Use of Intravesical Injections of Platelet-Rich Plasma for the Treatment of Bladder Pain Syndrome: A Comprehensive Literature Review

Abstract

Background: Bladder pain syndrome/interstitial cystitis (BPS/IC) or primary bladder pain syndrome (PBPS) is a complex and poorly understood condition. This comprehensive review aimed to discuss the potential application of platelet-rich plasma (PRP) in the treatment of BPS/IC. The pathophysiology of BPS/IC is characterized by urothelial damage that triggers a chain of events leading to chronic inflammation and other conditions. Frequently, in subjects affected by BPS/IC, recurrent urinary tract infection (rUTI) is associated with difficult therapeutic management. For these reasons, many oral and intravesical treatments (e.g., antibiotic therapy and intravesical anesthetic instillations) have been proposed to alleviate the symptoms of IC/BPS. However, the limitation of these treatments is the short duration of improvement. The purpose of this review is to analyze the efficacy of intravesical PRP injections in subjects with PBS/IC and to try to understand the potential therapeutic effects on the pathophysiology of this disease. Methods: A nonsystematic literature search using Pubmed, EMBASE, Scopus, Web of Science, Medline was performed from January 2000 to August 2021. The following terms were combined to capture relevant publications: “platelet-rich plasma”, “interstitial cystitis”, “PRP”, “bladder pain syndrome”, and “painful bladder syndrome”. Results: After exclusion of non-pertinent studies/articles, we have analyzed 5 studies. In detail, 2 articles concerned preclinical studies in which animal models were used. The authors showed an improvement in the histological pattern with less bleeding in treated subjects, a lower presence of inflammatory cytokines and an increase in the mitotic index of urothelial cells in animals treated with intravesical PRP. In the three prospective clinical trials analyzed, patients with BPS/IC who underwent monthly intravesical PRP injections were found to have a statistically significant improvement in symptoms with modulation of growth factors and inflammatory proteins. Conclusions: New evidence suggests that treatment with intravesical PRP could improve urothelial regeneration and reduces chronic inflammation in BPS/IC, modifying the clinical history of its pathology.

Pentosan polysulfate in patients with bladder pain syndrome/interstitial cystitis with Hunner’s lesions or glomerulations: systematic review and meta-analysis

“…Most of the studies included had a small sample size and were published a long time ago. Regarding implications for future research, we recommend that researchers seek new therapeutic approaches (intravesical or oral) to manage this condition in patients with BPS/IC 30. Going forward, we need more robust, well-conducted, prospective and randomized studies that include cystoscopic criteria in the diagnosis of BPS/IC.…”

Platelet-Rich Plasma: A Promising Regenerative Therapy in Gynecological Disorders

“…It has the potential to act as a modulator of urothelial repair, and this could be made useful in painful bladder syndromes [32]. Various research in the past couple of years is clearly suggestive of the fact that intravesical platelet-rich plasma reduces chronic inflammation in bladder pain syndrome/interstitial cystitis (BPS/IC) as they could improve regeneration of the urothelium [33].…”

Current role of neuromodulation in bladder pain syndrome/interstitial cystitis

“…2–4 Other new therapeutic approaches are being studied like the intravesical injection of platelet-rich plasma for the reparation of urothelial defects and regeneration of the epithelium in patients with BPS/IC. 6…”

“…[2][3][4] Other new therapeutic approaches are being studied like the intravesical injection of platelet-rich plasma for the reparation of urothelial defects and regeneration of the epithelium in patients with BPS/IC. 6 The effect of neuromodulation on pain disorders is usually explained by the gate theory proposed by Melzack and Wall. 7 They suggested that pain perceived to have a visceral origin, which stimulates primary afferent fibres and travels to the brain via transmission cells, could be blocked by converging impulses arising from a somatic origin (by non-nociceptive fibres at the same dermatome) that activate inhibitory interneurons located in the dorsal horn of the spinal cord.…”