Department of Urology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, 20122, Italy.
Department of Clinical Sciences and Community Health, University of Milan, Milan, 20122, Italy.
J Sex Med. 2024 Jun 27;21(7):627-634. doi: 10.1093/jsxmed/qdae052.
Intravesical instillation of hyaluronic acid (HA) has been associated with reduced sexual dysfunction in participants with recurrent urinary tract infections (rUTIs), but the efficacy of an oral treatment has never been investigated.
To investigate the efficacy of an oral preparation of HA, chondroitin sulfate, N-acetylglucosamine, and vitamin C in improving sexual and urinary symptoms in a cohort of reproductive-age participants with rUTI.
In a monocentric randomized crossover pilot trial, participants with rUTI who were referred to our institute between March 2022 and April 2023 were randomized 1:1 in 2 groups: intervention vs control. All participants had an oral preparation of cranberry, D-mannose, propolis extract, turmeric, and Boswellia twice a day for 3 months. The intervention group also included an oral preparation of HA, chondroitin sulfate, N-acetylglucosamine, and vitamin C once a day for 3 months. Crossover of treatment occurred at 3 months for an additional 3 months. At baseline and 3 and 6 months, participants were evaluated clinically and with the International Prostate Symptom Score (IPSS) and Female Sexual Function Index (FSFI). Descriptive statistics and logistic regression models tested the impact of the intervention on urinary and sexual symptoms at each follow-up assessment.
Improvement in sexual and urinary symptoms as measured by the FSFI and IPSS.
Overall, 27 (54%) participants had an FSFI score <26.5 at enrollment. At 3 months, FSFI scores were higher in the intervention group vs control (P < .001), but IPSS scores were lower (P = .03). After crossover of treatment, FSFI and IPSS scores remained stable in the intervention group. However, after crossover, the control group showed a significant improvement in IPSS and FSFI scores (all P < .01) vs the 3-month assessment. At last follow-up, urinary and sexual symptoms were comparable between groups. In logistic regression analyses, the intervention group was associated with early improvement in sexual symptoms (odds ratio, 3.9; P = .04) and urinary symptoms (odds ratio, 5.1; P = .01) after accounting for clinical confounders.
Combination treatment with HA, chondroitin sulfate, N-acetylglucosamine, and vitamin C is effective if started immediately or even after a few months from symptoms in participants with rUTI.
The main limitation is the lack of long-term follow-up.
The oral formulation of HA, chondroitin sulfate, N-acetylglucosamine, and vitamin C could be an effective therapy against urinary and sexual distress in participants with rUTI (NCT06268483; ClinicalTrials.gov).
膀胱内注射透明质酸（HA）已被证明可降低复发性尿路感染（rUTI）患者的性功能障碍，但口服治疗的疗效尚未得到研究。
研究口服 HA、硫酸软骨素、N-乙酰葡萄糖胺和维生素 C 制剂在改善复发性尿路感染生育期患者的性和尿路症状方面的疗效。
在一项单中心随机交叉先导试验中，2022 年 3 月至 2023 年 4 月期间转至我院的 rUTI 患者被随机分为 1:1 两组：干预组和对照组。所有患者均每日两次口服蔓越莓、D-甘露糖、蜂胶提取物、姜黄和 Boswellia 制剂，持续 3 个月。干预组还每日口服一次 HA、硫酸软骨素、N-乙酰葡萄糖胺和维生素 C 制剂，持续 3 个月。治疗交叉在 3 个月时进行，再持续 3 个月。在基线、3 个月和 6 个月时，采用国际前列腺症状评分（IPSS）和女性性功能指数（FSFI）对患者进行临床评估和评估。描述性统计和逻辑回归模型测试了干预措施对每个随访评估时的尿路和性功能症状的影响。
整体而言，27 名（54%）患者在入组时 FSFI 评分<26.5。3 个月时，干预组的 FSFI 评分高于对照组（P<.001），但 IPSS 评分较低（P=.03）。治疗交叉后，干预组的 FSFI 和 IPSS 评分保持稳定。然而，治疗交叉后，对照组的 IPSS 和 FSFI 评分均显著改善（均 P<.01），与 3 个月评估相比。最后一次随访时，两组间的尿路和性功能症状相当。在逻辑回归分析中，在考虑了临床混杂因素后，干预组与性症状（优势比，3.9；P=.04）和尿路症状（优势比，5.1；P=.01）的早期改善相关。
如果在 rUTI 症状出现后立即或甚至几个月开始使用 HA、硫酸软骨素、N-乙酰葡萄糖胺和维生素 C 的联合治疗，可能是有效的。
