Intravesical hyaluronic acid treatment in recurrent urinary tract infections in children with spina bifida and neurogenic bladder

Abstract

Damage to the glycosaminoglycanlayer of the urothelium, which is composed of hyaluronic acid (HA), may increase the possibility of bacterial adherence and infections. Patients with neurogenic bladder (NB) who perform clean intermittent catheterization (CIC) 4-6 times a day are also under great risk for recurrent urinary tract infections (RUTIs). The aim of this study was to assess the efficacy and safety of intravesical HA in reducing the frequency of RUTIs in patients with spina bifida (SB) and NB, who perform CIC. Ten patients (nine girls, one boy) with SB and NB affected by RUTIs received intravesical instillation of HA. Ten patients (seven girls, three boys) with SB and NB who did not accept the intravesical HA therapy were included in the control group. All patients developed symptomatic RUTIs, which occurred at least three times in the previous 12 months. The study group was treated with intravesical 40mg HA (Hyacyst®) weekly for four weeks, then monthly for the consequent three months. Recurrence of UTIs before and after the treatment was analyzed. The mean age of the study group and the controls were 11.1±4.8 (3.2-18.6) and 9.3±5.4 (2.1-16.2) years, respectively. The mean UTIs per patient-month in the study group and the controls were 0.34±0.05 and 0.35±0.06, respectively. The mean follow-up time after the treatment was 16.6±6.9 months in the study group and 16±6.1 months in the controls. The mean UTIs per patient-month significantly decreased in the study group after the treatment (p<0.001) but showed no significant difference in the control group (p=0.174). When study and control groups were compared, the mean UTIs per patient-month showed no significant difference before treatment (p=0.77) but significantly decreased in the study group after the treatment (p<0.001). To the best of the authors' knowledge, this study is the first one evaluating the efficacy of intravesical HA in the treatment of RUTIs in children with SB and NB. However, this study has several limitations, such as the small sample size and short follow-up time. The findings of the present study indicate that intravesical HA is an effective and safe treatment that reduces RUTIs in patients with SB and NB, who perform CIC.