Outcomes in BPS/IC better with intravesical chondroitin sulphate vs hyaluronic acid
Intravesical chondroitin sulphate (CS) is superior to intravesical hyaluronic acid (HA) in the treatment of bladder pain syndrome (BPS)/interstitial cystitis (IC), improving 24-hour frequency, nocturia and interstitial cystitis problem index (ICPI), according to a study.
A total of 42 patients with BPS/IC were randomized equally to receive either CS (mean age 47.10) and HA (mean age 48.90). Assessments for visual analogue pain scale (VAS), interstitial cystitis symptom index (ICSI), ICPI, voiding diary for frequency/nocturia and mean urine volume per void were performed at baseline and after 6 months. All patients had initial potassium sensitivity test (PST). Wilcoxon and Mann-Whitney U tests were used for statistical analysis.
Prior to treatment, Parson’s test returned positive in more than half (64.3 percent) of the patients overall, with no between-group difference. Outcomes including VAS of pain, ICSI, ICPI, frequency at 24 hours and nocturia improved significantly in both treatment groups. However, the improvements were found to be greater with intravesical CS vs HA, especially 24-hour frequency, nocturia and ICPI (p<0.05). No severe adverse effects were reported.
BPS/IC is a chronic pain syndrome characterized by pain and discomfort in the bladder, with associated urgency and urinary frequency. The mechanisms underlying the syndrome’s development are said to involve the urothelium/transitional epithelium, with the protective layer of glycosaminoglycans (GAG) on the surface of the urothelial cells shown to be defective in some BPS/IC patients. The GAG layer—which constitutes HA, CS, heparin sulphate, dermatan sulphate and keratin sulphate—particularly provides a barrier against solutes in the urine. [Transl Androl Urol 2015;4:629–637]
In the management of BPS/IC, intravesical therapies have the advantage of targeting the bladder, allowing high drug concentrations and minimizing systemic side effects. In contrast, a major advantage is that delivery of the agent requires instrumentation of the urethra and bladder, potentially exacerbating pain and increasing the risk of urinary tract infection.