Skip to main content

Advertisement

Log in

Intravesical hyaluronic acid and chondroitin sulphate for bladder pain syndrome/interstitial cystitis: long-term treatment results

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

Abstract

Introduction and hypothesis

Reconstruction of the glycosaminoglycan layer plays a role in the successful treatment of bladder pain syndrome/interstitial cystitis (BPS/IC). Intravesical instillations of hyaluronic acid (HA) and chondroitin sulphate (CS) have given results in the short term. We hypothesise that these benefits continue in the longer term.

Methods

With the aim of evaluating this therapy over a longer period we treated 12 BPS/IC patients refractory to other treatments with a combination of HA 1.6 % and CS 2.0 % over a period of 3 years assessing symptoms and quality of life using a visual analogue scale, 3-day voiding diaries and validated questionnaires.

Results

Improvements in bladder function were sustained for 3 years (mean number of daily voids decreased from 17.8 at baseline to 15.5 at 9 months and 11.9 at 3 years, and mean volume per void from 136.8 ml at baseline to 143.9 ml at 9 months and 180.9 ml at 3 years). Quality of life assessments confirmed these improvements.

Conclusions

Intravesical instillations of HA and CS produced a sustained improvement of the symptomatology, up to 3 years, in patients with BPS/IC refractory to previous treatments. Further confirmation would be expected from larger controlled trials.

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.

Similar content being viewed by others

References

  1. Chancellor MB, Yoshimura N (2004) Treatment of interstitial cystitis. Urology 63(3 Suppl 1):85–92

    Article  PubMed  Google Scholar 

  2. Phatak S, Foster HE Jr (2006) The management of interstitial cystitis: an update. Nat Clin Pract Urol 3(1):45–53

    Article  PubMed  Google Scholar 

  3. van de Merwe JP, Nordling J, Bouchelouche P, Bouchelouche K, Cervigni M et al (2008) Diagnostic criteria, classification, and nomenclature for painful bladder syndrome/interstitial cystitis: an ESSIC proposal. Eur Urol 53(1):60–67

    Article  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  5. Iavazzo C, Athanasiou S, Pitsouni E, Falagas ME (2007) Hyaluronic acid: an effective alternative treatment of interstitial cystitis, recurrent urinary tract infections, and hemorrhagic cystitis? Eur Urol 51(6):1534–1540

    Article  PubMed  CAS  Google Scholar 

  6. Patel BN, Evans RJ (2010) Overactive bladder and pain: management strategies. Curr Urol Rep 11(6):379–384

    Article  PubMed  Google Scholar 

  7. Cervigni M, Natale F, Nasta L, Padoa A, Voi RL, 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 19:943–947

    Article  PubMed  CAS  Google Scholar 

  8. 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 

  9. Lubeck DP, Whitmore K, Sant GR, Alvarez-Horine S, Lai C (2001) Psychometric 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 

  10. Brewen ME, White WM, Klein FA, Klein LM, Waters WB (2007) Validity of Pelvic Pain, Urgency, and Frequency questionnaire in patients with interstitial cystitis/painful bladder syndrome. Urology 70(4):646–649

    Article  Google Scholar 

  11. Riedl CR, Engelhardt PF, Daha KL et al (2008) Hyaluronan treatment of interstitial cystitis/painful bladder syndrome. Int Urogynecol J Pelvic Floor Dysfunct 19(5):717–721

    Article  PubMed  Google Scholar 

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

    Article  Google Scholar 

  13. Engelhardt PF, Morakis N, Daha LK, Esterbauer B, Riedl CR (2011) Long-term results of intravesical hyaluronan therapy in bladder pain syndrome/interstitial cystitis. Int Urogynecol J 22(4):401–405

    Article  PubMed  Google Scholar 

  14. Parsons CL, Housely T, Schmidt JD et al (1994) Treatment of interstitial cystitis with intravesical heparin. Br J Urol 73:504–507

    Article  PubMed  CAS  Google Scholar 

  15. Davis EL, El Khoudary SR, Talbott EO et al (2008) Safety and efficacy of the use of intravesical and oral pentosan polysulfate sodium for interstitial cystitis: a randomized double-blind clinical trial. J Urol 179(1):177–185

    Article  PubMed  CAS  Google Scholar 

  16. Daha LK, Riedl CR, Lazar D et al (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 

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

    Article  PubMed  CAS  Google Scholar 

  18. Kallestrup EB, Jorgensen SS, Nordling J et al (2005) Treatment of interstitial cystitis with Cystistat: a hyaluronic acid product. Scand J Urol Nephrol 39:143–147

    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. Porru D, Campus G, Tudino 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 

  21. Morales A, Emerson L, Nickel JC (1996) Treatment of refractory interstitial cystitis. Int Urogynecol J Pelvic Floor Dysfunct 7:215–220

    Article  PubMed  CAS  Google Scholar 

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

    PubMed  Google Scholar 

  23. Steinhoff G (2003) The efficacy of chondroitin sulphate in treating interstitial cystitis. Eur Urol Suppl 2:14–16

    Article  CAS  Google Scholar 

  24. Nickel JC, Egerdie B, Downey J et al (2008) 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):56–60

    Article  PubMed  Google Scholar 

  25. Porru D, Cervigni M, Nasta L et al (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 

Download references

Acknowledgements

Thanks go to David Nicholson for assistance with native English.

Conflicts of interest

M. Cervigni: Consultant for Medtronic and Bard, Speaker for IBSA. F. Natale, L. Nasta and A. Mako: none.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to M. Cervigni.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Cervigni, M., Natale, F., Nasta, L. et al. Intravesical hyaluronic acid and chondroitin sulphate for bladder pain syndrome/interstitial cystitis: long-term treatment results. Int Urogynecol J 23, 1187–1192 (2012). https://doi.org/10.1007/s00192-012-1742-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00192-012-1742-y

Keywords

Navigation