AccScience Publishing / Bladder / Online First / DOI: 10.14440/bladder.2024.0066
REVIEW

Hyaluronic acid as a treatment for refractory Bacillus Calmette–Guérin-induced cystitis: A narrative review

Ayoub Gomati1* Mai Teggaz1 Mazen Allam1 Wasim Mahmalji1
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1 Department of Urology, Wye Valley Trust, Hereford County Hospital, Hereford HR1 2EX, United Kingdom
Submitted: 24 November 2024 | Revised: 20 December 2024 | Accepted: 11 February 2025 | Published: 24 March 2025
© 2025 by the Author(s). This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution 4.0 International License ( https://creativecommons.org/licenses/by/4.0/ )
Abstract

Background: Hyaluronic acid (HA) instillation has emerged as a potential alternative treatment for Bacillus Calmette–Guérin (BCG)-induced cystitis, a common complication of BCG intravesical therapy for non-muscle-invasive bladder cancer (NMIBC). BCG-induced cystitis presents with symptoms similar to bacterial infections, such as urinary urgency, frequency, and pain. Conventional treatments, such as BCG discontinuation, antibiotic therapy, and corticosteroid use, are often insufficient. HA therapy works by restoring the bladder’s glycosaminoglycan layer, reducing inflammation, and promoting tissue repair. Objectives: This narrative review assessed the efficacy and safety of HA in managing BCG-induced cystitis based on a literature search of PubMed, Google Scholar, and Cochrane databases, identifying seven relevant studies. Conclusion: HA treatment has been associated with improvements in bladder symptoms, including reductions in pain, urgency, and frequency, as well as an increase in bladder capacity. Combination treatments with chondroitin sulfate or pirarubicin demonstrated superior outcomes compared to HA alone. While the studies reported minimal adverse effects, variability in study design, sample sizes, and follow-up durations limited the strength of the evidence. These findings suggest that HA can be safely administered to NMIBC patients alongside BCG therapy with minimal side effects and no adverse impact on treatment outcomes.

Keywords
Hyaluronic acid
Bacillus Calmette–Guérin-induced cystitis
Intravesical therapy
Glycosaminoglycan layer
Combination therapy
Chondroitin sulfate
Cystistat
Funding
None.
Conflict of interest
The authors declare no conflicts of interest.
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