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Updated: Jul 17, 2026
Vessel-sparing Excision and Primary Anastomosis
Published on: January 7, 2019
Intravesical HA/EGF Salvage Therapy for Hyaluronic Acid-Refractory Interstitial Cystitis/Bladder Pain Syndrome: A
Wen-Chen Huang1,2,3,4, Jenn-Ming Yang5
1Department of Obstetrics and Gynecology, Cathay General Hospital, Taipei, Taiwan.
Introduction And Hypothesis:
Some patients with interstitial cystitis/bladder pain syndrome (IC/BPS) remain symptomatic despite prolonged intravesical hyaluronic acid (HA). We report a small retrospective pilot case series evaluating HA plus epidermal growth factor (HA/EGF) as salvage therapy in selected HA-refractory patients.
Methods:
HA nonresponders were identified from a multicenter routine-care IC/BPS program. Nonresponse was defined as Global Response Assessment (GRA) < +2 after at least 2 years of HA instillation. Patients electing HA/EGF received eight instillations over 6 months. Outcomes included pain visual analog scale (Pain-VAS), diary variables, Interstitial Cystitis Symptom Index/Problem Index (ICSI/ICPI), GRA, European Society for the Study of Interstitial Cystitis (ESSIC) grade, cystoscopic bladder capacity, and early treatment intolerance. Within-patient changes were analyzed using paired tests. Composite salvage success required ≥ 50% Pain-VAS reduction, ≥ 50-mL functional bladder capacity increase, and ≥ 50% nocturia reduction.
Results:
Twelve women initiated HA/EGF and 11 completed 6 months. Pain-VAS decreased by 6.7 ± 1.8 points and functional bladder capacity increased by 106 ± 41 mL (both p < 0.001). Daytime frequency and nocturia decreased by 5.6 and 3.1 episodes (both p < 0.01), and ICSI/ICPI improved (both p < 0.001). Cystoscopic improvement occurred in 8/11 (73%), and composite salvage success in 9/11 (82%). Severe early dysuria occurred in 2/12, with one patient discontinuing treatment. No serious procedure-related adverse events were recorded.
Conclusions:
HA/EGF was associated with clinical, voiding, and cystoscopic improvements and acceptable short-term tolerability in selected HA-refractory IC/BPS patients. These preliminary findings are hypothesis-generating and require prospective controlled validation.
