A novel management for postprostatectomy urinary incontinence: platelet-rich plasma urethral sphincter injection

Abstract

Platelet-rich plasma (PRP) is the most innovative blood-derived product used in regenerative medicine. We aimed to investigate the therapeutic efficacy of PRP urethral sphincter injection for the management of postprostatectomy incontinence (PPI). In total, 28 PPI patients with a mean age of 71.8 ± 8.9 years were prospectively enrolled. They received four PRP urethral sphincter injections each month. The clinical outcomes were assessed 3 months after the fourth injection as posttreatment Global Response Assessment (GRA) score, the newly designed visual analogue scale of stress urinary incontinence (VAS of SUI), and in urodynamic parameters. After injections, the posttreatment median GRA with quartiles was 2.0 (1.0, 2.0). Overall, six (21.4%) patients achieved complete continence and pad-free status, 20 (71.4%) achieved successful outcome (GRA score ≥ 2), and 26 (92.9%) showed clinical improvement (GRA score ≥ 1). The VAS of SUI significantly improved from 6.5 (5.0, 8.0) to 3.5 (2.0–5.8) (p < 0.001) as well as abdominal leak point pressure, from 57.5 (50.0, 115.0) to 126.0 (68.3, 150.0), (p = 0.004). After repeated PRP urethral sphincter injections, the SUI severity reduced significantly with high success rates. There was no major adverse event, except three patients with mild hematuria and micturition pain. In conclusion, PRP urethral sphincter injection is safe and effective as a novel management of PPI.

The Efficacy and Mid-term Durability of Urethral Sphincter Injections of Platelet-Rich Plasma in Treatment of Female Stress Urinary Incontinence

“…Platelet-derived products have been widely used in tissue regeneration and recovery, including skeletomuscular defects, skin ulcer or burn, and dental implants ( Liggett et al, 1995 ; Anitua, 1999 ; Burnouf et al, 2016 ). It could decrease tissue inflammation and improve urothelial barrier function in IC/BPS patient ( Burnouf et al, 2016 ), and improved SUI severity in patient with postprostatectomy urinary incontinence and non-neurogenic ISD ( Jiang et al, 2021 ; Lee et al, 2021 ). In this study, the effective results in improving severity of SUI and increase of ALPP, suggesting the urethral sphincter regeneration might be improved and this minimally invasive procedure might have a certain role in the future treatment of female SUI.…”

“…According to the potential regenerative effect, PRP injection might benefit the patient with SUI by increasing the sphincter muscle cells as well as the urethral resistance. The concept was first reported in 2016 and has been proved in both animal model and clinical use ( Nikolopoulos et al, 2016 ; Nikolopoulos et al, 2019 ; Lee et al, 2021 ). In this study, we performed a clinical trial to investigate the therapeutic efficacy, and durability of autologous PRP urethral sphincter injections for treatment of SUI due to Intrinsic sphincter deficiency in women.…”

Therapeutic Efficacy and Mid-Term Durability of Urethral Sphincter Platelet-Rich Plasma Injections to Treat Postprostatectomy Stress Urinary Incontinence

“…The primary etiology of PPI, i.e., urethral incompetence, needed to be fulfilled. Patients with a large post-void residual (PVR) volume ≥ 150 mL, known platelet dysfunction, anticoagulant use, critical thrombocytopenia, hypofibrinogenemia, hemodynamic instability, sepsis, acute or chronic infections, chronic liver disease, and known malignancy outside the urinary tract were excluded from the study [ 12 ].…”

“…The PRP was circumferentially injected into the external urethral sphincter at five injection sites using a rigid cystoscopic injection instrument through the urethra (23 Fr; Richard Wolf, Knittlingen, Germany). To confirm the effects following each injection, swelling of the urethral surface was identified [ 12 ]. Patients did not undergo urethral catheterization and were discharged shortly after the injections, provided no complications developed.…”

“…In 2016, the potential role of PRP in treating SUI was first proposed [ 9 ] and was applied in an animal model in 2019, in which a significant increase in leak point pressure was observed [ 10 ]. Based on the hypothesis that deficient urethral sphincter function improves following regenerated innervation and increased striated muscle cell volume via repeated PRP urethral sphincter injections, several recent studies have shown the safety and therapeutic efficacy of autologous PRP urethral sphincter injections for the treatment of SUI in humans [ 11 , 12 , 13 , 14 ].…”