Korean J Urol.  2014 May;55(5):354-359. 10.4111/kju.2014.55.5.354.

Instillation of Hyaluronic Acid via Electromotive Drug Administration Can Improve the Efficacy of Treatment in Patients With Interstitial Cystitis/Painful Bladder Syndrome: A Randomized Prospective Study

• Gulpinar O
• Haliloglu
• Gokce MI
• Arikan N

• KMID: 1988414
• DOI: http://doi.org/10.4111/kju.2014.55.5.354

Abstract

PURPOSE
In the treatment of interstitial cystitis, intravesical hyaluronic acid application may be suggested as a treatment option. In this randomized prospective study, the authors aimed to identify whether instilling the hyaluronic acid with electromotive drug administration (EMDA) would increase the tissue uptake and improve the efficacy.
MATERIALS AND METHODS
The data of 31 patients who had been diagnosed with bladder pain syndrome/interstitial cystitis (BPS/IC) between 2004 and 2005 were examined. The patients were randomized to two groups: patients in group A received hyaluronic acid directly with a catheter and patients in group B received hyaluronic acid with EMDA. The patients were followed for 24 months and the two groups were compared at certain time intervals. The primary end points of the study were visual analogue scale (VAS) score, global response assessment, and micturition frequency in 24 hours.
RESULTS
There were 6 males and 25 females. The two groups were similar in baseline parameters. The decrease in VAS score and the micturition frequency in 24 hours were significantly lower with EMDA at months 6 and 12. The difference between the two groups was not significant at months 1 and 24. Also, treatment with EMDA, positive KCl test, and pretreatment voiding frequency >17 were associated with higher response rates.
CONCLUSIONS
Hyaluronic acid installation is an effective glycosaminoglycan substitution therapy in patients with BPS/IC. Instillation of hyaluronic acid via EMDA can improve the efficacy of the treatment; however, lack of long-term efficacy is the major problem with this glycosaminoglycan substitution therapy.

Keyword

Hyaluronic acid; Interstitial cystitis; Painful bladder syndrome

MeSH Terms

Catheters
Cystitis
Cystitis, Interstitial
Female
Humans
Hyaluronic Acid*
Male
Prospective Studies*
Urinary Bladder*
Urination
Hyaluronic Acid

Reference

1. Kallestrup EB, Jorgensen SS, Nordling J, Hald T. Treatment of interstitial cystitis with Cystistat: a hyaluronic acid product. Scand J Urol Nephrol. 2005; 39:143–147.

2. Temml C, Wehrberger C, Riedl C, Ponholzer A, Marszalek M, Madersbacher S. Prevalence and correlates for interstitial cystitis symptoms in women participating in a health screening project. Eur Urol. 2007; 51:803–808.

3. Gupta SK, Pidcock L, Parr NJ. The potassium sensitivity test: a predictor of treatment response in interstitial cystitis. BJU Int. 2005; 96:1063–1066.

4. Parsons CL, Stein PC, Bidair M, Lebow D. Abnormal sensitivity to intravesical potassium in interstitial cystitis and radiation cystitis. Neurourol Urodyn. 1994; 13:515–520.

5. Moldwin RM, Sant GR. Interstitial cystitis: a pathophysiology and treatment update. Clin Obstet Gynecol. 2002; 45:259–272.

6. Parsons CL. The therapeutic role of sulfated polysaccharides in the urinary bladder. Urol Clin North Am. 1994; 21:93–100.

7. Morales A, Emerson L, Nickel JC, Lundie M. Intravesical hyaluronic acid in the treatment of refractory interstitial cystitis. J Urol. 1996; 156:45–48.

8. Porru D, Campus G, Tudino D, Valdes E, Vespa A, Scarpa RM, et al. Results of treatment of refractory interstitial cystitis with intravesical hyaluronic acid. Urol Int. 1997; 59:26–29.

9. Constantinides C, Manousakas T, Nikolopoulos P, Stanitsas A, Haritopoulos K, Giannopoulos A. Prevention of recurrent bacterial cystitis by intravesical administration of hyaluronic acid: a pilot study. BJU Int. 2004; 93:1262–1266.

10. Manas A, Glaria L, Pena C, Sotoca A, Lanzos E, Fernandez C, et al. Prevention of urinary tract infections in palliative radiation for vertebral metastasis and spinal compression: a pilot study in 71 patients. Int J Radiat Oncol Biol Phys. 2006; 64:935–940.

11. Rose AE, Azevedo KJ, Payne CK. Office bladder distention with electromotive drug administration (EMDA) is equivalent to distention under general anesthesia (GA). BMC Urol. 2005; 5:14.

12. Henry R, Patterson L, Avery N, Tanzola R, Tod D, Hunter D, et al. Absorption of alkalized intravesical lidocaine in normal and inflamed bladders: a simple method for improving bladder anesthesia. J Urol. 2001; 165(6 Pt 1):1900–1903.

13. Rose AE, Payne CK, Azevedo K. Pilot study of the feasibility of in-office bladder distention using electromotive drug adminstration (EMDA). Neurourol Urodyn. 2005; 24:254–260.

14. Rosamilia A, Dwyer PL, Gibson J. Electromotive drug administration of lidocaine and dexamethasone followed by cystodistension in women with interstitial cystitis. Int Urogynecol J Pelvic Floor Dysfunct. 1997; 8:142–145.

15. Di Stasi SM, Giannantoni A, Giurioli A, Valenti M, Zampa G, Storti L, et al. Sequential BCG and electromotive mitomycin versus BCG alone for high-risk superficial bladder cancer: a randomised controlled trial. Lancet Oncol. 2006; 7:43–51.

16. Di Stasi SM, Vespasiani G, Giannantoni A, Massoud R, Dolci S, Micali F. Electromotive delivery of mitomycin C into human bladder wall. Cancer Res. 1997; 57:875–880.

17. Propert KJ, Mayer RD, Wang Y, Sant GR, Hanno PM, Peters KM, et al. Responsiveness of symptom scales for interstitial cystitis. Urology. 2006; 67:55–59.

18. Sato H, Takahashi T, Ide H, Fukushima T, Tabata M, Sekine F, et al. Antioxidant activity of synovial fluid, hyaluronic acid, and two subcomponents of hyaluronic acid. Synovial fluid scavenging effect is enhanced in rheumatoid arthritis patients. Arthritis Rheum. 1988; 31:63–71.

19. Balasz EA, Denlinger JL. The role of hyaluronic acid in arthritis and its therapeutic use. In : Peyron JG, editor. Osteoarthritis: current clinical and fundamental problems. Paris: Geigy;1984. p. 165–174.

20. Goldberg RL, Toole BP. Hyaluronate inhibition of cell proliferation. Arthritis Rheum. 1987; 30:769–778.

21. Abatangelo G, Martelli M, Vecchia P. Healing of hyaluronic acid-enriched wounds: histological observations. J Surg Res. 1983; 35:410–416.

22. Hadler NM, Napier MA. Structure of hyaluronic acid in synovial fluid and its influence on the movement of solutes. Semin Arthritis Rheum. 1977; 7:141–152.

23. Engelhardt PF, Morakis N, Daha LK, Esterbauer B, Riedl CR. Long-term results of in-travesical hyaluronan therapy in bladder pain syndrome/interstitial cystitis. Int Urogynecol J. 2011; 22:401–405.

24. Di Stasi SM, Giannantoni A, Stephen RL, Capelli G, Navarra P, Massoud R, et al. Intravesical electromotive mitomycin C versus passive transport mitomycin C for high risk superficial bladder cancer: a prospective randomized study. J Urol. 2003; 170:777–782.

25. Riedl CR, Knoll M, Plas E, Pfluger H. Electromotive drug administration and hydrodis-tention for the treatment of interstitial cystitis. J Endourol. 1998; 12:269–272.