Intravesical Hyaluronic acid for Painful Bladder Syndrome / interstitial Cystitis

PICHON RIVIERE, A.; AUGUSTOVSKI, F.; GARCIA MARTI, S.; GLUJOVSKY, D.; ALCARAZ, A.; LOPEZ, A.; BARDACH, A.; CIAPPONI, A; SPIRA, C

Documento de Evaluación de Tecnologías Sanitarias

IECS

Año: 2012 p. 1 - 30

1668-2793

Painful bladder syndrome/interstitial cystitis (PDS/IC) is a clinical diagnosis characterized by pelvic or bladder pain, urinary urge and increased urinary frequency. The lack of a unique standard diagnostic criterion makes its diagnosis difficult; therefore many times diagnosis is reached by exclusion. Many theories have been proposed, among them uroepithelial dysfunction due to anomalies in the glycosaminoglycan (GAG) layer. Diagnosis may be long and complex due to the absence of markers or specific diagnostic tests. There is no standard treatment. Several therapeutic options have been proposed, many of them with anti-inflammatory actions, such as GAG. Technology Hyaluronic acid (HA) instillation is performed directly into the bladder through a catheter. Treatment consists of weekly instillations for approximately 4-8 weeks or up to symptom remission; and then a monthly maintenance treatment for responders. Purpose To assess the available evidence on the efficacy, safety and issues related with use coverage policies of intravesical hyaluronic acid for patients with painful bladder syndrome/interstitial cystitis. Methods A bibliographic search was carried out on the main databases: DARE, NHS EED, on Internet general search engines, in health technology evaluation agencies and health sponsors. Priority was given to the inclusion of systematic reviews; controlled, randomized clinical trials (RCTs); health technology assessments and economic evaluations; clinical practice guidelines and coverage policies of other health systems. Results A controlled prospective study and 5 case series were included. The prospective, uncontrolled study evaluated 47 patients with PDS/IC who all underwent hydrodistension before treatment with HA, heparin or control arm. The objective was to evaluate the decrease in daily urinary frequency, symptom decrease measured by means of a visual analog scale (VAS) and the increase in bladder capacity over 9 months. In this time period, the decrease in urinary frequency (-1.8±2.5; p