Platelet-Rich Plasma as Adjuvant Therapy for Recurrent Vesicovaginal Fistula: A Prospective Case Series

Abstract

Vesicovaginal fistula (VVF) is the nonphysiological communication between the bladder and vagina, and surgical closure is the gold treatment standard. Despite that successful closure occurs in around 85% of patients after the first repair, recurrence remains a highly distressing complication for patients and surgeons. The aim of our study was to evaluate the efficacy of a platelet-rich plasma (PRP) injection as a supportive treatment in the surgical repair of recurrent VVF. Between January 2018 and July 2019, 16 patients with recurrent VVF were injected with PRP in a tertiary gynecological department. Subsequently, a surgical Latzko procedure for VVF closure was scheduled 6-8 weeks after the PRP injection allowing proper neovascularization and remodeling of surrounding tissues. Patients were considered cured if no leakage was observed after surgery and negative dye test results were indicated at follow-up. All patients who were examined therein remained dry. To the best of our knowledge, this is the first study aiming to assess PRP injections as a supporting treatment prior to surgical procedure for recurrent VVF. Preliminary results are encouraging, and we incorporated this method in our clinical practice. Further reports on a larger group will follow.

Radiation-Induced Recurrent Vesicovaginal Fistula—Treatment with Adjuvant Platelet-Rich Plasma Injection and Martius Flap Placement—Case Report and Review of Literature

“…The preliminary results of the research of Streit-Ciećkiewicz et al on patients with recurrent vesicovaginal fistulas showed the successful surgical closure of a fistula 4–6 weeks after PRP injection with no complications or adverse reactions [ 7 ]. In this research, an attempt was made to find factors that might have had predictive value when assigning the patient surgical treatment.…”

“…In December 2019, the patent qualified for a platelet-rich plasma (PRP) injection procedure of the fistula edges. This operation is described elsewhere [ 7 ]. In February 2020 (7 weeks after the injection), a 2nd Latzko reconstructive procedure was performed.…”

Therapeutic Pathways of Vesicovaginal Fistula, From the Past to the Future: A Mini-Review

“…In cases with increase residual rate, or decreased surgical rate, a few new therapeutic techniques are very helpful and promising. Many conducted studies arising from the current bibliography, such as blood-based products (autologous platelet-rich plasma and fibrin glue) managed to establish new standards and accomplish their scope [18]. Sharma et al first described the use of endoscopic injection of fibrin concerning the therapeutic strategy of VVF, not depicting any potential postoperative complications [19].…”

Predictive value of classification systems and single fistula‐related factors in surgical management of vesicovaginal fistula

“…Data about PRP application in the treatment of recurrent VVF was published elsewhere. 12 Each patient was classified according to Sims, Mahfouz, Chassar Moir, McConnachie, Bird, Gray, Lawson, Hamlin and Nicholson, Waaldijk, Goh, Arrowsmith, Tafesse, and WHO systems. [4][5][6][7][8][9][10][11]13 Patients were dichotomized into two groups: women with primary and with secondary VVF.…”

“…The tubes were centrifuged with the Arthrex Angel System® kit (Arthrex Inc.), resulting in 4–6 ml PRP volumes. Data about PRP application in the treatment of recurrent VVF was published elsewhere 12 …”