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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

Vittorio Imperatore, Massimiliano Creta, Sergio Di Meo, Roberto Buonopane, Nicola Longo, Ferdinando Fusco, Lorenzo Spirito, Ciro Imbimbo, Vincenzo Mirone
  • Vittorio Imperatore
    Unità Operativa di Urologia, Ospedale Buon Consiglio - Fatebenefratelli, Napoli, Italy | v.imperatore@alice.it
  • 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

Abstract

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.

Keywords

Bacillus Calmette-Guérin; Bladder cancer; Chondroitin sulphate; Cystitis; Hyaluronic acid

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Submitted: 2017-08-25 16:52:30
Published: 2018-03-31 00:00:00
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Copyright (c) 2018 Vittorio Imperatore, Massimiliano Creta, Sergio Di Meo, Roberto Buonopane, Nicola Longo, Ferdinando Fusco, Lorenzo Spirito, Ciro Imbimbo, Vincenzo Mirone

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