Intravesical hyaluronic acid and chondroitin sulphate for recurrent urinary tract infections: a prospective multicentre comparison of two instillation protocols.

BACKGROUND: Recurrent urinary tract infections (r-UTIs) are highly prevalent in women and are associated with reduced quality of life and increased healthcare burden. Intravesical glycosaminoglycan (GAG) replenishment with hyaluronic acid (HA) and chondroitin sulphate (CS) has shown clinical benefit, but the optimal instillation schedule remains undefined. This study aimed to compare the safety and effectiveness of two HA + CS instillation protocols in women with r-UTIs. METHODS: In this prospective multicentre observational study, women ≥18 years with r-UTIs, defined according to European Association of Urology guidelines, were enrolled. Patients received HA + CS according to institutional practice: Group A (weekly instillations for 4 weeks followed by monthly maintenance for 12 months) or Group B (weekly instillations for 8 weeks followed by monthly maintenance for 12 months). Clinical evaluation, 3-day bladder diary, uroflowmetry (UF), post-void residual (PVR), visual analogue scale (VAS) for pelvic pain, urinalysis, urine culture, and ICIQ-FLUTS questionnaire were assessed at baseline and during follow-up (1, 3, 6, and 12 months). The primary outcome was the cumulative number of UTI episodes recorded throughout the entire 12-month follow-up period. RESULTS: A total of 140 women (70 per group) were included. At 12 months, mean UTI episodes decreased to 0.6 ± 0.5 in Group A and 0.7 ± 0.3 in Group B, without significant between-group differences (p > 0.05). Storage and voiding symptoms, pelvic pain (VAS), and ICIQ-FLUTS scores significantly improved from baseline in both groups (all p < 0.001). UF parameters and PVR remained stable. No serious adverse events were observed. CONCLUSION: Intravesical HA + CS significantly reduced UTI recurrence and improved urinary symptoms over 12 months. No statistically significant differences in clinical outcomes were observed between the two treatment groups over the 12-month follow-up.