Intravesical Instillation of Hyaluronic Acid
What is intravesical instillation of hyaluronic acid and how does it work?
Intravesical instillation is a modern, innovative method of intravesical treatment of interstitial cystitis and other various lower urinary tract disorders. For this purpose, a sterile solution of high concentration of sodium hyaluronate (Instylan, Hyacyst) is used, which works on the principle of effective and long-term restoration of the natural protective layer of glycosaminoglycans (GAG) of the bladder mucosa. The protective layer of GAG plays a very important role in protecting the urothelium, and also has a significant impact on blood vessels and endothelial cells. It is known that its deficiency can cause various diseases. Therefore, a weakened GAG layer is one of the main reasons for the increased penetration of harmful compounds in urine to the bladder wall, which causes inflammation and irritation. When hyaluronic acid is introduced into the bladder, it creates a highly elastic layer on the surface of the mucosa, as well as a three-dimensional molecular network in the interstitial space of the connective tissue, thereby effectively repairing existing microdamage.
How is intravesical instillation of hyaluronic acid performed?
The procedure is quick and simple and is performed on an outpatient basis without any special prior preparation or anesthesia. The hyaluronic acid preparation (Instylan, Hyacyst) is directly inserted into the bladder using a thin-profile disposable urinary catheter, which is immediately removed, while the solution is being left in the bladder until the patient urinates spontaneously. Immediately after the procedure, the patient is discharged home, and natural body movement will ensure proper distribution of the solution in the bladder. The content of the bladder should be retained as long as possible, for at least 30 minutes. The patient can also remain in a lying position, but then active positioning and movement are necessary for better distribution of the preparation in the bladder. The preparation is stored at room temperature, and the temperature of the solution before administration should be at least 20 °C.
When can results be expected after the use of intravesical hyaluronic acid treatment?
Due to the nature of the disease and the mechanism of action, improvement in the effectiveness of the therapy and the quality of life of patients is achieved after repeated administration, despite the fact that most patients feel relief after the first administration.
Instillation is continued for 4-6 times/once a week, with maintenance once a month, for a total of up to 12 treatments or until the symptoms disappear completely. Irregular treatment may lead to a relapse of the disease.
What are the indications for intravesical instillation of hyaluronic acid?
Intravesical instillation is a simple and effective solution for the following long-term symptoms of damage to the GAG layer and urothelium, as well as lower urinary tract disorders:
- recurrent/chronic bacterial cystitis
- post-radiation cystitis
- painful bladder/chronic pelvic pain syndrome
- overactive bladder
- painful urination and other painful symptoms
- urinary urgency and poor quality of life due to chronic lower urinary tract disorders
- after instrumental manipulations (cystoscopy, ureteroscopy, transurethral resection, etc.).
Numerous clinical studies have shown a high frequency of objective response to intravesical instillation of hyaluronic acid. As a practical and clinically confirmed treatment with a successful therapeutic effect and a significant improvement in the quality of life, intravesical instillation is a respectable and reliable therapeutic option for patients with the aforementioned disorders resistant to conventional medical treatments.
