title: Intravesical treatment with highly-concentrated hyaluronic acid and chondroitin sulphate in patients with recurrent urinary tract infections: Results from a multicentre survey.
abstract: BACKGROUND
  We assess the effectiveness of intravesical instillation of hyaluronic acid (HA) and chondroitin sulphate (CS) as a non-antibiotic treatment option for prophylaxis of recurrent urinary tract infections (UTIs) in female patients.
  
  
  METHODS
  This was a retrospective cohort study involving 7 European institutions. We included patients with recurrent UTIs who received intravesical instillations of Ialuril (IBSA International) (50 mL HA 1.6% and CS 2% solution) between January 2010 and March 2012. Medication schedule, length of follow-up, recurrence infection time, number of UTIs/patients/year, patient quality of life, subjective symptoms score, and treatment-emergent side effects were recorded and analyzed.
  
  
  RESULTS
  In total, 157 women (mean age: 54.2 ± 4.1 years) were included in the analysis. All patients had at least 12 months follow-up. After 4 weekly and 5 monthly HA-CS bladder instillations, UTI episodes decreased from 4.13 ± 1.14 to 0.44 ± 0.50 (p = 0.01) at 12 months, while recurrent UTI time prolonged from 94.8 ± 25.1 days to 178.4 ± 37.3 days (p = 0.01) at 12 months. An improvement in symptoms and quality of life was achieved. A medium-depth pain after medication instillation was the most reported side effect. Regression model analysis showed significant risk factors in developing new UTI episodes: being more than 50 years old and having more than 4 UTI episodes per year (OR 3.41; CI 95%; 1.51-7.71, p = 0.003 and OR 3.31; CI 95% 1.51-7.22; p = 0.003, respectively). Retrospective design and lack of a control group represent two main limitations of the study.
  
  
  CONCLUSIONS
  Restoring glycosaminoglycans bladder layer therapy is a promising non-antibiotic therapy to prevent recurrent UTIs.
authors.affiliation: Department of Urology & Research Doctorate Urology Program, Magna Graecia University, Catanzaro, Italy;
authors.forename: Antonio
authors.initials: A
authors.lastname: Cicione
authors.affiliation: Department of Urology & Research Doctorate Urology Program, Magna Graecia University, Catanzaro, Italy;
authors.forename: Francesco
authors.initials: F
authors.lastname: Cantiello
authors.affiliation: Department of Urology & Research Doctorate Urology Program, Magna Graecia University, Catanzaro, Italy;
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Ucciero
authors.affiliation: Department of Urology, University Vita-Salute San Raffaele, Milano, Italy;
authors.forename: Andrea
authors.initials: A
authors.lastname: Salonia
authors.affiliation: Gynaecology Unit, Second University of Naples, Napoli, Italy;
authors.forename: Marco
authors.initials: M
authors.lastname: Torella
authors.affiliation: Urology Unit, Second University of Naples, Napoli, Italy;
authors.forename: Marco
authors.initials: M
authors.lastname: De Sio
authors.affiliation: Urology Unit, Second University of Naples, Napoli, Italy;
authors.forename: Riccardo
authors.initials: R
authors.lastname: Autorino
authors.affiliation: Unit of Urology - ICOT, Sapienza University of Rome, Latina, Italy;
authors.forename: Antonio
authors.initials: A
authors.lastname: Carbone
authors.affiliation: Department of Urology, St. Cyril and Method University Hospital, Bratislava, Slovakia;
authors.forename: Martin
authors.initials: M
authors.lastname: Romancik
authors.affiliation: Department of Urology, Faculty Hospital of Martin (MFN), Martin, Slovakia.
authors.forename: Roman
authors.initials: R
authors.lastname: Tomaskin
authors.affiliation: Department of Urology & Research Doctorate Urology Program, Magna Graecia University, Catanzaro, Italy;
authors.forename: Rocco
authors.initials: R
authors.lastname: Damiano