Therapeutic Efficacy of Intravesical Platelet-Rich Plasma Injections for Interstitial Cystitis/Bladder Pain Syndrome—A Comparative Study of Different Injection Number, Additives and Concentrations

Abstract

Purpose: Intravesical platelet-rich plasma (PRP) injections have been demonstrated effective in relieving symptoms among patients with interstitial cystitis/bladder pain syndrome (IC/BPS). This study compared the clinical efficacy among different injection number, adding solution, and concentrations of PRP.Methods: A total of 63 patients with IC/BPS were enrolled and randomly allocated to four subgroups who received single high-dose PRP (from 100 ml whole blood) plus 10 ml of normal saline or plasma injected over 20 or 40 sites. Patients were followed up at 1, 3, and 6 months for changes in the IC symptom index (ICSI) and problem index (ICPI), visual analog scale (VAS), global response assessment (GRA), and urodynamic parameters. Furthermore, we compared the clinical outcome with our previous study in a group of 55 IC/BPS patients who underwent four monthly low-dose PRP (from 50 ml whole blood) injections.Results: The result of this study showed significant improvements in IC symptoms (ICSI 11.9 ± 4.4 vs. 10.2 ± 4.9, p = 0.009; ICPI 12.3 ± 3.4 vs. 10.6 ± 4.7, p = 0.003); VAS (5.46 ± 2.96 vs. 3.83 ± 3.1, p 0.000), and maximum flow rate (10.4 ± 4.9 vs. 17.1 ± 11.5 ml/s, p = 0.000) at 3 months after single high-dose PRP injection. However, no significant differences in therapeutic results were observed among subgroups, regardless of the added component or injecting site. The improvements of ICSI, ICPI, and GRA at 6 months were lower in comparison with the results of four low-dose PRP injections. All patients were free of dysuria, urinary retention, or urinary tract infection after PRP treatment.Conclusion: Intravesical PRP injection is effective for IC/BPS. The addition of normal saline or plasma and injection site had no influence on therapeutic efficacy. However, the symptom improvement and GRA after a single high-dose PRP injection was lower than that after four low-dose PRP injections 6 months after the first treatment. Limitation of the study is lack of sham control group.

Comparison of the Clinical Efficacy and Adverse Events between Intravesical Injections of Platelet-Rich Plasma and Botulinum Toxin A for the Treatment of Interstitial Cystitis Refractory to Conventional Treatment

“…Four monthly injections might also increase the complications related with bladder injections, including hematuria and UTI. Although therapy with a single high-dose injection of PRP has been attempted, the efficacy on symptom improvement was inferior to that of four monthly low-dose PRP injections [ 14 ]. In addition, the economic burden of frequent admission, anesthesia, and the cost of preparing the PRP might be much higher than that of a single BoNT-A injection within a six-month treatment period.…”

“…On the other hand, the PRP injection does not have such adverse events. However, the effect of PRP on inflammation might be less remarkable than that of BoNT-A; frequent monthly PRP injections are necessary to achieve a therapeutic efficacy similar to that of BoNT-A on IC/BPS [ 14 ].…”

Intravesical injections of autologous platelet‐rich plasma for the treatment of refractory interstitial cystitis

“…The platelet-poor plasma is removed, and the platelet pellets are added to the plasma by gently shaking the tube to form 10 mL of sterile PRP, of which 1 mL is sent for culture and another 1 mL for platelet count. 31 The concentration of the final PRP solution is approximately three to five times that of the platelet concentration in peripheral blood. 32 The concentration of PRP can be modified in accordance with the requirements of the treatment.…”

“…This suggests that a single high-dose PRP injection cannot provide a satisfactory treatment result because the therapeutic effects of a single PRP injection cannot eliminate chronic inflammation or enable urothelial regeneration. 31 Currently, several minimally invasive procedures have been developed to treat IC/BPS that is refractory to medical treatment, such as BoNT-A injection. BoNT-A treatment has been listed in the American Urological Association guidelines of IC/BPS and has been demonstrated to be well tolerated and effective for relieving bladder pain in IC/BPS patients.…”

“…At the bottom of the tube, platelet pellets are formed: the lower third represents PRP, and the upper two thirds represent platelet‐poor plasma. The platelet‐poor plasma is removed, and the platelet pellets are added to the plasma by gently shaking the tube to form 10 mL of sterile PRP, of which 1 mL is sent for culture and another 1 mL for platelet count 31 . The concentration of the final PRP solution is approximately three to five times that of the platelet concentration in peripheral blood 32 .…”