Although the pathophysiology of acute chronic
cystitis and other '
sensory' disorders, i.e.
painful bladder syndrome (PBS) or
interstitial cystitis (IC), often remains multifactorial, there is a wide consensus that such clinical conditions may arise from a primary defective urothelium lining or from damaged
glycosaminoglycans (GAGs). A 'cascade' of events starting from GAG injury, which fails to heal, may lead to chronic bladder epithelial damage and
neurogenic inflammation. To restore the GAG layer is becoming the main aim of new
therapies for the treatment of chronic
cystitis and PBS/IC. Preliminary experiences with GAG replenishment for different pathological conditions involving the lower urinary tract have been reported. There is a range of commercially available intravesical formulations of these components, alone or in combination. Literature evidence shows that exogenous intravesical
hyaluronic acid markedly reduces recurrences of
urinary tract infections (UTIs). Patients treated with exogenous GAGs have fewer UTI recurrences, a longer time to recurrence and a greater improvement in quality of life. Exogenous intravesical GAGs have been used for the treatment of PBS/IC. Despite the limitations of most of the studies, findings confirmed the role of combination
therapy with
hyaluronic acid and
chondroitin sulfate as a safe and effective option for the treatment of PBS/IC. To prevent and/or treat
radiotherapy and
chemotherapy induced
cystitis, GAG replenishment
therapy has been used showing preliminary encouraging results. The safety profile of exogenous GAGs has been reported to be very favourable, without adverse events of particular significance.