Repeated intravesical injections of platelet‐rich plasma are effective in the treatment of interstitial cystitis: a case control pilot study

• Published in: Lower urinary tract symptoms 2019-04, Vol.11 (2), p.O42-O47
• Main Authors: Jhang, Jia‐Fong, Wu, Shu‐Yu, Lin, Teng‐Yi, Kuo, Hann‐Chorng
• Format: Article
• Language: English
• Subjects: Administration, Intravesical; Bladder; bladder pain; Case-Control Studies; Cystitis, Interstitial - therapy; Female; Humans; Infections; inflammation; Injections; lower urinary tract symptoms; Middle Aged; Pain; Pilot Projects; Plasma; Platelet-Rich Plasma; platelet‐rich plasma therapy; Treatment Outcome; Urinary tract infections
• ISSN: 1757-5664; 1757-5672
• DOI: 10.1111/luts.12212

Objective Interstitial cystitis (IC), also known as bladder pain syndrome (BPS), is a debilitating chronic disease. There are few treatment options for IC/BPS refractory to current medical therapy. This study investigated the clinical efficacy of intravesical injections of platelet‐rich plasma (PRP) in IC/BPS. Methods Fifteen patients with IC/BPS received 4 intravesical injections, at 1‐monthly intervals, of 12 mL PRP extracted from 50 mL of the patient's whole blood, followed by cystoscopic hydrodistention. The primary endpoint was the change in O’Leary‐Sant symptom (OSS) index from baseline to 1 month after the 4th PRP injection. Secondary endpoints were changes in pain (measured using a visual analog scale [VAS]), daily frequency, nocturia, functional bladder capacity (FBC), maximum flow rate, voided volume, post‐void residual (PVR) volume, and global response assessment (GRA). Urinary cytokine levels were measured at baseline and 1 month after the 1st PRP treatment. Results Of the 15 women in the study, 13 completed the 4 injections and follow‐up visits (mean [± SD] age 52.9 ± 12.1 years). The OSS index and VAS pain score decreased significantly and FBC and GRA increased after the 1st PRP injection and lasted until the final endpoint. There was no change in PVR after repeated PRP injections, and all patients were free of urinary tract infections and difficulty urinating. Urinary interleukin (IL)‐2 and IL‐8 concentrations increased significantly after the 1st PRP injection. In patients with reductions in the VAS pain score ≥1, urinary IL‐8 and vascular endothelial growth factor increased. In patients without reductions in the VAS pain score, IL‐6 concentrations increased after PRP injection. Conclusions Repeated intravesical PRP injections are well tolerated and appear to be safe and effective in medically refractive IC/BPS, providing significant symptom improvement.