The use of intravesical hyaluronic acid for the treatment of refractory interstitial cystitis/bladder pain syndrome in Taiwan

Interstitial cystitis/bladder pain syndrome (IC/BPS) is a chronic bladder disease characterized by pelvic pain, irritative urinary symptoms and typical cystoscopic findings in the absence of other identifiable pathology. Intravesical hyaluronic acid (HA) instillation, which is a glycosaminoglycan replenishment therapy, has been indicated for the treatment of refractory IC/BPS in Taiwan since 2008. To assess treatment outcomes, we conducted a thorough literature review and EMBASE, PubMed and The Cochrane Library were used to retrieve relevant studies. Eight studies with a total of 428 patients were included in the review. A standard 6-month therapy with four weekly followed by five monthly bladder instillations was used in these studies. All studies reported statistically significant (p < 0.05) improvements of bladder symptoms, bother and overall bladder conditions after treatment via the pain-Visual Analogue Scale, the O'Leary-Sant Interstitial Cystitis Symptom and Problem Index, a three-day voiding diary and the Global Response Assessment. Hyaluronic acid instillation also significantly (p < 0.05) improved urodynamic parameters, sexual function scores, and mental health scores. However, some bladder pain and storage symptoms persisted, and cystoscopic abnormality was not improved after treatment in most patients. No significant adverse events from the treatment were reported. In conclusion, intravesical HA therapy is a safe and effective treatment for refractory IC/BPS. The persistence of some bladder pain, storage symptoms, and cystoscopic abnormalities after treatment verifies the chronicity of the disease. Further studies on maintenance and additional therapy for refractory IC/BPS with longer-term follow-up are necessary to further improve treatment outcomes.