[TP-045]

Clinical Comparison of Intravesical Hyaluronic Acide and Chondroitin Sulphate Therapy for Bladder Pain Syndrome/Interstitital Cystitis

Aytaç Kayış1, Barış Esen2, Evren Süer2, Mehmet İlker Gökçe2, Ömer Gülpınar2, Aykut Akıncı1
1Kars State Hospital
2Department of Urology, Ankara University, Ankara, Turkey

PURPOSE: In this study, patients with history of bladder pain syndrome/interstitial cystitis(BPS/IC) are compared for clinical efficacy of intravesical hyaluronic acide (HA) or chondroitin sulphate (CS) therapy.
MATERIALS-METHODS: Patients are randomized for intravesical therapy with 50 ml/120 mg sterile sodium HA (HYACYST®) or 40 ml/80 mg sodium CS (GEPAN INSTILL®). Intravesical instillations were done weekly in first month, once in 15 days in second month and monthly in third and fourth months as total of 8 intravesical doses. Patients were evaluated for visual analog scale score (VAS) for pain, 24 hours frequency, nocturia, median voided volume, symptom index score (ICSI) and problem index score (ICPI) at the beginning of the therapy and after 6 months. Wilcoxon and Mann-Whitney tests were used for statistical analysis.
RESULTS: In our study, a total of 42 patients were randomized. Twenty one patients that randomized for CS group have a mean age of 47,10 and 21 patients that randomized for HA group have a mean age of 48,90 (p>0,05). Parson’s test was positive for 14 patients (%66,7) and 13 patients (%61,9) in CS and HA groups respectively (p>0,05). Total positiveness rate of Parson’s test was %64,3 of the patients (27/42). T There was no severe adverse effects noted. Pretreatment characteristics of both groups are summarized in table 1. Pretreatment and 6. months findings of the patients are also shown in table 2. There was no severe adverse affects noted.
CONCLUSION: With 6 months follow up of patients with BPS/IC, both CS and HA instillation reduced symptoms significantly with no severe adverse effects. Intravesical CS is superior to intravesical HA in terms of 24 hours frequency, nocturia and ICPI in patients with BPS/IC in short term period. CS treatment was also found to increase mean urine volume per void.


Table 1: Pretreatment characteristics of the two groups.
ParametersHyaluronic Acide (HA)
n=21		Chondroitin Sulphate (CS) n=21p value
Age48.90±17.1847.10±10.70p>0,05
VAS of pain9 (min:0 - max:10)8 (min:5 - max:10)p>0,05
Micturition frequency (24 hours)13.90±5.6916.48±5.08p>0,05
Nocturia2 (min:0 - max:12)3 (min:1- max:6)p>0,05
Mean voided volume (ml)148 (min:26 - max:369)136 (min:29 - max:355)p>0,05
ICSI16 (min:4 - max:20)17 (min:11 - max:20)p>0,05
ICPI13 (min:6 - max:16)14 (min:8 - max:16)p>0,05
PST positivity rate61.9%66.7%p>0,05
HA= Hyaluronic acid, CS=chondroitin sulphate, VAS=visual analog scale, ICSI= interstitial cystitis symptom index, ICPI interstitial cystitis problem index, PST= potassium sensitivity test


Table 2: Pretreatment and 6. months findings of the patients treated with HA-CS and HA.
Hyaluronic Acide (HA)Hyaluronic Acide (HA)Hyaluronic Acide (HA)Chondroitin Sulphate (CS)Chondroitin Sulphate (CS)Chondroitin Sulphate (CS)HA-CS
Initial visit6. monthp valueInitial visit6. monthp valuep value
VAS of pain9 (min:0 - max:10)4 (min:0 - max:9)<0.058 (min:5 - max:10)5 (min:0 - max:8)<0,05>0.05
24 hours frequency13.90±5.6911.86±4.52<0.0516.48±5.0810.57±3.61<0,05<0,05
Nocturia2 (min:0 - max:12)1 (min:0 - max:5)<0.053 (min:1 - max:6)1 (min:0 - max:4)<0,05<0,05
Mean voided volume (ml)148 (min:26 - max:369)168 (min:20 - max:333)>0.05136 (min:29 - max:355)155 (min:64 - max:369)<0,05>0.05
ICSI16 (min:4 - max:20)10 (min:4 - max:19)<0.0517 (min:11 - max:20)9 (min:4 - max:18)<0,05<0,05
ICPI13 (min:6 - max:16)8 (min:2 - max:16)<0.0514 (min:8 - max:16)7 (min:1 - max:13)<0,05<0,05
HA=hyaluronic acid, CS=chondroitin sulphate, VAS=visual analog scale, ICSI=interstitial cystitis symptom index, ICPI=interstitial cystitis problem index