Efficacy and predictive factors of clinical response to hyaluronic acid + chondroitin sulfate bladder instillations for the treatment of BPS/IC
Continence(2024)
摘要
Aim of the study:
To assess the efficacy of intravesical hyaluronic acid and chondroitin sulfate (HACS) instillations in treating patients with bladder pain syndrome/interstitial cystitis (BPS/IC), as well as to identify predictive factors for clinical response.
Materials and methods:
Patients diagnosed with BPS/IC and treated with Ialuril® (HACS) bladder instillations between January 2018 and August 2020 were included. Data collected included Visual Analog Scale (VAS) scores, number of pain episodes, 3-day frequency volume chart measurements (at baseline and last follow-up), Patient Global Impression of Improvement (PGI-I) questionnaire responses, age, history of urinary tract infections (UTIs), and endoscopic findings from cystoscopy with hydrodistension. Statistical analyses included Mann–Whitney’s non-parametric U-test and chi-square test with a 95% confidence interval (p≤ 0.05) to identify predictive factors of treatment success.
Results:
A total of 104 patients were treated with a median follow-up of 29 months (IQR 14-40), predominantly female with a mean age of 60 ± 16 years. At the last follow-up, there was a median reduction of 1 point in the VAS score (IQR 1-1), whilst only 20% experienced a reduction of ≥ 2 points. A statistically significant correlation was observed in the reduction of days with pain per month before and after treatment (ΔDPV) (median reduction: 6 days, IQR 2-7, p< 0.001). No adverse events were reported during treatment. Regarding prognostic factors, three statistically significant correlations were found: between PGI-I success and age (p=0.050), between ΔVAS score and recurrent UTIs (p=0.044), and between ΔDPV and recurrent UTIs (p=0.04).
Discussion:
The study did not demonstrate any significant reduction of VAS score or diurnal and nocturnal voiding frequency after treatment, on the contrary it did show a reduction in the number of days with pain. Consequently, 88.3% of patients reported positive subjective improvement on the PGI-I questionnaire, and none discontinued treatment. Endoscopic findings did not appear to correlate with treatment response.
Conclusion:
Age and the presence of recurrent UTIs may influence the response to intravesical HACS therapy in terms of PGI-I, VAS score, and reduction in days with pain.
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关键词
Interstitial cystitis,Bladder pain syndrome,Hyaluronic acid,Chondroitin sulfate,Bladder instillations
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