 156:45–48PubMedCrossRefGoogle Scholar
  3. 3.
    Fall M, Oberpenning F, Peeker R (2008) Treatment of bladder pain syndrome/interstitial cystitis 2008: can we make evidence-based decisions? Eur Urol 54:65–78PubMedCrossRefGoogle Scholar
  4. 4.
    Porru D, Campus G, Tudino D, Valdes E, Vespa A, Scarpa RM, Usai E (1997) Results of treatment of refractory interstitial cystitis with intravesical hyaluronic acid. Urol Int 59:26–29PubMedCrossRefGoogle Scholar
  5. 5.
    Bade JJ, Laseur M, Nieuwenburg A, van der Weele LT, Mensink HJ (1997) A placebo controlled study of intravesical pentosanpolysulfate for the treatment of interstitial cystitis. Br J Urol 79:168–171PubMedGoogle Scholar
  6. 6.
    Parsons CL, Housley T, Schmidt JD, Lebow D (1994) Treatment of interstitial cystitis with intravesical heparin. Br J Urol 73:504–507PubMedCrossRefGoogle Scholar
  7. 7.
    Steinhoff G, Ittah B, Rowan S (2002) The efficacy of chondroitin sulfate 0.2% in treating interstitial cystitis. Can J Urol 9:1454–1458PubMedGoogle Scholar
  8. 8.
    Nickel JC, Egerdie B, Downey J, Singh R, Skehan A, Carr L, Irvine-Bird K (2009) A real-life multicentre clinical practice study to evaluate the efficacy and safety of intravesical chondroitin sulphate for the treatment of interstitial cystitis. BJU Int 103(1):56–60PubMedCrossRefGoogle Scholar
  9. 9.
    Riedl CR, Engelhardt PF, Daha KL, Morakis N, Pflüger H (2008) Hyaluronan treatment of interstitial cystitis/painful bladder syndrome. Int Urogyneocol J Pelvic Floor Dysfunct 19(5):717–721CrossRefGoogle Scholar
  10. 10.
    Kallestrup EB, Steinunn S, Jørgense S, Nordling J, Hald T (2005) Treatment of interstitial cystitis with Cystistat®: a hyaluronic acid product. Scand J Urol Nephrol 39:143–147PubMedCrossRefGoogle Scholar
  11. 11.
    Daha LK, Riedl CR, Hohlbrugger G, Knoll M, Engelhardt PF, Pfluger H (2003) Comparative assessment of maximal bladder capacity, 0.9% NaCL versus 0.2M KCl, for the diagnosis of interstitial cystitis: a prospective controlled study. J Urol 170:807–809PubMedCrossRefGoogle Scholar
  12. 12.
    Hurst RE (1994) Structure, function, and pathology of proteoglycans and glycosaminoglycans in the urinary tract. World J Urol 12:3–10PubMedCrossRefGoogle Scholar
  13. 13.
    Leppilahti M, Hellström P, Tammela TLJ (2002) Effect of diagnostic hydrodistension and four intravesical Hyaluronan Instillations on bladder ICAM-1 intensity and association of ICAM-1 intensity with clinical response in patients with interstitial cystitis. Urology 60:46–51PubMedCrossRefGoogle Scholar
  14. 14.
    Schulz A, Vestweber AM, Dressler D (2009) Anti-inflammatory action of a hyaluronic acid-chondroitin sulphate preparation in an in vitro bladder model. Akt Urol 40(2):109–112CrossRefGoogle Scholar
  15. 15.
    Parsons CL, Forrest J, CJ CJ, the Elmiron Study Group (2002) Effect of pentosan polysulfate therapy on intravesical potassium sensitivity. Urology 59:329–334PubMedCrossRefGoogle Scholar
  16. 16.
    Gupta SK, Pidcock L, Parr NJ (2005) The potassium sensitivity test: a predictor of treatment response in interstitial cystitis. BJU Int 96:1063–1066PubMedCrossRefGoogle Scholar
  17. 17.
    Teichman JM, Nielsen-Omeis BJ (1999) Potassium leak test predicts outcome in interstitial cystitis. J Urol 161:1791–1796PubMedCrossRefGoogle Scholar
  18. 18.
    Daha L, Riedl CR, Lazar D, Simak R, Pflüger H (2008) Effect of intravesical glycosaminoglycan substitution therapy on bladder pain syndrome/interstitial cystitis, bladder capacity and potassium sensitivity. Scand J Urol 42(4):369–372CrossRefGoogle Scholar

Copyright information

© The International Urogynecological Association 2010

Authors and Affiliations

  • Paul F. Engelhardt
    • 1
  • Nike Morakis
    • 1
  • Lukas K. Daha
    • 2
  • Britta Esterbauer
    • 3
  • Claus R. Riedl
    • 1
  1. 1.Department of UrologyLandesklinikum Thermenregion BadenBadenAustria
  2. 2.Department of UrologyKrankenhaus HietzingViennaAustria
  3. 3.Urologic ClinicParacelsus University of MedicineSalzburgAustria

Personalised recommendations