A minimally invasive treatment for selected bladder conditions
Bladder instillations are a non-surgical treatment used for selected benign bladder conditions, particularly when symptoms such as bladder pain, urinary urgency and frequency persist despite other treatments. They may also be considered in selected patients with recurrent urinary tract infections (UTIs) as part of a strategy to reduce the risk of further infections.
The treatment involves passing a small temporary catheter through the urethra into the bladder and introducing a solution directly into the bladder. The catheter is then removed, and the solution is left in the bladder for a specified period before being passed naturally.
Several different products can be used for bladder instillations. These include preparations containing hyaluronic acid (sodium hyaluronate), chondroitin sulphate, or a combination of both. Examples include Cystistat®, Hyacyst® and iAluRil®.
Mr Gidon Ellis provides specialist assessment and treatment for men with bladder and lower urinary tract symptoms and can discuss whether bladder instillation treatment may be appropriate for your individual condition.
What are bladder instillations?
Bladder instillation is a treatment in which a therapeutic solution is introduced directly into the bladder through a temporary urinary catheter. The bladder lining contains a protective layer known as the glycosaminoglycan (GAG) layer. This includes substances such as hyaluronic acid and chondroitin sulphate.
In some bladder conditions, this protective barrier may be disrupted. Treatments containing hyaluronic acid and/or chondroitin sulphate are intended to help restore or support this protective layer and reduce bladder irritation. The precise effect and benefit of treatment varies between individuals and depends on the underlying condition.
What conditions can bladder instillations help?
Bladder instillations may be considered for selected patients with benign bladder conditions, including:
Bladder pain syndrome
Bladder pain syndrome (also known as interstitial cystitis/bladder pain syndrome) can cause:
- Bladder or pelvic pain
- Urinary urgency
- Frequent urination
- Discomfort as the bladder fills
- Symptoms that improve temporarily after passing urine
Bladder instillations containing hyaluronic acid and/or chondroitin sulphate may be considered as part of a broader treatment plan for selected patients. Bladder pain syndrome is a diagnosis that requires careful assessment because similar symptoms can occur with urinary infection, bladder stones and other conditions.
Recurrent urinary tract infections
Bladder instillations containing hyaluronic acid and/or chondroitin sulphate may be considered in selected patients with recurrent urinary tract infections, particularly when conventional preventative measures have not provided sufficient benefit. The aim is to support the protective lining of the bladder and reduce the likelihood of further infections.
Bladder instillations are not a treatment for an active urinary tract infection. An active infection requires appropriate assessment and treatment, including antibiotics where indicated.
The cause of recurrent infections should also be investigated before considering bladder instillation treatment. In men, factors such as incomplete bladder emptying, bladder outlet obstruction, urinary stones or other urinary tract abnormalities may contribute to recurrent infection.
Radiation-related bladder symptoms
Bladder instillations may sometimes be considered for selected patients with bladder symptoms following pelvic radiotherapy. Treatment is individualised and depends on the nature and severity of the bladder symptoms.
Other selected bladder conditions
The appropriate use of bladder instillations depends on the specific product, the underlying condition and the available clinical evidence. They are not appropriate for every bladder symptom and should generally form part of an overall assessment and treatment plan.
What products are used?
Different bladder-instilled products contain different substances.
Hyaluronic acid
Products containing sodium hyaluronate, such as Cystistat® and Hyacyst®, are designed to support the protective GAG layer of the bladder lining.
Hyaluronic acid and chondroitin sulphate
Products such as iAluRil® contain a combination of hyaluronic acid and chondroitin sulphate. The combination is intended to help restore the protective bladder lining and reduce irritation. The choice of product depends on the underlying condition, previous treatment and individual circumstances.
What happens during a bladder instillation?
Bladder instillations are usually performed as an outpatient treatment.
The procedure typically involves:
- You will be asked to empty your bladder.
- A small sterile catheter is gently passed through the urethra into the bladder.
- Any remaining urine is drained.
- The treatment solution is introduced through the catheter.
- The catheter is removed.
- The solution remains in the bladder for the recommended period before you pass urine normally.
The procedure itself usually takes only a short time. A local anaesthetic gel may be used to make catheter insertion more comfortable. There are no surgical incisions and you can normally return home after the treatment.
How many treatments will I need?
Bladder instillations are generally given as a course of treatments rather than as a single procedure.
The frequency and total number of treatments depend on:
- The underlying bladder condition
- The product being used
- Your response to treatment
- Previous treatments
- The treatment plan agreed with your clinician
Some treatment schedules involve more frequent instillations initially followed by less frequent maintenance treatment if symptoms improve. There is no single regimen that is appropriate for every patient.
What are the benefits of bladder instillations?
Potential benefits include:
- Direct delivery of treatment into the bladder
- No surgery or external incisions
- Usually performed as an outpatient treatment
- No general anaesthetic is normally required
- May reduce bladder pain, urgency or frequency in selected patients
- May reduce the risk of recurrent urinary tract infections in selected patients
- Can be used alongside other bladder treatments
The degree of benefit varies between individuals, and treatment is usually continued only if there is a meaningful improvement in symptoms.
Are there any risks or side effects?
Bladder instillations are generally well tolerated, but temporary urinary symptoms can occur.
These may include:
- Mild burning or stinging when passing urine
- Increased urinary frequency or urgency
- Mild discomfort in the bladder or urethra
- A small amount of blood in the urine
- Urinary tract infection
Catheterisation itself can occasionally cause urethral irritation or trauma.
