Abstract
Introduction and hypothesisThe objective was to assess the efficacy of intravesical hyaluronic acid (HA) and chondroitin sulfate (CS), alone or in combination, for recurrent urinary tract infections (RUTIs) in adult female patients using a systematic review and meta-analysis.MethodsEnglish-language articles were obtained from the MEDLINE, Embase, and Cochrane databases through November 2016, by manual searching and cross-referencing. Randomized and nonrandomized trials of adult female patients with a documented history of RUTIs who received HA, CS or HA plus CS were included. The random effects model was applied to all pooled analyses. Risk of bias was assessed for individual studies and across studies.ResultsTwo randomized (n = 85) and six nonrandomized (n = 715) studies met the inclusion criteria. These studies assessed HA ± CS; studies of CS alone were not identified in the search. HA ± CS decreased the UTI rate per patient-year (pooled mean difference [MD] –2.56; 95% confidence interval [CI] –3.86, −1.26; p < 0.001) and increased the time to first UTI recurrence (pooled MD 130.05 days; 95% CI 5.84, 254.26; p = 0.04). There was heterogeneity in most outcomes considered, and publication bias in many studies. The standard of trial reporting was low. The patient population size, and the number of studies included, were small.ConclusionsHA ± CS appears to reduce the rate of UTI and increase the time to recurrence in women with RUTI. As randomized controlled studies are available only for HA plus CS, the quality of evidence is higher for the combination than for HA alone.
Highlights
Introduction and hypothesisThe objective was to assess the efficacy of intravesical hyaluronic acid (HA) and chondroitin sulfate (CS), alone or in combination, for recurrent urinary tract infections (RUTIs) in adult female patients using a systematic review and meta-analysis
When compared with control treatment, HA, with or without CS, was associated with a significantly lower mean UTI rate per patient-year (MD –2.56; 95% CI –3.86, −1.26; p < 0.001; Fig. 2a) and a significantly longer time to UTI recurrence (MD 130.05 days; 95% CI 5.84, 254.26; p = 0.04; Fig. 2b)
The percentage of patients with UTI recurrence during follow-up was lower with HA plus CS than in the control group (RR 0.75; 95% CI 0.57, 0.99; p = 0.043; Fig. 2c)
Summary
Introduction and hypothesisThe objective was to assess the efficacy of intravesical hyaluronic acid (HA) and chondroitin sulfate (CS), alone or in combination, for recurrent urinary tract infections (RUTIs) in adult female patients using a systematic review and meta-analysis. Randomized and nonrandomized trials of adult female patients with a documented history of RUTIs who received HA, CS or HA plus CS were included. Results Two randomized (n = 85) and six nonrandomized (n = 715) studies met the inclusion criteria. According to the European Association of Urology guidelines, recurrent UTI (RUTI) is defined as the occurrence of at least three episodes of uncomplicated infection, documented by positive urine culture (>103 colonyforming units/mL [cfu]) in the previous 12 months [7]. The specific strategy for patient care depends on individual clinical characteristics (e.g., the number of recurrences per year), risk factors, and preferences, RUTIs are commonly managed with intermittent or prolonged antibiotics therapy [7]. In isolates from UTIs, varying degrees of resistance to multiple antibiotics are commonly reported [10,11,12,13,14,15], and those studies
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