Intravesical administration of combined hyaluronic acid and chondroitin sulfate can improve symptoms in patients with refractory bacillus Calmette-Guerin-induced chemical cystitis: Preliminary experience with one-year follow-up


Submitted: August 25, 2017
Accepted: October 23, 2017
Published: March 31, 2018
Abstract Views: 1744
PDF: 800
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Authors

  • Vittorio Imperatore Unità Operativa di Urologia, Ospedale Buon Consiglio - Fatebenefratelli, Napoli, Italy.
  • Massimiliano Creta Clinica Urologica, Università Federico II di Napoli, Napoli, Italy.
  • Sergio Di Meo Unità Operativa di Urologia, Ospedale Buon Consiglio - Fatebenefratelli, Napoli, Italy.
  • Roberto Buonopane Unità Operativa di Urologia, Ospedale Buon Consiglio - Fatebenefratelli, Napoli, Italy.
  • Nicola Longo Clinica Urologica, Università Federico II di Napoli, Napoli, Italy.
  • Ferdinando Fusco Clinica Urologica, Università Federico II di Napoli, Napoli, Italy.
  • Lorenzo Spirito Clinica Urologica, Università Federico II di Napoli, Napoli, Italy.
  • Ciro Imbimbo Clinica Urologica, Università Federico II di Napoli, Napoli, Italy.
  • Vincenzo Mirone Clinica Urologica, Università Federico II di Napoli, Napoli, Italy.
Objective: We investigated the efficacy of intravesical instillations of combined hyaluronic acid (HA) and chondroitin sulphate (CS) in patients with bacillus Calmette-Guérin (BCG)-induced chemical cystitis unresponsive to first-line therapies.
Patients and methods: We retrospectively reviewed the clinical records of patients with grade 2 BCG-induced chemical cystitis unresponsive to first line therapeutic options performed according to the International Bladder Cancer Group guidelines who underwent intravesical instillations of HA/CS. Bladder pain, urinary urgency, voiding volume and number of voids/24 hours recorded prior to treatment, at the end of the treatment, at six months and at one-year follow-up were recorded and analyzed.
Results: The records of 20 patients were identified. All patients underwent eight weekly instillations of HA/CS. Mean baseline visual analogue scale (VAS) scores ± Standard Deviation (SD) for urinary urgency and bladder pain were 7.8 ± 0.5 and 7.2 ± 1.0, respectively. Mean number of voids/24 hours ± SD was 15.4 ± 2.3 and mean urine volume per void ± SD was 85.8 ± 21.0 mL. At the end of the treatment, mean VAS scores ± SD for urgency and pain significantly decreased to 4.7 ± 1.1 and 4.2 ± 0.9, respectively (p < 0.05 in both cases). Mean number of voids/24 hours ± SD decreased to 9.6 ± 1.4 (p < 0.05) and mean urine volume per void ± SD significantly increased to 194.1 ± 59.5 mL (p < 0.05). At six months and one-year followup, all outcome measures remained stable.
Conclusions: Bladder instillations of HA/CS provide significant and durable improvement of bladder pain, urinary urgency, urinary volume per void and urinary frequency in patients with refractory BCG-induced chemical cystitis.

Imperatore, V., Creta, M., Di Meo, S., Buonopane, R., Longo, N., Fusco, F., Spirito, L., Imbimbo, C., & Mirone, V. (2018). Intravesical administration of combined hyaluronic acid and chondroitin sulfate can improve symptoms in patients with refractory bacillus Calmette-Guerin-induced chemical cystitis: Preliminary experience with one-year follow-up. Archivio Italiano Di Urologia E Andrologia, 90(1), 11–14. https://doi.org/10.4081/aiua.2018.1.11

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