ORIGINAL ARTICLE Sequential hydrodistension and intravesical instillation of hyaluronic acid under general anaesthesia for treatment of refractory interstitial cystitis: a pilot study Imran Ahmad & Nalagatla Sarath Krishna & Robert N. Meddings Received: 19 December 2006 / Accepted: 4 August 2007 # International Urogynecology Journal 2007 Abstract Pilot study looking at the combination of general anaesthetic hydrodistension and intravesical hyaluronic acid for treatment of refractory interstitial cystitis. Twenty-three treatment refractory patients were recruited with an average age 53.4 years. All underwent general anaesthetic cysto- scopy, hydrodistension and instillation of hyaluronic acid (40 mg/50 ml). The bladder was then subsequently drained with the patient awake. Two initial treatments were carried out a month apart and duration between treatments increased depending upon symptom response. In the responders, the average number of treatments was 6.6 (median 4.5), duration between treatments was 3.1 months (median 2.6) and follow-up 15.8 months (median 16). Seventeen patients (74%) responded with immediate im- provement in symptoms. In all responders, healing of ulceration and resolution of inflammation occurred. Aver- age anaesthetic bladder capacity increased in the responder group from an average of 492 ml (median 500 ml) to an average of 776 ml (median 700 ml). Our pilot data suggests sequential hydrodistension and hyaluronic acid treatment under general anaesthesia may be considered for resistant cases of interstitial cystitis, especially those that cannot tolerate the instillation procedure under local anaesthesia. Further prospective trials are required. Keywords Interstital cystitis . Hyaluronic acid . Hydrodistension Introduction Interstitial cystitis (IC) is a chronically progressive, severely debilitating, heterogeneous syndrome affecting the urinary bladder, mainly associated with urgency, frequency and pain. It has been well known for over 100 years, but despite this the aetiology is poorly understood and universally effective treatments are lacking. Prominent amongst the theories is that interstitial cystitis may be related to a primary defect of the glycosaminoglycan (GAG) layer of the bladder urothelium [1]. This mucous layer of bladder urothelium is thought to protect against urinary toxins: ions, micro-organisms, crystal and toxic molecules. Qual- itative studies found different percentages of specific carbohydrates between IC cases and controls [2]. At present, it is well established that these abnormalities in the GAG layer exist in patients with IC, but whether they are the cause or an effect of this condition has yet to be ascertained [3]. Hyaluronic acid (HA) is a major mucopolysaccharide component of the extracellular matrix of most tissues and is widely distributed in most body fluids. It also forms an important component of the GAG layer on the bladder surface. Intravesical instillation of HA has been shown to benefit patients by relieving the distressing symptoms of pain, urinary frequency, urgency, nocturia and haematuria [4]. Morales et al. [4] reported a positive response rate in up Int Urogynecol J DOI 10.1007/s00192-007-0443-4 I. Ahmad : N. Sarath Krishna Department of Urology, Southern General Hospital, 1345 Govan Road, Glasgow G51 4TF, UK R. N. Meddings Department of Urology, Ayr Hospital, Dalmellington Road, Ayr KA6 6DX, UK Present address: I. Ahmad (*) 2/2 80 Beith Street, Glasgow G11 6DQ, UK e-mail: imranahmad@doctors.net.uk