title: Managing chronic bladder diseases with the administration of exogenous glycosaminoglycans: an update on the evidence.
abstract: Although the pathophysiology of acute chronic cystitis and other 'sensory' disorders, i.e. painful bladder syndrome (PBS) or interstitial cystitis (IC), often remains multifactorial, there is a wide consensus that such clinical conditions may arise from a primary defective urothelium lining or from damaged glycosaminoglycans (GAGs). A 'cascade' of events starting from GAG injury, which fails to heal, may lead to chronic bladder epithelial damage and neurogenic inflammation. To restore the GAG layer is becoming the main aim of new therapies for the treatment of chronic cystitis and PBS/IC. Preliminary experiences with GAG replenishment for different pathological conditions involving the lower urinary tract have been reported. There is a range of commercially available intravesical formulations of these components, alone or in combination. Literature evidence shows that exogenous intravesical hyaluronic acid markedly reduces recurrences of urinary tract infections (UTIs). Patients treated with exogenous GAGs have fewer UTI recurrences, a longer time to recurrence and a greater improvement in quality of life. Exogenous intravesical GAGs have been used for the treatment of PBS/IC. Despite the limitations of most of the studies, findings confirmed the role of combination therapy with hyaluronic acid and chondroitin sulfate as a safe and effective option for the treatment of PBS/IC. To prevent and/or treat radiotherapy and chemotherapy induced cystitis, GAG replenishment therapy has been used showing preliminary encouraging results. The safety profile of exogenous GAGs has been reported to be very favourable, without adverse events of particular significance.
authors.affiliation: Department of Urology, Istituto Clinico Humanitas IRCCS, Clinical and Research Center, via Manzoni 56, 20089 Rozzano, MI, Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: Lazzeri
authors.affiliation: Department of Urology, Istituto Clinico Humanitas IRCCS, Clinical and Research Center, Rozzano, MI, Italy.
authors.forename: Rodolfo
authors.initials: R
authors.lastname: Hurle
authors.affiliation: Department of Urology, Istituto Clinico Humanitas IRCCS, Clinical and Research Center, Rozzano, MI, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Casale
authors.affiliation: Department of Urology, Istituto Clinico Humanitas IRCCS, Clinical and Research Center, Rozzano, MI, Italy.
authors.forename: NicolòMaria
authors.initials: N
authors.lastname: Buffi
authors.affiliation: Department of Urology, Istituto Clinico Humanitas IRCCS, Clinical and Research Center, Rozzano, MI, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Lughezzani
authors.affiliation: Department of Urology, Istituto Clinico Humanitas IRCCS, Clinical and Research Center, Rozzano, MI, Italy.
authors.forename: Girolamo
authors.initials: G
authors.lastname: Fiorini
authors.affiliation: Department of Urology, Istituto Clinico Humanitas IRCCS, Clinical and Research Center, Rozzano, MI, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Peschechera
authors.affiliation: Department of Urology, Istituto Clinico Humanitas IRCCS, Clinical and Research Center, Rozzano, MI, Italy.
authors.forename: Luisa
authors.initials: L
authors.lastname: Pasini
authors.affiliation: Department of Urology, Istituto Clinico Humanitas IRCCS, Clinical and Research Center, Rozzano, MI, Italy.
authors.forename: Silvia
authors.initials: S
authors.lastname: Zandegiacomo
authors.affiliation: Department of Urology, Istituto Clinico Humanitas IRCCS, Clinical and Research Center, Rozzano, MI, Italy.
authors.forename: Alessio
authors.initials: A
authors.lastname: Benetti
authors.affiliation: Department of Urology, Istituto Clinico Humanitas IRCCS, Clinical and Research Center, Rozzano, MI, Italy.
authors.forename: Gianluigi
authors.initials: G
authors.lastname: Taverna
authors.affiliation: Department of Urology, Istituto Clinico Humanitas IRCCS, Clinical and Research Center, Humanitas University, Rozzano, MI, Italy.
authors.forename: Giorgio
authors.initials: G
authors.lastname: Guazzoni
authors.affiliation: Centro Chirurgico Toscano, Arezzo, Italy.
authors.forename: Guido
authors.initials: G
authors.lastname: Barbagli
keywords: cystitis; glycosaminoglycans; therapy; urothelium