title: Bladder Instillation Therapy With Hyaluronic Acid and Chondroitin Sulfate Improves Symptoms of Postradiation Cystitis: Prospective Pilot Study.
abstract: After radiotherapy (RT) for prostate cancer (PCa), several patients reported lower urinary tract symptoms (LUTS) due to damage and discontinuation of the glycosaminoglycan layer of the bladder. Instillation of hyaluronic acid and chondroitin sulfate (HA-CS) represents replenishment therapy of the glycosaminoglycan layer. The aim of the study is to evaluate the efficacy and safety of HA-CS in men with symptomatic cystitis after RT for PCa.
  
  
  
  Eighty consecutive men were treated with RT for PCa; 30 of these (37.5%) reported clinically relevant LUTS and associated bother as measured by the Interstitial Cystitis Symptom Index and Problem Index (ICSI/ICPI) Questionnaire 3 months after RT. Symptomatic patients received instillation therapy with HA-CS weekly for the first month and then at weeks 6, 8, and 12. All patients completed the ICSI/ICPI questionnaire before and after RT and at the end of HA-CS treatment.
  
  
  
  HA-CS significantly reduced postradiation LUTS (P < .001) and bother (P = .006). Age, Gleason score, and radiation dose were the main determinants of worsening of LUTS after radiation (ICSI score baseline vs. postradiation: P = .047, .043, and .023). In multivariate analysis, only age influenced LUTS worsening after RT (P = .01). Age, radiation dose, and radiation toxicity were related to recovery of LUTS (ICSI score postradiation vs. post-HA-CS P = .041, P = .050, and P = .046). In multivariate analysis, no factor was statistically significant.
  
  
  
  A remarkable worsening of symptoms and bother was observed after RT. HA-CS instillation is a safe treatment and resulted in an improvement of LUTS irrespective of age and clinical features, with full recovery of urinary bother.
authors.affiliation: Department of Urology, University of Florence, Careggi Hospital, Florence, Italy.
authors.forename: Mauro
authors.initials: M
authors.lastname: Gacci
authors.affiliation: Department of Urology, University of Florence, Careggi Hospital, Florence, Italy. Electronic address: os11nov@hotmail.com.
authors.forename: Omar
authors.initials: O
authors.lastname: Saleh
authors.affiliation: Department of Urology, University of Florence, Careggi Hospital, Florence, Italy.
authors.forename: Claudia
authors.initials: C
authors.lastname: Giannessi
authors.affiliation: Department of Urology, University of Florence, Careggi Hospital, Florence, Italy.
authors.forename: Tommaso
authors.initials: T
authors.lastname: Chini
authors.affiliation: Department of Urology, University of Florence, Careggi Hospital, Florence, Italy.
authors.forename: Pier Andrea
authors.initials: PA
authors.lastname: Della Camera
authors.affiliation: Department of Radiation Therapy, University of Florence, Careggi Hospital, Florence, Italy.
authors.forename: Beatrice
authors.initials: B
authors.lastname: Detti
authors.affiliation: Department of Radiation Therapy, University of Florence, Careggi Hospital, Florence, Italy.
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Livi
authors.affiliation: Department of Urology, Tor Vergata University, Rome, Italy.
authors.forename: Enrico
authors.initials: E
authors.lastname: Finazzi Agro
authors.affiliation: Department of Urology, University of Florence, Careggi Hospital, Florence, Italy.
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Li Marzi
authors.affiliation: Department of Urology, University of Florence, Careggi Hospital, Florence, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Minervini
authors.affiliation: Department of Urology, University of Florence, Careggi Hospital, Florence, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Carini
authors.affiliation: Department of Urology, Hannover Medical School, Hannover, Germany.
authors.forename: Matthias
authors.initials: M
authors.lastname: Oelke
authors.affiliation: Department of Urology, University Hospital of Larissa, Larissa, Greece.
authors.forename: Stavros
authors.initials: S
authors.lastname: Gravas
authors.affiliation: Department of Urology, University of Florence, Careggi Hospital, Florence, Italy.
authors.forename: Sergio
authors.initials: S
authors.lastname: Serni
mesh_terms: D000283:Administration, Intravesical; D000368:Aged; D002809:Chondroitin Sulfates / Q000008:administration & dosage* / Q000627:therapeutic use; D003556:Cystitis / Q000188:drug therapy* / Q000209:etiology; D004359:Drug Therapy, Combination; D006801:Humans; D006820:Hyaluronic Acid / Q000008:administration & dosage* / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D010865:Pilot Projects; D011446:Prospective Studies; D011471:Prostatic Neoplasms / Q000473:pathology / Q000532:radiotherapy*; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
chemical_list: D006820:Hyaluronic Acid; D002809:Chondroitin Sulfates
keywords: Adjuvant radiotherapy; Bladder Drug Administration; Lower urinary tract symptoms; Prostate cancer; Sodium hyaluronate