Defects in the glycosaminoglycan layer (GAG) of the bladder mucosa have been identified as a significant contributor to the pathogenesis and clinical progression of chronic inflammatory diseases of the bladder, such as post-radiation cystitis, bladder pain syndrome and recurrent urinary tract infections. This narrative review aims to explore the contemporary evidence on the role of GAG reconstitution with intravesical installations of hyaluronic acid and chondroitin sulfate in the management of those patients, with a goal to provide valuable insights for clinical practice. The reviewed studies consistently demonstrate that GAG reconstitution can result in varying degrees of clinical improvement in patients with post-radiation cystitis, bladder pain syndrome and recurrent urinary tract infections, and is associated with a very favorable safety profile. While the available evidence is growing, its level is still limited, mainly by relatively low number of randomized controlled trials, with small sample sizes. Further research with larger, well-designed trials is needed to solidify the findings and optimize the clinical application of GAG reconstitution.
Pain and therapy. 2023 Nov 02 [Epub ahead of print]
Sławomir Poletajew, Magdalena M Brzózka, Wojciech Krajewski, Hubert Kamecki, Łukasz Nyk, Piotr Kryst
Second Department of Urology, Medical Centre of Postgraduate Education, Warsaw, Poland. ., Medical Department, IBSA Poland, Warsaw, Poland., Department of Minimally Invasive and Robotic Urology, Wroclaw Medical University, Wroclaw, Poland., Second Department of Urology, Medical Centre of Postgraduate Education, Warsaw, Poland.