title: Effectiveness of intravesical hyaluronic acid with or without chondroitin sulfate for recurrent bacterial cystitis in adult women: a meta-analysis.
abstract: OBJECTIVE
  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.
authors.affiliation: Department of Obstetrics and Gynaecology, Battipaglia Hospital, Battipaglia, SA, Italy.
authors.forename: Davide
authors.initials: D
authors.lastname: De Vita
authors.forename: Henrik
authors.initials: H
authors.lastname: Antell
authors.forename: Salvatore
authors.initials: S
authors.lastname: Giordano
mesh_terms: D000283:Administration, Intravesical; D001424:Bacterial Infections / Q000188:drug therapy*; D002809:Chondroitin Sulfates / Q000008:administration & dosage*; D003556:Cystitis / Q000188:drug therapy*; D005260:Female; D006801:Humans; D006820:Hyaluronic Acid / Q000008:administration & dosage*; D055502:Secondary Prevention; D055675:Viscosupplements / Q000008:administration & dosage*
chemical_list: D055675:Viscosupplements; D006820:Hyaluronic Acid; D002809:Chondroitin Sulfates