2. Engelhardt PF, Morakis N, Daha LK et al. Long-term results of intravesical hyaluronan therapy in Bladder Pain Syndrome/Interstitial Cystitis. Int Urogynecol J 2011;22:401-405.

3. Constantinides C, Manousakas T, Nikolopoulos P et al. Prevention of recurrent bacterial cystitis by intravesical administration of hyaluronic acid: a pilot study. Br J Urol lnt 2004;93:1262-1266.

4. Delgado Perez JM, Samper P & Garrido JS. Hyaluronic acid in the prevention of radiation-induced cystitis. Proc Am Soc Clin Oncol 2003;22.

7. Raymond I, Vasdev N, Ferguson J et al. The clinical effectiveness of intravesical sodium hyaluronate (Cystistat) in patients with interstitial cystitis/painful bladder syndrome and recurrent urinary tract infections. Curr Urol 2012;6:93-98.

9. Kallestrup EB, Jørgensen SS, Nordling J et al. Treatment of interstitial cystitis with Cystistat: A hyaluronic acid product. Scand J Urol Nephrol 2005;39:143-147.

10. Sommariva ML, Sandri SO & Ceriani V. Efficacy of sodium hyaluronate in the management of chemical and radiation cystitis. Minerva Urol Nefrol 2010;62:145-150.

11. Morales A, Emerson L, Nickel JC et al. Intravesical hyaluronic acid in the treatment of refractory interstitial cystitis. J Urol 1996;156:45-48.

12. Lipovac M, Kurz C, Reithmayr F et al. Prevention of recurrent bacterial urinary tract infections by intravesical instillation of hyaluronic acid. lnt J Gynaecol Obstet 2007;96:192-195.

13. Ahmad I, Sarath Krishna N & Meddings RN. Sequential hydrodistension and intravesical instillation of hyaluronic acid under general anaesthesia for treatment of refractory interstitial cystitis: a pilot study. lnt Urogynecol J 2007;19:543-546.

14. Nickel JC, Egerdie B, Downey J et al. A real-life multi-centre clinical practice study to evaluate the efficacy and safety of intravesical chondroitin sulphate for the treatment of interstitial cystitis. BJU lnt 2009;103:56-60.

15. Nickel JC, Egerdie RB, Steinhoff G et al. A multicenter, randomized, double-blind, parallel group pilot evaluation of the efficacy and safety of intravesical sodium chondroitin sulfate versus vehicle control in patients with interstitial cystitis/painful bladder syndrome. J Urol 2010;76:804-809.

25. Manas A, Glarfa L, Pena C et al. Prevention of urinary tract infections in palliative radiation for vertebral metastasis and spinal compression: a pilot study in 71 patients. lnt J Radiat Oncol Bioi Phys 2006;64:935-940.

Cystistat is no longer recommended for use in Chemical-Induced Cystitis and this study included both Chemical-Induced and Radiation-Induced Cystitis.

Efficacy of Cystistat

Cystistat significantly improves patient quality of life7,10

In a prospective study, carried out by Sommariva, 69 male patients aged 53-81 years with iatrogenic acute cystitis were enrolled into the study. Patients had received radiotherapy for the treatment of prostate cancer. Patients were given 40mg/ml of intravesical sodium hyaluronate weekly from 8-24 weeks. In all but two patients, symptoms were relieved after four weeks of treatment. No adverse reactions were observed in this group.

In almost all patients symptoms were relieved after just 4 weeks10

The mean VAS score dropped from 8.6 to 0.9 at the end of treatment10

Overall 97% (67/69) of patients reported complete relief of dysuria and pain10

n=69 patients (54 - chemotherapy; 15 - radiotherapy)

All patients were able to restart their cancer therapy, following treatment with Cystistat10

Cystistat maintains high patient response rates for up to 5 years2

Significant reduction in VAS score after therapy (p=0.0001)

The initial VAS score was reduced from 8.15 to 2.70 6 months after therapy, with an even lower score of 2.14 5 years later2

50% of patients initially treated with Cystistat did not need additional therapy after 5 years2

85.4% (41/48) patients experienced a decrease in VAS score of >22

"Patients have a high chance of symptom remission when treated with Cystistat"2

Cystistat delivers patient response rates of up to 97%2,3,9,10,11,12,13

Cystistat (sodium hyaluronic acid) clinical experience in 7 studies*, 266 patients, 8 weeks to 5 years

* Sommariva ML et al. 2010, Morales A et al. 1996, Lipovac M et al. 2007, Constantinides C et al. 2004, Ahmad I et al. 2007, Kallestrup EB et al. 2005, Engelhardt PF et al. 2007

In clinical studies, response rates for Cystistat (hyaluronic acid) have ranged from 65-97%2,3,9,10,11,12,13 and for chondroitin sulphate from 39-60%14,15

Cystistat significantly increases time to recurrence versus previous history3,12

Time to recurrence in women with Recurrent Bacterial Cystitis (RBC), pre- and post- Cystistat treatment

40 female patients (mean age of 35 years) with a history of recurrent urinary tract infection (UTI) received intravesical instillations of Cystistat once weekly for 4 weeks then once monthly for 4 months

96 days to recurrence before treatment with Cystistat3

498 days to recurrence after treatment with Cystistat3

70% of patients had no recurrence after 12 months3

20 female patients with a history of recurrent UTI each received 9 intravesical instillations of Cystistat over 6 months

76.7 days to recurrence before treatment with Cystistat12

178.3 days to recurrence after treatment with Cystistat12

65% of patients had no recurrence after 11 months12

Intravesical instillation of Cystistat is effective in preventing recurrent UTI3,12

Cystistat reduces the incidence of radiation-induced cystitis4

Average radiation toxicity over time

90 female patients with cervical or uterine cancer stage FIGO 3 were studied retrospectively and treated in the same centre with the same radiation protocol. 45 patients received standard care and 45 patients were treated with Cystistat

Cystistat decreases delays in radiotherapy schedules4

75% decrease in UTI occurrence with no adverse events4

Cystistat protects the bladder and decreases radiation-induced toxicity4

Cystistat reduces the incidence of UTI post-radiation in patients with metastatic spinal cord compression (MSCC)25

Incidence of UTI requiring systemic treatment post-radiation

A pilot study of 71 male and female patients receiving emergency radiotherapy for MSCC. 34 patients received usual care and 37 patients were treated with intravesical instillations of Cystistat

5.7 fold decrease in the percentage of patients with a UTI during hospital stay25

5.2 fold decrease in antibiotic use during hospital stay25

The instillation of Cystistat had a significant impact on the prevalence of UTI in patients with MSCC25