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Effectiveness of intravesical hyaluronic acid with or without chondroitin sulfate for recurrent bacterial cystitis in adult women: a meta-analysis

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Abstract

Introduction and hypothesis

Glycosaminoglycan hyaluronic acid (HA) and chondroitin sulphate (CS) protect the urothelium. Damage to the urothelium may increase bacterial adherence and infection risk. This meta-analysis evaluated the effect of intravesical HA and HA and CS (HA-CS) combination therapy in recurrent bacterial cystitis (RBC) in adult women.

Methods

A systematic literature search was performed. Primary outcomes were urinary tract infection (UTI) rate per patient-year, and UTI recurrence time (days). Secondary outcomes were 3-day voids and Pelvic Pain and Urgency/Frequency (PUF) symptom scale total score.

Results

Four studies involving a total of 143 patients were retrieved and assessed in this analysis. Two were randomized, and two were nonrandomized. A significantly decreased UTI rate per patient-year [mean difference (MD) −3.41, 95 % confidence interval (CI) −4.33 to −2.49, p < 0.00001) was found. Similarly, pooled analysis showed a significantly longer mean UTI recurrence time (days) using either HA or HA-CS therapy (MD 187.35, 95 % CI 94.33–280.37, p < 0.0001). Two studies using HA and HA-CS therapy reported outcomes on 3-day voids, which were not significantly improved after therapy (MD −3.59, 95 % CI −8.43–1.25, p = 0.15), but a significantly better PUF total score (MD −7.17, 95 % CI −9.86 to −4.48, p < 0.00001) was detected in HA-CS groups.

Conclusions

Intravesical HA and HA-CS in combination significantly reduced cystitis recurrence, mean UTI recurrence time, and PUF total score. Study limitations include the small number of patients and possible bias. Further studies are needed to validate this promising treatment modality.

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Authors and Affiliations

  1. Department of Obstetrics and Gynaecology, Battipaglia Hospital, Battipaglia, SA, Italy

    Davide De Vita

  2. Biomedicum Helsinki, Neurosurgery Research Group, Helsinki, Finland

    Henrik Antell

  3. Helsinki Medical Imaging Center, Maria Hospital, Helsinki, Finland

    Henrik Antell

  4. Department of Surgery, Division of Plastic Surgery, Turku University Hospital, Turku, Finland

    Salvatore Giordano

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  1. Davide De Vita
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  2. Henrik Antell
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  3. Salvatore Giordano
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Correspondence to Salvatore Giordano.

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De Vita, D., Antell, H. & Giordano, S. Effectiveness of intravesical hyaluronic acid with or without chondroitin sulfate for recurrent bacterial cystitis in adult women: a meta-analysis. Int Urogynecol J 24, 545–552 (2013). https://doi.org/10.1007/s00192-012-1957-y

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  • DOI: https://doi.org/10.1007/s00192-012-1957-y

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