Hyaluronic Acid: An Effective Alternative Treatment Of Interstitial Cystitis, Recurrent Urinary Tract Infections, And Hemorrhagic Cystitis?

UroToday- Hyaluronic acid is a putative protective barrier of the urothelium. A damaged glycosaminoglycan layer may increase the possibility of bacterial adherence and infection. This damage is proposed to be a causative factor in the development of bladder pain syndrome/interstitial cystitis, urinary tract infection, and hemorrhagic cystitis. Iavazzo and colleagues from Athens, Greece and Boston, Massachusetts reviewed the available data regarding the use of exogenous hyaluronic acid as an alternative treatment of these conditions.

Nine relevant studies were identified and evaluated. Hyaluronic acid was administered intravesically at a dose of 40mg in 40cc normal saline weekly for 4 6 weeks. Patients with noted improvement received two additional monthly doses. The available data suggest that the total short term response of patients with interstitial cystitis is from 30% to 73% and the long-term (3 year) response of such patients could reach 55%. One study reported that the total response to the treatment in patients with hemorrhagic cystitis is 71%. In patients with recurrent urinary tract infection intravesical hyaluronic acid was associated with absence of recurrence in 100% and 70% of patients during 5 month and 1 year follow up respectively.

The authors note that only three of the nine reviewed studies were randomized controlled trials and in only two was hyaluronic acid compared to placebo. They conclude that the limited evidence available does not permit any conclusions with regard to the efficacy of hyaluronic acid treatment.

It should be noted that hyaluronic acid is not approved in the United States. In the summer of 2003 Bioniche Life Science Inc and in the spring of 2004 Seikagaku Corporation completed large double blind, placebo controlled, multicenter clinical studies of their hyaluronic acid preparations (40mg or 200mg per cc respectively) in North America and neither showed significant efficacy of sodium hyaluronate compared to placebo. These negative studies have not been published in peer reviewed literature.

Iavazzo C, Athanasiou S, Pitsouni E, Falagas ME

European Urology. 51(6):1534-1541, June 2007.
doi:10.1016/j.eururo.2007.03.020

Reported by UroToday Contributing Editor Philip M Hanno, M.D

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