Intravesical hyaluronic acid with chondroitin sulphate to prevent urinary tract infection after spinal cord injury

Abstract

Context/Objective

Prevention of urinary tract infection (UTI) after spinal cord injury is an important goal. Intravesical hyaluronic acid with chondroitin sulphate (HA+CS) has been effective in preventing UTI in other settings. We aimed to demonstrate safety and feasibility of a standard treatment course of 7 intravesical HA+CS instillations over 12 weeks, in patients with acute (Arm A) and chronic (Arm B) spinal cord injury (SCI).

Design

Follow-up of adverse events, quality of life bladder management difficulty (BMD) and bladder complication (BC) T-scores at baseline (Arm B only), 12 and 24 weeks, and symptomatic urinary tract infection (UTI).

Results

Of 33 and 14 individuals screened, 2 and 8 participants were recruited to the study for Arm A and Arm B respectively. Of the 10 participants, 8 completed all 7 instillations. HA+CS commonly caused cloudy urine with urinary sediment which was mild and short-lived. In Arm B, a mean reduction in BMD and BC T-scores was observed from baseline (57.3 and 54.4 respectively), of 6.8 and 4.3 at 12 weeks and 1.6 and 2.8 at 24 weeks, respectively. Four participants with a history of frequent UTI in the prior 12 months did not have UTI in the 24 weeks of the study.

Conclusions

HA+CS was well tolerated. Recruitment was more difficult in early acute SCI; participants with chronic SCI were highly motivated to reduce UTI and manage self-administration without difficulty. Larger case–control or randomized controlled trials in patients with neurogenic bladder from SCI are warranted.

Trial registration

ClinicalTrials.gov identifier: NCT03945110.

Keywords:

• Urinary tract infection
• UTI
• Spinal cord injury
• Hyaluronic acid
• Chondroitin sulphate

Conflicts of interest

No potential conflict of interest was reported by the author(s).

Funding

This study was funded via the NRP/ICWA (Neurotrauma Research Program [Perron Institute for Neurological and Translational Science, Western Australia] and the Insurance Commission of Western Australia) Grant Program.

Author contributions

GK King: Project development, data collection, data analysis, manuscript writing; LM Goodes: project development, data collection, data analysis, manuscript writing; C Hartshorn: project development, data collection, manuscript writing; J Thavaseelan: project development, manuscript writing; S Jonescu: data collection; A Watts: project development, data collection; M Rawlins: project development, data analysis, manuscript writing; P Woodland: project development, manuscript writing; E-L Synnott: project development, data analysis, manuscript writing; T Barrett: project development, manuscript writing; D Hayne: project development, manuscript writing; P Boan: project development, data collection, data analysis, manuscript writing; SA Dunlop: project development, data collection, data analysis, manuscript writing.

Data deposition

Data is completely supplied in this manuscript. There is no supplemental data.