1. Efficacy of sodium hyaluronate in the management of chemical and radiation cystitis Sommariva et al. Minerrva Urol Nefrol 2010

2. Indications 1)Cystitis after radiotherapy for prostatic cancer 2)Cystitis in patients receiving inmuno-chemotherapeutic agents by intravesical injstillation for non-muscle invasive transitional cell carcinoma of the bladder (BCG or Mitomycin C) Poor and Slow response to the usual symptomatic treatments These bladder symptoms often mean that cancer therapy has to be interrupted, which has further clinical implications, like the impact on the possibility of success

3. Administration of Cystistat 69 male consecutive patients -15 after Radiotherapy (Rxt) -24 after BCG -30 after Mitomycin C

4. Administration of Cystistat Cystistat was administered weekly from 8 to 24 weeks, depending on how thye symptoms released. Lidocaine 2% 30 mL was instilled 30 min before, to allow patients to keep Cystistat within the bladder In the first 4 weeks, Dexamethasone 32 mg was mixed to HA looking for an antiinflammatory effect

5. Results – Bladder Capacity (BC) – Visual Analogic Score (VAS) for Pain After only 4 weeks BC increased in all patients, and Urgency and Pain almost disappeared. Treatment was continuedhowever for another 4 weeks, even in patients with total remission of their symptoms. It was seen previously by the authors that if therapy stopped to soon, then the symptoms could return.

6. Chemical Cystitis group RIC group BT AT BT AT VAS 8,6 0,9 Not Measured (Frequency + Urgency) BC BT AT BT AT 58,4 283,7 85,0 243,3

7. 97% reported complete relief of dysuria and pain No adverse reactions, allowing the conclusion of treatments for bladder cancer After therapy, urinary citology and cistoscopy ruled out bledderr cancer progression Conclusion: Intravesical Hyaluronan (HA) seems a valid and quick therapeutic solution for iatrogenic cystitis from chemo or radiotherapy