Skip to main content

Advertisement

Log in

A combined intravesical therapy with hyaluronic acid and chondroitin for refractory painful bladder syndrome/interstitial cystitis

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

Abstract

The aims of this study were to evaluate the efficacy and tolerability of intravesical instillations of high-molecular-weight hyaluronic acid (HA) 1.6% and chondroitin sulfate (CS) 2.0% in patients with refractory painful bladder syndrome/interstitial cystitis (PBS/IC) and to observe their impact on Quality of Life. Twenty-three women were enrolled. They received bladder instillations with HA and CS weekly for 20 weeks and then monthly for 3 months. Mean follow-up after completion of therapy was 5 months. We observed a significant improvement in urinary symptoms on voiding diaries and Visual Analogue Scale for frequency (p = 0.045), urgency (p = 0.005), and pain (p = 0.001). The O’Leary–Sant Interstitial Cystitis Symptom Index and Interstitial Cystitis Problem Index resulted in a significant improvement in both scores (p = 0.004 and 0.01, respectively). The Pelvic Pain and Urgency/Frequency Symptom Scale only showed significant improvement in the symptom score (p = 0.001). This promising experience seems to offer an additional therapeutic option in patients with refractory PBS/IC.

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

Access this article

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. Tait J (1994) Urethral syndrome (a bacterial cystitis) search for a pathogen. Br J Urol 57:552–556

    Google Scholar 

  2. Ochs RL et al (1994) Autoantibodies in interstitial cystitis. J Urol 151:587–592

    PubMed  CAS  Google Scholar 

  3. Pang X (1995) Increased number of substance P positive nerve fibres in interstitial cystitis. Br J Urol 75:744–750

    PubMed  CAS  Google Scholar 

  4. McGillis JP (1990) Immunomudulation by tachykinin neuropeptides. Ann N Y Acad Sci 594:85–94

    Article  PubMed  CAS  Google Scholar 

  5. Rosamilia A (1999) Activation of the kallikrein kinin system in interstitial cystitis. J Urol 162:129–134

    Article  PubMed  CAS  Google Scholar 

  6. McMahon SB (1996) NGF as a mediator of inflammatory pain. Philos Trans R Soc Lond B Biol Sci 351:431–440

    Article  PubMed  CAS  Google Scholar 

  7. Niku SD (1994) A new method for cytodestruction of bladder epithelium using protamine sulphate and urea. J Urol 152:1025–1028

    PubMed  CAS  Google Scholar 

  8. Wesselmann U (1997) Mechanism of referred visceral pain: uterine inflammation in the adult virgin rat results in neurogenic plasma extravasation in the skin. Pain 73:309–317

    Article  PubMed  CAS  Google Scholar 

  9. Theodarides TC, Sant GR (2005) A pilot label study of Cystoprotek in interstitial cystitis. Int J Immunopathol Pharmacol 18(1):183–188

    Google Scholar 

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

    Article  PubMed  CAS  Google Scholar 

  11. 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(1):26–29

    Article  PubMed  CAS  Google Scholar 

  12. Kallenstrup EB, Joregensen S, Nordling J, Hald T (2005) Treatment of interstitial cystitis with Cystistat®: a hyaluronic acid product. Scand J Urol Nephrol 39:143–147

    Article  CAS  Google Scholar 

  13. Gillenwater JY, Wein AJ (1988) Summary of the National Institute of Arthritis, Diabetes, Digestive and Kidney Diseases Workshop on Interstitial Cystitis, National Institutes of Health, Bethesda, Maryland, August 28–29, 1987. J Urol 140(1):203–206

    PubMed  CAS  Google Scholar 

  14. Lewi H (1995) Cimetidine in the treatment of interstitial cystitis. Urology 45(6):1088

    Article  PubMed  CAS  Google Scholar 

  15. Lubeck DP, Witmore K, Sant GR, Alvares-Horine S, Lai C (2001) Psycometric validation of the O’Leary–Sant interstitial cystitis symptom index in a clinical trial of pentosan polysulfate sodium. Urology 57:62–66

    Article  PubMed  CAS  Google Scholar 

  16. Ito T, Tomoe H, Ueda T, Yoshimura N, Sant G, Hanno P (2003) Clinical symptoms scale for interstitial cystitis for diagnosis and for following the course of the disease. Int J Urol 10:S24

    Article  PubMed  Google Scholar 

  17. Evans RJ, Sant GR (2007) Current diagnosis of interstitial cystitis an evolving paradigm. Urology 69(Suppl 4):64–72

    Article  PubMed  Google Scholar 

  18. Toft BR, Nordling J (2006) Recent developments of intravesical therapy of painful bladder sindrome/interstitial cystitis: a review. Curr Opin Urol 16(4):268–272

    Article  PubMed  Google Scholar 

  19. Kho HC (2005) Preliminary results of suburothelial injection of botulinum a toxin in the treatment of chronic interstitial cystitis. Urol Int 75(2):170–174

    Article  CAS  Google Scholar 

  20. Parsons CL, Housely T, Schmidt JD et al (1994) Treatment of interstitial cystitis with intravesical heparin. Br J Urol 73:504–7

    Article  PubMed  CAS  Google Scholar 

  21. Parsons CL (2005) Successful downregulation of bladder sensory nerves with combination of heparin and alkalinized lidocaine in patients with interstitial cystitis. Urology 65(1):45–48

    Article  PubMed  Google Scholar 

  22. Leppilahti M, Hellstrom P, Tammela TL (2002) Effect of diagnostic hydrodistension and four intravesical hyaluronic acid instillations on bladder ICAM-1 intensity and association of ICAM-1 intensity with clinical response in patients with interstitial cystitis. Urology 60(1):46–51

    Article  PubMed  Google Scholar 

  23. Daha LK, Riedl CR, Lazar D, Hohlbrugger G, Pfluger H (2005) Do cystometric findings predict the results of intravesical hyaluronic acid in women with interstitial cystitis? Eur Urol 47:393–397

    Article  PubMed  Google Scholar 

  24. Ahmad I, Sarath Krishna N, Meddings RM (2008) Sequential hydrodistension and intravesical instillation of hyaluronic acid under general anaesthesia for treatment of refractory interstitial cystitis: a pilot study. Int Urogynecol J Pelvic Floor Dysfunct Sep 14 (in press)

Download references

Conflicts of interest

None.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to F. Natale.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Cervigni, M., Natale, F., Nasta, L. et al. A combined intravesical therapy with hyaluronic acid and chondroitin for refractory painful bladder syndrome/interstitial cystitis. Int Urogynecol J 19, 943–947 (2008). https://doi.org/10.1007/s00192-008-0572-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00192-008-0572-4

Keywords

Navigation