Intravesical hyaluronic acid treatment in recurrent urinary tract infections in children with spina bifida and neurogenic bladder
Damage to the glycosaminoglycan layer 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...
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| Veröffentlicht in: | Journal of pediatric urology 2020-06, Vol.16 (3), p.366.e1-366.e5 |
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| creator | Cicek, Neslihan Yildiz, Nurdan Alpay, Harika |
| description | Damage to the glycosaminoglycan layer 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 40 mg 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 |
| doi_str_mv | 10.1016/j.jpurol.2020.02.009 |
| format | Article |
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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 40 mg 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.Summary TableData of study and control groupsSummary TableStudy GroupControl GrouppAge (years)11.1 ± 4.89.3 ± 5.40.44Gender (F/M)9/17/30.26UTI ppm before HA0.34 ± 0.0590.35 ± 0.060.77UTI ppm after HA0.11 ± 0.070.39 ± 0.07<0.001Follow-up time (month)16.6 ± 6.916 ± 6.10.83Serum creatine (mg/dl)0.33 ± 0.070.41 ± 0.140.13UTI: urinary tract infection, F: female, M: male, ppm: per patient-month, HA: hyaluronic acid.</description><identifier>ISSN: 1477-5131</identifier><identifier>EISSN: 1873-4898</identifier><identifier>DOI: 10.1016/j.jpurol.2020.02.009</identifier><identifier>PMID: 32197933</identifier><language>eng</language><publisher>England: Elsevier Ltd</publisher><subject>Child ; Hyaluronic acid ; Neurogenic bladder ; Spina bifida ; Urinary tract infection</subject><ispartof>Journal of pediatric urology, 2020-06, Vol.16 (3), p.366.e1-366.e5</ispartof><rights>2020 Journal of Pediatric Urology Company</rights><rights>Copyright © 2020 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c362t-941fda01e80cd7777e997263b9f77d4149407cfef5698450adc6db7deed6bd3a3</citedby><cites>FETCH-LOGICAL-c362t-941fda01e80cd7777e997263b9f77d4149407cfef5698450adc6db7deed6bd3a3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.jpurol.2020.02.009$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,777,781,3537,27905,27906,45976</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/32197933$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Cicek, Neslihan</creatorcontrib><creatorcontrib>Yildiz, Nurdan</creatorcontrib><creatorcontrib>Alpay, Harika</creatorcontrib><title>Intravesical hyaluronic acid treatment in recurrent urinary tract infections in children with spina bifida and neurogenic bladder</title><title>Journal of pediatric urology</title><addtitle>J Pediatr Urol</addtitle><description>Damage to the glycosaminoglycan layer 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 40 mg 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.Summary TableData of study and control groupsSummary TableStudy GroupControl GrouppAge (years)11.1 ± 4.89.3 ± 5.40.44Gender (F/M)9/17/30.26UTI ppm before HA0.34 ± 0.0590.35 ± 0.060.77UTI ppm after HA0.11 ± 0.070.39 ± 0.07<0.001Follow-up time (month)16.6 ± 6.916 ± 6.10.83Serum creatine (mg/dl)0.33 ± 0.070.41 ± 0.140.13UTI: urinary tract infection, F: female, M: male, ppm: per patient-month, HA: hyaluronic acid.</description><subject>Child</subject><subject>Hyaluronic acid</subject><subject>Neurogenic bladder</subject><subject>Spina bifida</subject><subject>Urinary tract infection</subject><issn>1477-5131</issn><issn>1873-4898</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><recordid>eNp9kE1r3DAQhkVp6ObrH5SiYy929eG1rEuhhCQNBHpJzkLWjLtavPJWklP2mH8emd32GF0kMc-8wzyEfOas5oy337b1dj_HaawFE6xmomZMfyDnvFOyajrdfSzvRqlqzSVfkYuUtoxJxYT-RFZScK20lOfk9SHkaF8weWdHujnYsWQG76h1HmiOaPMOQ6Y-0IhujnH5zNEHGw-lbN1SGtBlP4W0UG7jRygU_evzhqZ9IWnvBw-W2gA0YMn_jcuEfrQAGK_I2WDHhNen-5I8390-3fysHn_dP9z8eKycbEWudMMHsIxjxxyoclBrJVrZ60EpaHijG6bcgMO61V2zZhZcC70CRGh7kFZekq_H3H2c_syYstn55HAcbcBpTkbIjrclkMuCNkfUxSmliIPZR78rGxvOzCLfbM1RvlnkGyZMkV_avpwmzP0O4X_TP9sF-H4EsOz54jGa5DwGh-CL3Gxg8u9PeAN_GZte</recordid><startdate>20200601</startdate><enddate>20200601</enddate><creator>Cicek, Neslihan</creator><creator>Yildiz, Nurdan</creator><creator>Alpay, Harika</creator><general>Elsevier Ltd</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20200601</creationdate><title>Intravesical hyaluronic acid treatment in recurrent urinary tract infections in children with spina bifida and neurogenic bladder</title><author>Cicek, Neslihan ; Yildiz, Nurdan ; Alpay, Harika</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c362t-941fda01e80cd7777e997263b9f77d4149407cfef5698450adc6db7deed6bd3a3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Child</topic><topic>Hyaluronic acid</topic><topic>Neurogenic bladder</topic><topic>Spina bifida</topic><topic>Urinary tract infection</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Cicek, Neslihan</creatorcontrib><creatorcontrib>Yildiz, Nurdan</creatorcontrib><creatorcontrib>Alpay, Harika</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of pediatric urology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Cicek, Neslihan</au><au>Yildiz, Nurdan</au><au>Alpay, Harika</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Intravesical hyaluronic acid treatment in recurrent urinary tract infections in children with spina bifida and neurogenic bladder</atitle><jtitle>Journal of pediatric urology</jtitle><addtitle>J Pediatr Urol</addtitle><date>2020-06-01</date><risdate>2020</risdate><volume>16</volume><issue>3</issue><spage>366.e1</spage><epage>366.e5</epage><pages>366.e1-366.e5</pages><issn>1477-5131</issn><eissn>1873-4898</eissn><abstract>Damage to the glycosaminoglycan layer 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 40 mg 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.Summary TableData of study and control groupsSummary TableStudy GroupControl GrouppAge (years)11.1 ± 4.89.3 ± 5.40.44Gender (F/M)9/17/30.26UTI ppm before HA0.34 ± 0.0590.35 ± 0.060.77UTI ppm after HA0.11 ± 0.070.39 ± 0.07<0.001Follow-up time (month)16.6 ± 6.916 ± 6.10.83Serum creatine (mg/dl)0.33 ± 0.070.41 ± 0.140.13UTI: urinary tract infection, F: female, M: male, ppm: per patient-month, HA: hyaluronic acid.</abstract><cop>England</cop><pub>Elsevier Ltd</pub><pmid>32197933</pmid><doi>10.1016/j.jpurol.2020.02.009</doi></addata></record> |
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| subjects | Child Hyaluronic acid Neurogenic bladder Spina bifida Urinary tract infection |
| title | Intravesical hyaluronic acid treatment in recurrent urinary tract infections in children with spina bifida and neurogenic bladder |
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