The Comparison of intravesical hyaluronic acid and other modalities for the improvement of interstitial cystitis symptoms: a systematic reviews and meta-analysis

Background: Interstitial cystitis (IC) is a chronic inflammation of the bladder which causes unpleasant sensations. This condition considerably reduces patients' quality of life. Intravesical hyaluronic acid is one of the new interventions for interstitial cystitis management, in which a thorough review and meta-analysis regarding this topic are still limited. This study aimed to compare the efficacy of intravesical hyaluronic acid with other intravesical treatment modalities available to treat interstitial cystitis.Method: Systematic literature searching with the main keywords of "interstitial cystitis" or "bladder pain syndrome" and "intravesical hyaluronic acid" was conducted. The main outcome of this study was pain assessment using a visual analogue scale (VAS) and Interstitial Cystitis Symptoms Index (ICSI), and problem index (ICPI). Meta-analysis was carried out when comparative studies were available. Eleven studies were obtained to assess intravesical hyaluronic acid's effects, including three in the meta-analysis. The intravesical treatments found as a comparison were heparin and chondroitin sulphate.Result: There was significant heterogeneity among studies included in all parameters. The pooled analysis showed no significant difference in VAS reduction, improvement of ICSI and ICPI score (p = 0.11, p = 0.35, and p = 0.28, respectively) between hyaluronic acid and other intravesical treatments.Conclusion: There was no significant difference between hyaluronic acid and other intravesical treatments. However, further research with a larger sample is needed to confirm the best modalities in interstitial cystitis.