Recently, there has been interest in the use of platelet-rich plasma (PRP) in the treatment of SUI. PRP is used in many other medical specialties, and there is justification for its use in SUI: PRP can supply a supraphysiologic amount of essential growth factors and cytokines, leading to tissue regeneration. There, PRP could theoretically lead to additional urethral support, which in turn may treat SUI. Several recent observational studies, along with one RCT, have shown promising results for the treatment of SUI.1-5
We performed a randomized, placebo-controlled, single-blind study of a single round of PRP injections versus sham injections into the anterior vaginal wall under the urethra for the treatment of SUI. Three injections were performed at one time point. The injections were located at the mid-urethra, where one would expect a mid-urethral sling to sit. The depth of the injection was at the level of the periurethral space. Treatment success was defined as a negative cough stress test and an answer of “much better” or “very much better” on the Patient’s Global Impression of Improvement (PGI-I) six months after the injections. We included adult women with bothersome stress-predominate urinary incontinence.
At six months, we found no difference in treatment success between placebo and PRP. There was also no difference in sexual function or quality of life. Our findings contrast those of Grigoriadis et al., who demonstrated a difference in primary outcome based on the ICIQ-FLUTS questionnaire in their RCT. Their methodology differed in that they injected the PRP over nine total injection sites (instead of three), and they repeated the injections four to six weeks later. This suggests that the number of injection sites and the total number of treatments significantly affect may efficacy.
Notably, we recruited participants via a mass email to employees at the University of Iowa. We were able to recruit 50 eligible participants in a short amount of time and able to complete our RCT in under 8 months, which speaks to the prevalence of bothersome SUI, as well as the desire for an effective, office-based minimally invasive option.
Written by:
- Colin Johnson, MD, University of Iowa Hospitals & Clinics, Iowa City, IA
- Annah J Vollstedt, MD, University of Iowa Hospitals & Clinics, Iowa City, IA
- Prodromidou A, Grigoriadis T, Athanasiou S. Platelet-rich plasma for the management of urogynecological disorders: the current evidence. Curr Opin Obstet Gynecol. Dec 1 2022;34(6):396-401. doi:10.1097/gco.0000000000000820
- Athanasiou S, Kalantzis C, Zacharakis D, Kathopoulis N, Pontikaki A, Grigoriadis T. The Use of Platelet-rich Plasma as a Novel Nonsurgical Treatment of the Female Stress Urinary Incontinence: A Prospective Pilot Study. Female Pelvic Med Reconstr Surg. Nov 1 2021;27(11):e668-e672.
- Long CY, Lin KL, Shen CR, et al. A pilot study: effectiveness of local injection of autologous platelet-rich plasma in treating women with stress urinary incontinence. Sci Rep. Jan 15 2021;11(1):1584.
- Chiang CH, Kuo HC. The Efficacy and Mid-term Durability of Urethral Sphincter Injections of Platelet-Rich Plasma in Treatment of Female Stress Urinary Incontinence. Front Pharmacol. 2022;13:847520.
- Grigoriadis T, Kalantzis C, Zacharakis D, et al. Platelet-Rich Plasma for the Treatment of Stress Urinary Incontinence-A Randomized Trial. Urogynecology (Phila). Jun 1, 2023.