Effectiveness of intravesical hyaluronic acid/chondroitin sulfate in recurrent bacterial cystitis: a randomized study

The glycosaminoglycan hyaluronic acid (HA) protects the urothelium; damage may increase bacterial adherence and infection risk. This study evaluated the effect of intravesical HA in recurrent bacterial cystitis (RBC). Women with RBC were randomized to intravesical HA 800 mg and chondroitin sulfate (CS) 1 g (IALURIL(A (R)), IBSA) in 50 mL of saline solution once weekly for 4 weeks then once every 2 weeks twice more (group 1) or long term antibiotic prophylaxis using sulfamethoxazole 200 mg and trimethoprim 40 mg once weekly for 6 weeks (group 2; control). Evaluations included: cystitis recurrence at 2 and 12 months; subjective pain symptoms (visual analog scale [VAS]); 3 day voiding; sexual function; quality of life (King's Health Questionnaire [KHQ]); frequency symptoms/frequency symptoms (PUF symptom scale); and maximum cystometric capacity (MCC). Means +/- standard deviations were reported, with Mann-Whitney test for between-group comparison (significance P < .05). Of 28 women (mean age 60 +/- 13 y) randomized, 26 completed follow-up (mean follow-up 11.5 mo). Group 1 showed a significant improvement in all evaluations; cystitis recurrence (1 +/- 1.2 versus 2.3 +/- 1.4, P = .02); 3-day voiding (mean 17.8 +/- 3.5 vs 24.2 +/- 8.3, P = .04); symptom VAS (1.6 +/- 0.8 vs 7.8 +/- 1.6, P < .001); PUF score (11.2 +/- 2.7 vs 19.6 +/- 2.2, P < .001), KHQ score (18.4 +/- 7.2 vs 47.3 +/- 13.6, P < .001), and MCC (380 +/- 78 vs 229 +/- 51 mL, P < .001) vs group 2 at 12 mo. No adverse effects were recorded. Intravesical HA and CS in combination significantly reduced cystitis recurrence and improved urinary symptoms, quality of life, and cystometric capacity in RBC patients at 12 mo follow-up versus antibiotic prophylaxis. Study limitations include a small sample and relatively short follow-up.