The role of hyaluronic acid in the management of uncomplicated recurrent female urinary tract infections: literature review and practical experience

Aim: To assess the efficacy and safety of intravesical hyaluronic acid (HA) in the management of female patients with recurrent urinary tract infections (UTIs) in our hospital. Also to perform a literature review about the use of Glycosaminoglycan (GAGs) such as hyaluronic acid (HA) and chondroitin sulphate (CS) in the management of female recurrent UTI and compare our findings to the published evidence available. Method: We performed a literature review of studies using HA or CS for the management of recurrent UTIs. We retrospectively reviewed the outcome of 22 female patients who were treated at our district general hospital for recurrent UTIs refractory to first line management and compared our experience of using this treatment to the recently published literature. Results: Literature review showed growing evidence for the use of intravesical HA and HA-CS for the prevention of female recurrent UTIs including three recently published prospective randomised controlled trials (RCTs). These studies show a reduction in UTIs by over 70% in comparison to placebo and that intravesical treatment is more effective than low dose antibiotic prophylaxis. In our experience, intravesical HA was an effective second line treatment for females with recurrent UTIs. Of 22 patients with recurrent UTIs (aged 17 - 72 years), 64% (14 patients) remained recurrence free one year after treatment. In our experience, this treatment was tolerated well by the patients with minimal side effects. Conclusion: HA offers an effective management option for female patients with recurrent UTIs. It is a safe and effective second line treatment for female patients with recurrent urinary tract infections that may be refractory to first line management strategies.