Skip to main content

Advertisement

SpringerLink
Log in

Hyaluronan treatment of interstitial cystitis/painful bladder syndrome

  • Original Article
  • Published:
International Urogynecology Journal Aims and scope Submit manuscript

Abstract

The aim of this study is to evaluate the efficacy of intravesical hyaluronan therapy in interstitial cystitis/painful bladder syndrome (IC/PBS). One hundred twenty-six patients with IC/PBS and an average disease duration of 6.1 years were treated with weekly instillations of a 50-cm3 phosphate-buffered saline solution containing 40 mg sodium hyaluronate. To be eligible for hyaluronan treatment, a positive modified potassium test was requested as a sign of a urine–tissue barrier disorder. Data were obtained by a visual analogue scale (VAS) questionnaire rating from 0 to 10 that asked for global bladder symptoms before and after therapy. Additional questions evaluated the therapeutic impact on quality of life. A positive and durable impact of hyaluronan therapy on IC/PBS symptoms was observed—103 (85%) of the patients reported symptom improvement (≥2 VAS units). The mean initial VAS score of 8.5 decreased to 3.5 after therapy (p < 0.0001). Out of 121 patients, 67 (55%) remained with no or minimal bladder symptoms after therapy (VAS 0–2). The majority (101, 84%) reported significant improvement of their quality of life. Intravesical therapy had to be initiated again with good success in 43 patients (34.5%) as symptoms recurred after discontinuation of treatment, while the rest stayed free of symptoms for up to 5 years. In general, hyaluronan therapy was well tolerated and, with the exception of mild irritative symptoms, no adverse reactions were reported for a total of 1,521 instillations. Timely hyaluronan instillation therapy may lead to complete symptom remission or even cure in part of the IC/PBS patients, while some responders need continuous intravesical therapy. The present results suggest that selection of patients for hyaluronan therapy by potassium testing improves the outcome of intravesical therapy with a response rate of >80%.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Van de Merwe JP, Nordling J (2006) Interstitial cystitis: definitions and confusable diseases. ESSIC meeting 2005, Baden. Eur Urol Today 18:6, 7, 16, 17

    Google Scholar 

  2. Karsenty G, AlTaweel W, Hajebrahimi S, Corcos J (2006) Efficacy of interstitial cystitis treatments: a review. EAU-EBU Update Series 4:47–61

    Article  Google Scholar 

  3. Parsons CL, Lilly JD, Stein P (1991) Epithelial dysfunction in nonbacterial cystitis (interstitial cystitis). J Urol 145:732–735

    PubMed  CAS  Google Scholar 

  4. Hohlbrugger G (1996) Leaky urothelium and/or vesical ischemia enable urinary potassium to cause idiopathic urgency/frequency syndrome and urge incontinence. Int Urogynecol J Pelvic Floor Dysfunction 7:242–255

    Article  CAS  Google Scholar 

  5. Hurst RE, Zebrowski R (1994) Identification of proteoglycans present at high density on bovine and human bladder luminal surface. J Urol 152:1641–1644

    PubMed  CAS  Google Scholar 

  6. Hurst RE (1994) Structure, function, and pathology of proteoglycans and glycosaminoglycans in the urinary tract. World J Urol 12:3–10

    Article  PubMed  CAS  Google Scholar 

  7. Russell AL (1999) Glycosaminoglycan (GAG) deficiency in protective barrier as an underlying, primary cause of ulcerative colitis, Crohn’s disease, interstitial cystitis and possibly Reiter’s syndrome. Med hypotheses 52:297–301

    Article  PubMed  CAS  Google Scholar 

  8. Toft BR, Nordling J (2006) Recent developments of intravesical therapy of painful bladder syndrome/interstitial cystitis: a review. Curr Opin Urol 16:268–272

    Article  PubMed  Google Scholar 

  9. Morales A, Emerson L, Nickel JC, Lundie M (1996) Intravesical hyaluronic acid in the treatment of refractory interstitial cystitis. J Urol 156:45–48

    Article  PubMed  CAS  Google Scholar 

  10. Hwang P, Auclair B, Beechinor D, Diment M, Einarson TR (1997) Efficacy of pentosan polysulfate in the treatment of interstitial cystitis: a meta-analysis. Urology 50:39–43

    Article  PubMed  CAS  Google Scholar 

  11. Parsons CL, Housley T, Schmidt JD, Lebow D (1994) Treatment of interstitial cystitis with intravesical heparin. Br J Urol 73:504–507

    Article  PubMed  CAS  Google Scholar 

  12. Steinhoff G, Ittah B, Rowan S (2002) The efficacy of chondroitin sulfate 0.2% in treating interstitial cystitis. Can J Urol 9:1454–1458

    PubMed  CAS  Google Scholar 

  13. Palylyk-Colwell E (2006) Chondroitin sulfate for interstitial cystitis. Issues Emerg Health Technol 84:1–4

    PubMed  Google Scholar 

  14. 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 59:26–29

    Article  PubMed  CAS  Google Scholar 

  15. 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 39:143–147

    Article  PubMed  CAS  Google Scholar 

  16. Constantinides C, Manousakas T, Nikolopoulos P, Stanitsas A, Haritopoulos K, Giannopoulos A (2004) Prevention of recurrent bacterial cystitis by intravesical administration of hyaluronic acid: a pilot study. BJU Intern 93:1262–1266

    Article  CAS  Google Scholar 

  17. Manas A, Glaria L, Pena C, Sotoca A, Lanzos E, Fernandez C, Riviere M (2006) Prevention of urinary tract infection in palliative radiation for vertebral metastasis and spinal compression: a pilot study in 71 patients. Int J Radiation Oncology Biol Phys 64:935–940

    Google Scholar 

  18. 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 170:807–809

    Article  PubMed  Google Scholar 

  19. Gupta SK, Pidcock L, Parr NJ (2005) The potassium sensitivity test: a predictor of treatment response in interstitial cystitis. BJU Intern 96:1063–1066

    Article  CAS  Google Scholar 

  20. Teichman JM, Nielsen-Omeis BJ (1999) Potassium leak test predicts outcome in interstitial cystitis. J Urol 161:1791–1796

    Article  PubMed  CAS  Google Scholar 

  21. Daha L, Riedl CR, Lazar D, Hohlbrugger G, Pfl, ger H (2005) Comparative assessment of maximal bladder capacity 0.9% vs. 0.2 M KCl, before and after therapy for interstitial cystitis. Eur Urol 136(Suppl4):534A

    Google Scholar 

  22. Parsons CL, Forrest J, Nickel CJ, Elmiron Study Group (2002) Effect of pentosan polysulfate therapy on intravesical potassium sensitivity. Urology 59:329–334

    Article  PubMed  Google Scholar 

  23. Buckley MS, Washington S, Laurent C, Erickson DE, Bhavanandan VP (1996) Characterization and immunohistochemical localization of the glycoconjugates of the rabbit bladder mucosa. Arch Biochem Biophys 330:163–173

    Article  PubMed  CAS  Google Scholar 

  24. 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 60:46–51

    Article  PubMed  Google Scholar 

  25. Sun Y, Keay S, De Deyne PG, Chai TC (2001) Augmented stretch activated adenosine triphosphate release from bladder uroepithelial cells in patients with interstitial cystitis. J Urol 166:1951–1954

    Article  PubMed  CAS  Google Scholar 

  26. Sadhukan PS, Tchetgen MB, Rackley RR, Vasavada SP, Liou L, Bandyopadhyay SK (2002) Sodium pentosan polysulfate reduces urothelial responses to inflammatory stimuli via an indirect mechanism. J Urol 168:289–292

    Article  Google Scholar 

  27. Sant GR, Propert KJ, Hanno PM, Interstitial Cystitis Clinical Trials Group (2003) A pilot clinical trial of oral pentosan polysulfate and oral hydroxyzine in patients with interstitial cystitis. J Urol 170:810–813

    Article  PubMed  CAS  Google Scholar 

  28. Bade JJ, Laseur M, Nieuwenburg A, van der Weele LT, Mensink HJ (1997) A placebo controlled study of intravesical pentosan polysulfate for the treatment of interstitial cystitis. Br J Urol 79:168–171

    PubMed  CAS  Google Scholar 

Download references

Conflicts of interest

None.

Author information

Authors and Affiliations

  1. Department of Urology, Landesklinikum Thermenregion, Wimmergasse 19, 2500, Baden, Austria

    Claus R. Riedl, Paul F. Engelhardt & Nike Morakis

  2. Department of Urology and Ludwig Boltzmann Institute for Andrology and Urology, Vienna, Austria

    Kurosch L. Daha & Heinz Pflüger

Authors
  1. Claus R. Riedl
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Paul F. Engelhardt
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Kurosch L. Daha
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Nike Morakis
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Heinz Pflüger
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Claus R. Riedl.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Riedl, C.R., Engelhardt, P.F., Daha, K.L. et al. Hyaluronan treatment of interstitial cystitis/painful bladder syndrome. Int Urogynecol J 19, 717–721 (2008). https://doi.org/10.1007/s00192-007-0515-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00192-007-0515-5

Keywords

Search

Navigation