Effectiveness of intravesical glycosaminoglycans in the treatment of recurrent urinary tract infections: Systematic review and meta-analysis

Objective: The objective of the study was to determine the efficacy of glycosaminoglycans in bladder instillation compared with placebo or other forms of prophylaxis in women with recurrent urinary tract infections (UTIs). Methods: A search strategy was performed in the Cochrane central register, Embase, and Medline until October 2020, along with manual searches and reference-list checking. Randomised and nonrandomized studies in women with recurrent UTIs who received hyaluronic acid (HA) or HA plus chondroitin sulfate (CS) were included. A random-effects model was applied to the pooled results. The risk of bias was evaluated using the Cochrane RoB 2 bias tool for clinical trials and MINORS for nonrandomized studies. The quality of the evidence was evaluated by the GRADE method. Results: One randomised study and eight nonrandomized studies were included. All evaluated HA or HA plus CS. HA or HA plus CS decreased the average UTI patient-years (mean difference (MD) = -2.62; 95% confidence interval (CI) = -4.00 to -1.23), increased the time to recurrence (MD = 145.70; 95% CI = 61.57 to 229.83), and improved symptoms and quality of life as evaluated through the total pelvic pain and urgency/frequency score (MD = -6.08; 95% CI = -7.68 to -4.48) and the visual analog scale (MD = -4.79; 95% CI = -5.55 to -4.03). There was high heterogeneity in the results, a high risk of bias in the one randomised study, and a low quality of evidence according to GRADE. The number of included studies was low. Conclusion: The application of HA or HA plus CS in intravesical instillation is associated with fewer UTI recurrences and improved symptoms and quality of life. The quality of the evidence provided by the studies is limited, so more studies of higher quality are needed to yield definitive conclusions.