Interstitial Cystitis / Painful Bladder Syndrome (IC/PBS)
Interstitial cystitis may be related to a loss in the high viscosity glycosaminoglycan (GAG) layer of the Urothelium. What is needed is a highly viscous substance that can provide a protective coating and subsequent healing effect. In the absence of bladder enzyme hyaluronidase, it can be expected that high molecular weight HA delivered locally via catheter will be able to reform longer in the bladder and have a sustained and lasting effect.
Regeneration of The Mucous Membrane of The
Urinary Bladder with INSTYLAN
Hyaluronic acid (HA) located in the basal membrane of cells helps to strengthen the urine and tissue barrier. Unlike surface GAGs which can be washed away with urine, HA creates a more stable permeability barrier.
Its large size and unique structure fills the interstitial space limits mobility and inhibits micro-organisms extension thereby reducing their pathogenicity, and by also facilitating the transport of nutrients promotes the regeneration of the urothelium.
The larger size of the hyaluronic acid molecules in INSTYLAN in comparison with other GAG substitutes, implies a higher efficiency of the barrier function. Low molecular weight fragments of HA have been shown to be present in the urine of patients with interstitial cystitis and have been reported to induce pro-inflammatory cytokines such as IL-12 and TNF-α, and could potentially exacerbate existing inflammation. High molecular weight HA are components of extracellular matrices and are more pre-resolving, shown to decrease secretion of inflammatory cytokines.
Higher Efficacy
Clinical studies have demonstrated high rates of objective response in intravesical application of HA.
“INSTYLAN is a High Molecular Weight Hyaluronic Acid of 2 million Dalton of higher concentration 80mg/50ml ”
95% of Patients with Chronic Cystitis Showed
Pronounced Positive Clinical Dynamics
Group 1, n = 10
Group 2, n = 11
Group 3, n = 9
INSTYLAN treatment study on severity of pain syndrome in nosological groups before and after treatment, scores *(p<0.05)1
Quality of Life Index
83% of patients in Instylan treatment group rated satisfactory Quality of Life (quality of life index L = 2)
Recurrent Urinary Tract Infection
A damaged GAG layer may increase the possibility of bacterial adherence and infection. This damage is proposed to be a causative factor in the development of interstitial cystitis…² A high molecular weight HA has high electronegativity and provides a better barrier protection.
Fig 1.
Fig 1. 24 hr post-UPEC infection of the urothelia: The monolayer of the HA-treated cells remained intact, suggesting that HA was functioning as a barrier and protecting the urothelium from bacterial adherence, and hence infection3.
Fig 1.
Fig 1. 24 hr post-UPEC infection of the urothelia: The monolayer of the HA-treated cells remained intact, suggesting that HA was functioning as a barrier and protecting the urothelium from bacterial adherence, and hence infection3.
Relief of HC Symptoms
Complete remission was defined as the disappearance of all symptoms; Partial response as cessation of blood clot discharges with the preservation of hematuria.
Treatment Of Hemorrhagic Radiocystitis
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The best evidence exists for intravesical hyaluronic acid as effective preventative and active treatment of hemorrhagic cystitis (HC).²
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Loss or defect in the glycosaminoglycan (GAG) layer which coats the uroepithelium is believed to be the first step in the development of HC.⁶
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As a result of using INSTYLAN, bleeding of the bladder wall significantly reduced, the intensity of pelvic pain and the frequency of urgent urination reduced in the absence of adverse reactions.²
“Improvement was generally observed in all patients during treatment, and persisted for 12 months.”
Comfort - Ergonomic Packaging
Packaging, which is more convenient both for the doctor and for self-instillation.
Mode of Administration
& Treatment Regiment
Ask your Doctor or urologist to find out more. INSTYLAN is available in most Medical Centres throughout Malaysia.
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The course of treatment includes 4 to 12 instillations.
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Warm the package to room temperature before use.
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Reduce water intake 4 hours before and after administration.
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Empty urinary bladder completely.
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INSTYLAN is administered into the cavity of the urinary bladder via a urological catheter; the duration of therapeutic exposure is from 30 minutes to 2 hours.
Mode of Administration & Treatment Regiment
-
The course of treatment includes 4 to 12 instillations.
-
Warm the package to room temperature before use.
-
Reduce water intake 4 hours before and after administration.
-
Empty urinary bladder completely.
-
INSTYLAN is administered into the cavity of the urinary bladder via a urological catheter; the duration of therapeutic exposure is from 30 minutes to 2 hours.
References
- O.D. Nikitin, The modern approach to intravesical therapy of chronic cystitis. Mens Health NN4 (55) 2015 ISSN 2307-5090
- S.P. Pasechnikov Intravesical hyaluronic acid – An effective option in the treatment of hemorrhagic radiocystitis Medical aspects of men’s health No. 1 (20) ‘2016
- Stakhovsky E.O. Practical application Instylan – modern protector of urinary bladder mucosa. National Cancer Institute, Ministry of Health of Ukraine, Kyiv
- Lavazzo C, et al., Hyaluronic acid: an effective alternative treatment of interstitial cystitis, recurrent urinary tract infections, and hemorrhagic cystitis? Eur Urol. 2007 Jun;51(6):1534-40; discussion 1540-1. Epub 2007 Mar 20.
- Catherine A Mowbray et al., High molecular weight hyaluronic acid: a two-pronged protectant against infection of the urogenital tract? Clinical & Translational Immunology 2018; e1021. doi: 10.1002/cti2.1021
- Payne H. et al. “Chemical- and radiation-induced haemorrhagic cystitis: current treatments and challenges BJU international
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