Abstract
Aims: This study investigated the therapeutic effect of repeated urethral sphincter injections of autologous platelet-rich plasma (PRP) in treatment of stress urinary incontinence (SUI) in women due to intrinsic sphincter deficiency (ISD) refractory to medical treatment or after the first anti-incontinence surgery. Methods: Twenty-six women with SUI due to urodynamically proven ISD were prospectively enrolled. Five milliliters of PRP (2.5–5 times of the platelet concentrations in peripheral blood) were injected into the external sphincter at 5 sites, with 4 treatments at monthly interval. The primary end-point was post-treatment Global Response Assessment (GRA, scored 0–3) score after four PRP treatments. A GRA ≥ 2 was considered as a successful result. The secondary endpoints included changes in visual analog scale (VAS) of SUI and urodynamic parameters. The follow-up date was 12 months after the fourth PRP treatment. Results: The mean age was 61.7 ± 15.3 years. The overall success rate was 50% with the post-treatment mean GRA of 1.5 ± 1.1. Complete dryness was achieved in 12 patients (46.2%) after the PRP treatment, and 7 (26.9%) kept total continence at 12 months. The mean VAS of SUI score decreased significantly from 6.4 ± 2.3 to 3.9 ± 2.3 after treatment (p < 0.001). The abdominal leak point pressure increased significantly from 117.5 ± 63.8 to 133.6 ± 61.7 cmH2O (p = 0.045). No perioperative adverse events or severe complications occurred, except 1 (3.8%) patient reported straining to void which was self-limited. Conclusion: Repeated urethral sphincter injections of autologous PRP are a safe procedure that provides significant reduction in the severity of female SUI and a mid-term durability, suggesting PRP treatment is effective to increase urethral sphincter resistance for female SUI.
Highlights
Stress urinary incontinence (SUI), defined as involuntary leakage of urine on effort or exertion, is common in women (Abrams et al, 2002; Agarwal and Agarwal, 2017)
Female SUI typically occurs with aging, multiple child births and menopause, and it may impairs the quality of life of the afflicted individual owing to shame and embarrassment caused by incontinence
After 4 Platelet-rich plasma (PRP) treatments, 21 (80.8%) women reported a positive response in alleviating SUI, including 13 (50%) achieved a successful outcome (GRA ≥2) and 8 (30.8%) experienced mild improvement (GRA = 1)
Summary
Stress urinary incontinence (SUI), defined as involuntary leakage of urine on effort or exertion, is common in women (Abrams et al, 2002; Agarwal and Agarwal, 2017). Once initial conservative treatment fails, surgical interventions such as midurethral slings, bulking agents, and colposuspension to restore urethral competence have been recommended (Gomelsky et al, 2019). These procedures have been widely performed with acceptable cure rate and durability (Freites et al, 2019; Liu and Kuo, 2019). Less invasive alternatives such as injection therapy with urethral bulking agent or stem cell formulation have been developed (Kirchin et al, 2017). A simple, effective and less invasive management is warranted for this distressing disorder in women with mild to moderate SUI
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