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Question 9#

How does Cystistat (hyaluronic acid) work?

A. Direct inhibition of mast cells in the urothelium
B. Coating of the urothelium
C. Intravesical instillation of histamine antagonist aimed to replenish the GAG layer
D. Intravesical instillation of proteoglycan aimed to repair defects in the GAG layer
E. Oral therapy substituting defects in the GAG layer

Correct Answer is D

Comment:

Answer D

There are numerous treatment regimens for bladder pain syndrome with different modes of administration and mechanism of action. Oral therapy includes the histamine receptor antagonist hydroxyzine (blocking mast cell activation) and pentosan polysulphate (Elmiron) which acts by repairing defects in the GAG layer. Intravesical treatments include local anaesthetics, heparin, pentosan polysulphate, hyaluronic acid and dimethyl sulphoxide (DMSO). DMSO acts by scavenging free radicals thus decreasing inflammation. Hyaluronic acid acts by repairing defects in the GAG later and it is postulated that heparin has similarities with the GAG layer.

Further Reading:

Vij M, Srikrishna S, Cardozo L. Interstitial cystitis: Diagnosis and management. Eur Obstet Gynecol Reprod Biol, 2012; 161: 1–7.