**2.3 Chondroitin sulfate**

Chondroitin sulfate (CS) is a glycoprotein and a component of the GAG layer of bladder mucosa. Commercially available CS products include iAluRil (Juno, AK), Uracyst (Galen, UK), and Uropol (Galen). Nickel et al. [11] performed a multicenter, randomized, double-blind study in which 20 ml of 2% CS or an inactive control solution were injected weekly for 8 weeks for female patients with IC/BPS. The proportion of patients with moderate or marked improvement at 11 weeks was 38.0% in the CS group and 31.3% in the control group; CS treatment in IC/BPS patients showed minor improvements in IC/BPS-related symptom and pain. In another recent report, intravesical CS was found to be superior to intravesical HA in terms of frequency, nocturia and ICPI in patients with BPS/IC during the 6 months of follow-up [12]. In refractory IC/BPS patients, the combination of 1.6% HA and 2.0% CS maintained improvement in symptoms for up to 3 years, indicating that the combination treatment might be more effective than the monotherapy [13].
