The Emerging Role on the Use of Platelet-Rich Plasma Products in the Management of Urogynaecological Disorders

Abstract

Background: The regenerative efficacy of platelet-derived products has been recently investigated in the treatment of pelvic floor disorders (PFDs). We aimed to synthesize the current evidence of platelet-rich plasma (PRP) products used in urogynaecological disorders including vaginal atrophy, pelvic organ prolapse (POP), urinary incontinence, vaginal fistulas and vaginal mesh exposure. Methods: A meticulous search of the currently available literature on the use of PRP for the management of PFDs was performed using 3 electronic databases. Results: PRP could be a feasible alternative modality for the management of vaginal atrophy with favourable outcomes in vaginal atrophy parameters and patients’ satisfaction, especially when hormone therapy is contraindicated. In patients with POP, an increase in collagen concentration after PRP application was observed while the use of PRP resulted in improvement of stress urinary incontinence symptoms. A considerable proportion of vesicovaginal fistulas were treated after application of PRP-based injections. Conclusions: There is only limited evidence of the use of PRP for PFDs. Platelet-rich plasma appears to be a promising, easy to apply, cost-effective and feasible alternative therapeutic modality for the management of various urogynaecological disorders. Future randomized trials are needed to confirm the efficacy of PRP in the treatment of urogynaecological disorders.

Platelet rich plasma for the management of urogynecological disorders: the current evidence

“…The vaginal health index (VHI) was significantly increased 6 months post treatment ( P < 0.0001 ) [23]. Similar outcomes were also observed in female sexual distress while patients were satisfied with the posttreatment outcome [4 ▪▪ ,23].…”

“…In the field of mesh surgery, preliminary in vitro and animal studies have also shown encouraging outcomes in improving the postoperative outcomes after the use of meshes coated with PRP [4 ▪▪ ]. The randomized experimental study by Dias et al evaluated the impact of PRP-coated polypropylene meshes compared to noncoated ones implanted in rabbit's vaginal submucosa [22 ▪ ].…”

“…Up until 2020 the use of PRP as a single therapy in patients with SUI was reported in case reports and animal studies showing beneficial outcomes [4 ▪▪ ,12,13]. In particular, in the case report by Matz et al a 50% decrease in pad use was recorded in a female patient with SUI who had transurethral injection with platelet rich fibrin [12].…”

“…This created the need of developing new therapeutic modalities aiming to provide similar outcomes with decreased risk of complications. The use of PRP has been proposed to enhance the effect of surgical repair of POP with native tissues with significant success rates as evaluated by both the patients and their physicians [4 ▪▪ ].…”

“…It has been claimed that platelets release a variety of substances such as growth factors and cytokines from the alpha-and dense granules [3]. Among them, PDGF, vascular endothelial growth factor, tumor necrosis factor (TNF), interferon-α, transforming growth factor-β (TGF-β) and interleukin-1, 6- and 8 are the main growth factors and cytokines that have been found in activated PRP [4 ▪▪ ]. In clinical practice, PRP has been proved to have regenerative, anti-inflammatory, angiogenic and restorative effects in a wide spectrum of tissues.…”