Glycosaminoglycan replacement therapy in preventing women’s recurrent urinary tract infections?: A systematic review and meta-analysis

Abstract

The aim of this study is to systematically review the published literature and pool the data to evaluate the effectiveness of glycosaminoglycans (GAGs) replacement therapy in preventing women’s recurrent urinary tract infections (rUTIs). A systematic search of PubMed was performed to identify comparative and randomized controlled trials that compared the efficacy of GAG replacement therapy with control groups (placebo/antibiotics/standard therapy) in preventing rUTI in women. The evaluated outcomes included risk of rUTI, rUTI episodes per patient-year, time to urinary tract infection recurrence, pelvic pain and urgency/frequency, and the quality of life (Short Form-36 questionnaire). The Cochrane Collaboration Review Manager software (RevMan, version 5.4) was used for statistical analysis. Seven trials, including 2 randomized control studies and 5 retrospective comparative trials, met the inclusion criteria and were enrolled into our meta-analysis. A total of 702 patients were included in the analysis. Five studies adopted intravesical instillations and 2 used oral-administered hyaluronic acid. The synthesized results revealed that GAG replacement therapy significantly reduced the risk of rUTI (odds ratio: 0.31), reduced urinary tract infection-associated symptoms on pelvic pain and urgency/frequency scores (WMD: −6.70), and contributed to nonsignificant influence in quality of life, prolongation of time to rUTI, and the risk of rUTI per patient-year. In conclusion, the current meta-analysis revealed that GAG replacement therapy might serve as an alternative treatment strategy for rUTI. Further studies should focus on the durability of the protective effect of hyaluronic acid and the optimal protocol for dosage and administration route for GAG replacement therapy.