title: Sodium hyaluronate and chondroitin sulfate replenishment therapy can improve nocturia in men with post-radiation cystitis: results of a prospective pilot study.
abstract: BACKGROUND
  Radiotherapy is one of the treatment options for prostate cancer (PCa) but up to 25% of men report about severe nocturia (nocturnal voiding). The combination of hyaluronic acid (HA) and chondroitin sulfate (CS) resembles glycosaminoglycan (GAG) replenishment therapy. The aim of our study was to evaluate the impact of HA and CS on nocturia, in men with nocturia after PCa radiotherapy.
  
  
  METHODS
  Twenty-three consecutive patients with symptomatic cystitis after external radiotherapy for PCa were enrolled. Patients underwent bladder instillation therapy with HA and CS weekly for the first month and, afterwards, on week 6, 8 and 12. Nocturnal voiding frequency was assessed by item 3 (Q3) of the Interstitial Cystitis Symptoms Index (ICSI) and item 2 (Q2) of the Interstitial Cystitis Problem Index (ICPI). Data were analyzed with paired-samples T-test and adjusted for age.
  
  
  RESULTS
  Eighteen patients (78%) reported about nocturia. Pre- and post-treatment ICSI-Q3 was 2.13 ± 0.28 and 1.61 ± 0.21 (-24.4%, p = 0.001). With logistic regression analysis, both age and baseline ICSI-Q3 had a significant impact on nocturnal voiding frequency (r = 0.293, p = 0.011 and r = 0.970, p < 0.001). Pre- and post-treatment ICPI-Q2 was 1.87 ± 0.26 and 1.30 ± 0.25 (-30.5%, p = 0.016); logistic regression analysis was without significant findings.
  
  
  CONCLUSIONS
  Bladder instillation treatment with a combination of HA and CS was effective in reducing nocturnal voiding frequency in men with post-radiation bladder pain for PCa. Randomized, controlled trials with sham treatment are needed to confirm our result.
authors.affiliation: Department of Urology, University of Florence, Careggi Hospital, Largo Brambilla 3, Urologic Clinic San Luca, Florence, 50100, Italy. maurogacci@yahoo.it.
authors.forename: Mauro
authors.initials: M
authors.lastname: Gacci
authors.affiliation: Department of Urology, University of Florence, Careggi Hospital, Largo Brambilla 3, Urologic Clinic San Luca, Florence, 50100, Italy. os11nov@hotmail.com.
authors.forename: Omar
authors.initials: O
authors.lastname: Saleh
authors.affiliation: Department of Urology, University of Florence, Careggi Hospital, Largo Brambilla 3, Urologic Clinic San Luca, Florence, 50100, Italy. cgiannessi@yahoo.it.
authors.forename: Claudia
authors.initials: C
authors.lastname: Giannessi
authors.affiliation: Department of Radiation Therapy, University of Florence, Careggi Hospital, Largo Brambilla 3, Florence, Italy. beatrice.detti@aouc.unifi.it.
authors.forename: Beatrice
authors.initials: B
authors.lastname: Detti
authors.affiliation: Department of Radiation Therapy, University of Florence, Careggi Hospital, Largo Brambilla 3, Florence, Italy. Lorenzo.livi@unifi.it.
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Livi
authors.affiliation: Department of Radiation Therapy, University of Florence, Careggi Hospital, Largo Brambilla 3, Florence, Italy. flowerle@tiscali.it.
authors.forename: Eleonora
authors.initials: E
authors.lastname: Monteleone Pasquetti
authors.affiliation: Department of Radiation Therapy, University of Florence, Careggi Hospital, Largo Brambilla 3, Florence, Italy. tatim@tiscali.it.
authors.forename: Tatiana
authors.initials: T
authors.lastname: Masoni
authors.affiliation: Department of Urology, Tor Vergata University, Via di Tor Vergata, Rome, Italy. efinazzi@tin.it.
authors.forename: Enrico
authors.initials: E
authors.lastname: Finazzi Agro
authors.affiliation: Department of Urology, University of Florence, Careggi Hospital, Largo Brambilla 3, Urologic Clinic San Luca, Florence, 50100, Italy. vlimarzi@hotmail.com.
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Li Marzi
authors.affiliation: Department of Urology, University of Florence, Careggi Hospital, Largo Brambilla 3, Urologic Clinic San Luca, Florence, 50100, Italy. andreamine@libero.it.
authors.forename: Andrea
authors.initials: A
authors.lastname: Minervini
authors.affiliation: Department of Urology, University of Florence, Careggi Hospital, Largo Brambilla 3, Urologic Clinic San Luca, Florence, 50100, Italy. carini@unifi.it.
authors.forename: Marco
authors.initials: M
authors.lastname: Carini
authors.affiliation: Department of Urology, University Hospital of Larissa, Larissa, Greece. sgravas2002@yahoo.com.
authors.forename: Stavros
authors.initials: S
authors.lastname: Gravas
authors.affiliation: Department of Urology, Hannover Medical School, Hannover, Germany. Oelke.Matthias@mh-hannover.de.
authors.forename: Matthias
authors.initials: M
authors.lastname: Oelke
authors.affiliation: Department of Urology, University of Florence, Careggi Hospital, Largo Brambilla 3, Urologic Clinic San Luca, Florence, 50100, Italy. sergio.serni@unifi.it.
authors.forename: Sergio
authors.initials: S
authors.lastname: Serni
mesh_terms: D000283:Administration, Intravesical; D000368:Aged; D002809:Chondroitin Sulfates / Q000008:administration & dosage*; D003556:Cystitis / Q000188:drug therapy* / Q000209:etiology; D004338:Drug Combinations; D006801:Humans; D006820:Hyaluronic Acid / Q000008:administration & dosage*; D008297:Male; D053158:Nocturia / Q000188:drug therapy* / Q000209:etiology*; D010865:Pilot Projects; D011446:Prospective Studies; D011471:Prostatic Neoplasms / Q000150:complications / Q000532:radiotherapy; D011832:Radiation Injuries / Q000188:drug therapy* / Q000209:etiology; D020266:Radiotherapy, Conformal / Q000009:adverse effects*; D016896:Treatment Outcome
chemical_list: D004338:Drug Combinations; C501944:chondroitin sulfate, sodium hyaluronate drug combination; D006820:Hyaluronic Acid; D002809:Chondroitin Sulfates