{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T04:28:52Z","timestamp":1791606532521,"version":"4.3.4"},"reference-count":21,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2024,3,31]],"date-time":"2024-03-31T00:00:00Z","timestamp":1711843200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>In non-muscle invasive bladder cancer, Bacillus Calmette\u2013Gu\u00e9rin (BCG) responders benefit from strong Th1-type inflammatory and T cell responses mediating tumor rejection. However, the corresponding lack of anti-inflammatory Th2-type immunity impairs tissue repair in the bladder wall and facilitates the development of cystitis, causing urinary pain, urgency, incontinence, and frequency. Mechanistically, the leakage of the glycosaminoglycan (GAG) layer enables an influx of potassium ions, bacteria, and urine solutes towards the underlying bladder tissue, promoting chronic inflammation. Treatments directed towards re-establishing this mucopolysaccharide-based protective barrier are urgently needed. We discuss the pathomechanisms, as well as the therapeutic rationale of how chondroitin and hyaluronic acid instillations can reduce or prevent BCG-induced irritative bladder symptoms. Moreover, we present a case series of five patients with refractory BCG-induced cystitis successfully treated with combined chondroitin and hyaluronic acid instillations.<\/jats:p>","DOI":"10.3390\/jcm13072031","type":"journal-article","created":{"date-parts":[[2024,3,31]],"date-time":"2024-03-31T13:32:56Z","timestamp":1711891976000},"page":"2031","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Treating BCG-Induced Cystitis with Combined Chondroitin and Hyaluronic Acid Instillations in Bladder Cancer"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5286-9048","authenticated-orcid":false,"given":"Renate","family":"Pichler","sequence":"first","affiliation":[{"name":"Department of Urology, Comprehensive Cancer Center Innsbruck, Medical University of Innsbruck, 6020 Innsbruck, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Johannes","family":"St\u00e4blein","sequence":"additional","affiliation":[{"name":"Department of Urology, Comprehensive Cancer Center Innsbruck, Medical University of Innsbruck, 6020 Innsbruck, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9070-5706","authenticated-orcid":false,"given":"Andrea","family":"Mari","sequence":"additional","affiliation":[{"name":"Unit of Oncologic Minimally-Invasive Urology and Andrology, Department of Experimental and Clinical Medicine, Careggi Hospital, University of Florence, 50134 Florence, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5472-1933","authenticated-orcid":false,"given":"Luca","family":"Afferi","sequence":"additional","affiliation":[{"name":"Department of Urology, Luzerner Kantonsspital, 6000 Luzern, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"D\u2019Andrea","sequence":"additional","affiliation":[{"name":"Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, 1090 Vienna, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1806-1448","authenticated-orcid":false,"given":"Gautier","family":"Marcq","sequence":"additional","affiliation":[{"name":"Department of Urology, Claude Huriez Hospital, CHU Lille, 59000 Lille, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3865-5988","authenticated-orcid":false,"given":"Francesco","family":"del Giudice","sequence":"additional","affiliation":[{"name":"Department of Maternal Infant and Urologic Sciences, Policlinico Umberto I Hospital, \u2018Sapienza\u2019 University of Rome, 00185 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesco","family":"Soria","sequence":"additional","affiliation":[{"name":"Urology Division, Department of Surgical Sciences, University of Studies of Torino, 10124 Turin, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jorge","family":"Ca\u00f1o-Velasco","sequence":"additional","affiliation":[{"name":"Department of Urology, Gregorio Mara\u00f1\u00f3n University Hospital, 28007 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4176-8174","authenticated-orcid":false,"given":"Jos\u00e9 Daniel","family":"Subiela","sequence":"additional","affiliation":[{"name":"Department of Urology, Hospital Universitario Ram\u00f3n y Cajal, IRYCIS, Universidad de Alcala, 28034 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"Gallioli","sequence":"additional","affiliation":[{"name":"Department of Urology, Fundaci\u00f3 Puigvert, Autonomous University of Barcelona, 08193 Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karl H.","family":"Tully","sequence":"additional","affiliation":[{"name":"Department of Urology and Neurourology, Marien Hospital Herne, Ruhr-University Bochum, 44625 Herne, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Keiichiro","family":"Mori","sequence":"additional","affiliation":[{"name":"Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, 1090 Vienna, Austria"},{"name":"Department of Urology, The Jikei University School of Medicine, Tokyo 105-8461, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Achim","family":"Herms","sequence":"additional","affiliation":[{"name":"Neuro-Urology Unit, Department of Urology, Medical University of Innsbruck, 6020 Innsbruck, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7768-8558","authenticated-orcid":false,"given":"Benjamin","family":"Pradere","sequence":"additional","affiliation":[{"name":"Department of Urology, La Croix du Sud Hospital, 31130 Quint-Fonsegrives, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marco","family":"Moschini","sequence":"additional","affiliation":[{"name":"Department of Urology, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, 20132 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura S.","family":"Mertens","sequence":"additional","affiliation":[{"name":"Department of Urology, The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, 1066 CX Amsterdam, The 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