Among all urinary tract infections, chronic cystitis ranks first in prevalence. Most often, cystitis affects women due to the anatomical features of the structure of the urinary tract. In the treatment of cystitis in women, there are always many questions about the appropriateness and effectiveness of the use of certain drugs. Recently, hyaluronic acid preparations have been used in the treatment of cystitis. Why it is advisable to use hyaluronic acid in the treatment of cystitis in women, read in our article.
Chronic cystitis. Reasons for the development of chronic cystitis
Cystitis can be acute or chronic. Acute cystitis does not cause any special problems in the treatment. But the treatment of chronic cystitis is difficult and often ineffective. Cystitis is considered chronic with three or more flare-ups per year.
Causes of chronic cystitis may include urinary tract stones, abnormalities in the anatomical structure of the urinary tract, the presence of a source of bacteriuria, and disruption of the normal passage of urine. Among these all clinical situations, a common process is permanent damage to the bladder mucosa. These damages lead to hyperplastic or atrophic changes in the mucous membrane of the bladder, to an increase in the frequency of episodes of exacerbation of chronic cystitis.
Dystrophic and atrophic changes in the bladder mucosa create a favorable environment for further damage to the stack and progression of the disease. When diagnosing chronic cystitis, identification of the source of bacteriuria, assessment of the condition of the bladder mucosa and microbiological examination are of great importance.
Treatment of cystitis in women. The role of hyaluronic acid in the treatment of cystitis
Treatment of chronic cystitis consists of etiotropic bacterial therapy. But along with the use of antimicrobial therapy, the issue of preventing frequent relapses, that is, protecting the bladder mucosa, remains relevant. It is important in the treatment of chronic cystitis to pay attention to the restoration of the protective forces of the walls of the bladder.
The treatment of cystitis in women is based on the use of drugs to protect the bladder wall using instillations, which are divided into cauterizing, anti-inflammatory and enveloping.
A group of drugs is being studied to strengthen the tissue framework of the bladder wall and create conditions for restoring the physiological barrier of the endothelium. One of the most commonly used classes of drugs in the treatment of cystitis in women are hyaluronic acid preparations.
Hyaluronic acid – a substance from the group of non-sulfated glycosaminoglycans. It is this substance that is the basis of the connective tissue and ensures its integrity.
Hyaluronic acid is a part of epithelial cells and nervous tissue, takes part in the process of cell proliferation. In addition, hyaluronic acid can be used for patients of all ages and genders. Chronic cystitis – This is an interstitial inflammatory process, which is based on a violation of the barrier between hyperosmolar urine and the intercellular substance of the bladder wall. This allows toxic substances from the urine to enter the stroma.
Treatment of chronic cystitis with hyaluronic acid. Research results
Hyaluronic acid preparations have been used in medicine for a long time, when their properties had not yet been studied and proven. The latest studies that confirm the effectiveness are needed for evidence-based medicine.
Study #1.
A study was conducted in 121 women aged 17 to 83 years with a diagnosis of chronic interstitial cystitis, painful bladder syndrome, with a mean duration of symptoms of 6 years.
Women underwent regular weekly instillation of hyaluronic acid preparations until the symptoms completely disappeared. Together with hyaluronic acid, nitrofurantoin was used in instillations to prevent complications during catheterization.
The results were based on the patients' feelings about the symptoms of chronic cystitis on a scale of 0 to 10. As a result of the study, it turned out that an improvement of at least 2 points on average was detected in 85% of women. 19 women noted the complete disappearance of symptoms.
As a result, it turned out that hyaluronic acid preparations are well tolerated in the treatment of chronic cystitis and do not cause side effects.
Study #2.
Another study was conducted in 33 women who had symptoms of chronic cystitis and who had no or little effect on drug therapy.
Women took 40 mg of hyaluronic acid by instillation for 4 weeks. The aim of the study was to determine the effect of hyaluronic acid on Hunner's ulcers, a characteristic manifestation of chronic interstitial cystitis. As a result, 61% of women noted a significant improvement in their condition.
Study #3.
A third study was carried out to determine the presence of anti-inflammatory and protective effects on the bladder wall. The studies were conducted in vitro.
Cultures of endothelial cells treated with hyaluronic acid were used. Studies have shown that hyaluronic acid is able to reduce induced cytokine production by 5 times and prevent a new development of the inflammatory process in chronic cystitis.
An increase in the formation of sulfated glycosaminoglycans and a decrease in transepithelial permeability have been noted without damage to natural barriers.
The main effects of hyaluronic acid on the course of chronic cystitis have been identified:
- decrease in the frequency and amplitude of contraction of the walls of the bladder;
- decrease in the level of bacterial growth;
- reduction of damage to the epithelium;
- inhibition of the inflammatory process in the wall of the bladder.
Based on the data of three studies, the authors conclude that the use of hyaluronic acid is the main clinical vector in the treatment of chronic cystitis.
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