Skip to main content

Impact of intravesical hyaluronic acid and chondroitin sulfate on bladder pain syndrome/interstitial cystitis

International Urogynecology Journal volume 23, pages 1193–1199 (2012)Cite this article

Abstract

Introduction and hypothesis

Intravesical instillations of hyaluronic acid (HA) and chondroitin sulfate (CS) may lead to regeneration of the damaged glycosaminoglycan layer in interstitial cystitis/bladder pain syndrome (IC/BPS).

Methods

Twenty-two patients with IC/BPS received intravesical instillations (40 ml) of sodium HA 1.6% and CS 2.0% in 0.9% saline solution (IALURIL®, IBSA) once weekly for 8 weeks, then once every 2 weeks for the next 6 months.

Results

The score for urgency was reduced from 6.5 to 3.6 (p = 0.0001), with a reduction in pain scores from an average of 5.6 to 3.2 (p = 0.0001). The average urine volume increased from 129.7 to 162 ml (p < 0.0001), with a reduction in the number of voids in 24 h, from 14 to 11.6 (p < 0.0001). The IC Symptom and Problem Index decreased from 25.7 to 20.3 (p < 0.0001), and the Pain Urgency Frequency score, from 18.7 to 12.8 (p < 0.0001).

Conclusion

The treatment appeared to be effective and well tolerated in IC/BPS in this initial experience.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

USD 39.95

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

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

References

  1. Hanno P (2002) Interstitial cystitis and related disorders. In: Walsh P (ed) Campbell's urology, 8th edn. Elsevier, Philadelphia, p 631

    Google Scholar 

  2. Hanno P, Nordling J, van Ophoven O (2008) What is new in bladder pain syndrome/interstitial cystitis? Curr Opin Urol 18:353

    Article  PubMed  Google Scholar 

  3. Abrams PH, Cardozo L, Fall M et al (2002) The standardisation of terminology of lower urinary tract function: report from the standardisation sub-committee of the International Continence Society. Neurourol Urodyn 21:167–178

    Article  PubMed  Google Scholar 

  4. Parsons CL, Parsons JK (1996) Interstitial cystitis. In: Raz S (ed) Female urology, 2nd edn. Saunders, Philadelphia, Chapter 15

    Google Scholar 

  5. Parsons CL (2003) Prostatitis, interstitial cystitis, chronic pelvic pain, and urethral syndrome share a common pathophysiology: lower urinary dysfunctional epithelium and potassium recycling. Urology 62(6):976–982

    Article  PubMed  Google Scholar 

  6. Boucher WS et al (2002) Intravesical sodium hyaluronate inhibits the rat urinary mast cell mediator increase triggered by acute immobilization stress. J Urol 167:380–384

    Article  PubMed  CAS  Google Scholar 

  7. Iavazzo C et al (2007) Hyaluronic acid: an effective alternative treatment of interstitial cystitis, recurrent urinary tract infections and hemorrhagic cystitis. Eur Urol 51(6):1534–1541

    Article  PubMed  CAS  Google Scholar 

  8. Morales A et al (1996) Intravesical hyaluronic acid in the treatment of refractory interstitial cystitis. J Urol 156:45–48

    Article  PubMed  CAS  Google Scholar 

  9. Nordling J et al (2001) Cystistat for the treatment of interstitial cystitis: a 3-year follow-up study. Urology 57(6 Suppl 1):123

    Article  PubMed  CAS  Google Scholar 

  10. Porru D et al (1997) Results of treatment of refractory interstitial cystitis with intravesical hyaluronic acid. Urol Int 59:26–29

    Article  PubMed  CAS  Google Scholar 

  11. Palylyk-Colwell E (2005) Chondroitin sulphate for interstitial cystitis. Issues Emerg Health Technol 86:1–4

    Google Scholar 

  12. Sant GR (2002) Etiology, pathogenesis and diagnosis of interstitial cystitis. Rev Urol 4:S9–S15

    PubMed  Google Scholar 

  13. Daha LK, Riedl CR, Lazar D, Hohlbrugger G, Pflüger H (2005) Do cystometric findings predict the results of intravesical hyaluronic acid in women with interstitial cystitis? Eur Urol 47(3):393–397

    Article  PubMed  Google Scholar 

  14. Hanno P (1997) Interstitial cystitis and related diseases. In: Walsh PC, Retik AB, Vaughan ED Jr, Wein AJ (eds) Campbell's urology, 7th edn. WB Saunders, Philadelphia, pp 631–662, Vol. 1, Sect. IV, Chapt 17

    Google Scholar 

  15. Balasz EA, Denlinger JL (1988) The role of hyaluronic acid in arthritis and its therapeutic use. In: Peyron JG (ed) Osteoarthritis: current clinical and fundamental problems. Geigy, Basel, pp 165–174

    Google Scholar 

  16. Oberpenning F et al (2002) Interstitial cystitis: an update. Curr Opin Urol 12(4):321–332

    Article  PubMed  Google Scholar 

  17. 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 

  18. 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 330:163–73

    Article  PubMed  CAS  Google Scholar 

  19. Leppilahti M, Hellström 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 60:46–51

    Article  PubMed  Google Scholar 

  20. Keay SK, Szekely Z, Conrads TP, Veenstra TD, Barchi J Jr, Zhang CO, Koch KR, Michejda CJ (2004) An antiproliferative factor from interstitial cystitis patients is a frizzled 8 protein-related sialoglycopeptide. PNAS 101:11803–11808

    Article  PubMed  CAS  Google Scholar 

  21. Keay SK, Zhang CO, Shoenfelt J, Erickson DR, Whitmore K, Warren JW, Marvel R, Chai T (2001) Sensitivity and specificity of antiproliferative factor, heparin-binding epidermal growth factor-like growth factor, and epidermal growth factor as urine markers for interstitial cystitis. Urology 57(6 Suppl 1):9–14

    Article  PubMed  CAS  Google Scholar 

  22. Rajasekaran M, Stein P, Parsons CL (2006) Toxic factors in human urine that injure urothelium. Int J Urol 13:409

    Article  PubMed  CAS  Google Scholar 

  23. Sun Y, Chen M, Lowentritt BH et al (2007) EGF and HB-EGF modulate inward potassium current in human bladder urothelial cells from normal and interstitial cystitis patients. Am J Physiol Cell Physiol 292:C106

    Article  PubMed  CAS  Google Scholar 

  24. Morrison S, Shah NM, Anderson DJ (1997) Regulatory mechanisms in stem cell biology. Cell 88:287

    Article  PubMed  CAS  Google Scholar 

  25. Elgavish A (2009) Epigenetic reprogramming: a possible etiological factor in bladder pain syndrome/interstitial cystitis? J Urol 181:980–984

    Article  PubMed  Google Scholar 

  26. Porru D, Cervigni M, Nasta L, Natale F, Lo Voi R, Tinelli C, Gardella B, Anghileri A, Spinillo A, Rovereto B (2008) Results of endovesical hyaluronic acid/chondroitin sulfate in the treatment of interstitial cystitis/painful bladder syndrome. Rev Recent Clin Trials 3:126–129

    Article  PubMed  CAS  Google Scholar 

  27. Cervigni M, Natale F, Nasta L, Padoa A, Lo Voi R, Porru D (2008) A combined intravesical therapy with hyaluronic acid and chondroitin for refractory painful bladder syndrome/interstitial cystitis. Int Urogynecol J Pelvic Floor Dysfunct 19(7):943–947

    Article  PubMed  CAS  Google Scholar 

  28. Dell JR, Butrick CW (2006) Multimodal therapy for painful bladder syndrome/interstitial cystitis. J Reprod Med 51(3 Suppl):253–260, Review

    PubMed  Google Scholar 

  29. Alagiri M, Chottiner S, Ratner V, Slade D, Hanno PM (1997) Interstitial cystitis: unexplained associations with other chronic disease and pain syndromes. Urology 49:52

    Article  PubMed  CAS  Google Scholar 

  30. Whitmore K, Siegel JF, Kellogg-Spadt S (2007) Interstitial cystitis/painful bladder syndrome as a cause of sexual pain in women: a diagnosis to consider. J Sex Med 4(3):720–727

    Article  PubMed  Google Scholar 

Download references

Conflicts of interest

None.

Financial disclosures

None.

Author information

Authors and Affiliations

  1. Urology Department, IRCCS Policlinico San Matteo, Pavia, Italy

    Daniele Porru, Fabio Leva, Alberto Parmigiani, Davide Barletta, Dimitrios Choussos & Bruno Rovereto

  2. Obstetric and Gynecology Clinics, IRCCS Policlinico San Matteo, Pavia, Italy

    Barbara Gardella, Maria Diletta Daccò & Arsenio Spinillo

  3. UO di Medicina Interna and Endocrinologia, IRCCS Fondazione S. Maugeri, Pavia, Italy

    Rossella Elena Nappi

  4. Pain Clinic Section, IRCCS Policlinico San Matteo, Pavia, Italy

    Massimo Allegri

  5. Service of Biometry and Clinical Epidemiology, Scientific Direction–IRCCS Policlinico San Matteo, Pavia, Italy

    Carmine Tinelli

  6. School of Specialization in Urology, University of Pavia, Pavia, Italy

    Carlo Maria Bianchi

  7. Divisione Urologia, Fondazione IRCCS Policlinico San Matteo, Viale Golgi 19, Pavia, 27100, Italy

    Daniele Porru

Authors
  1. Daniele Porru
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Fabio Leva
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Alberto Parmigiani
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Davide Barletta
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Dimitrios Choussos
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Barbara Gardella
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Maria Diletta Daccò
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Rossella Elena Nappi
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Massimo Allegri
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Carmine Tinelli
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Carlo Maria Bianchi
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Arsenio Spinillo
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Bruno Rovereto
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Daniele Porru.

Electronic supplementary material

Below is the link to the electronic supplementary material.

ESM 1

(Doc 56 kb)

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Porru, D., Leva, F., Parmigiani, A. et al. Impact of intravesical hyaluronic acid and chondroitin sulfate on bladder pain syndrome/interstitial cystitis. Int Urogynecol J 23, 1193–1199 (2012). https://doi.org/10.1007/s00192-011-1546-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00192-011-1546-5

Keywords

  • Chondroitin
  • Bladder pain syndrome
  • Interstitial cystitis
  • Hyaluronic acid