Intravesical therapy in recurrent cystitis: a multi-center experience

Area of Science:

• Urology
• Microbiology
• Pharmacology

Background:

• Recurrent cystitis affects 20-30% of women, often caused by bacterial internalization, particularly Escherichia coli.
• Damage to the urothelial mucous membrane is believed to facilitate bacterial internalization.
• Intravesical hyaluronic acid (HA) and chondroitin sulfate (CS) therapy has shown potential in improving urothelium health and reducing bacterial load.

Purpose of the Study:

• To evaluate the efficacy of intravesical HA and CS therapy compared to antibiotic therapy in reducing recurrent urinary tract infection (UTI) episodes and symptoms.
• To compare three therapeutic regimens: HA-CS alone, HA-CS with fosfomycin, and fosfomycin alone.

Main Methods:

• A comparative study involving three groups of patients with recurrent UTIs.
• Therapeutic regimens included: 1) HA-CS, 2) HA-CS + fosfomycin, 3) fosfomycin alone.
• Follow-up duration was 6 to 12 months, assessing the number of recurrent UTI episodes per patient.

Main Results:

• The 'event-free' rates at follow-up were 72.7% for the HA-CS group, 75% for the fosfomycin + HA-CS group, and 30.4% for the fosfomycin-only group.
• Fisher's exact test was used for statistical analysis of the results.
• Both HA-CS regimens demonstrated significantly higher efficacy in preventing recurrent episodes compared to fosfomycin alone.

Conclusions:

• Intravesical therapy with hyaluronic acid and chondroitin sulfate is a highly effective treatment for preventing recurrent cystitis episodes.
• Combining HA-CS with antibiotics may offer a synergistic effect, though HA-CS alone shows considerable promise.
• This approach offers a valuable alternative or adjunct to traditional antibiotic therapy for managing recurrent UTIs.