Document Type : Original Article

Authors

1 Physiology Research Center, Institute of Neuropharmacology, Kerman University of Medical Sciences, Kerman, Iran

2 Department of Urology, Shahid Bahonar Hospital, Kerman University of Medical Sciences, Kerman, Iran

3 Cell Therapy and Regenerative Medicine Center, Kerman University of Medical Sciences, Kerman, Iran

4 Cardiovascular Research Center, Institute of Basic and Clinical Physiology Sciences, and Department of Physiology and Pharmacology, Afzalipour Mediacl Faculty, Kerman University of Medical Sciences, Kerman, Iran

5 Urology-Nephrology Research Center, Shaheed Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran

Abstract

Background: Stress urinary incontinence is a prevalent condition among a large number of women and has a negative effect on their quality of life. One treatment option is the use of bio-injectable materials to enhance closing pressures. In this study, we aimed to investigate the effects of the periurethral injection of pure platelet-rich plasma on the treatment of stress urinary incontinence.
Methods: This study was conducted as a randomized controlled clinical trial on 20 women with stress urinary incontinence. Ten patients received periurethral injections of pure platelet-rich plasma (experimental group), while ten patients received midurethral sling procedure as the standard treatment for stress urinary incontinence ((control group). Follow-up was performed one and three months after the treatment using the international consultation on incontinence questionnaire (ICIQ), incontinence quality of life (I-QOL) questionnaire, urogenital distress inventory (UDI-6), and cough stress test.
Results: Out of ten patients in the experimental group, seven cases (70%) relatively recovered after the injection. Out of ten patients in the control group, eight patients completely recovered after the procedure. There was significant difference in the questionnaire results before and after treatments, which indicates the effectiveness of these treatments in both groups. However, the response to the midurethral sling procedure was better than the response to pure platelet-rich plasma injection, and the difference was statistically significant.
Conclusion: The periurethral injection of a single dose of pure platelet-rich plasma could relatively eliminate the symptoms of stress urinary incontinence in patients. More definite results can be obtained with repeated doses of pure platelet-rich plasma, even compared with standard treatments.

Keywords

  1. Mørkved S, Bø K. Effect of pelvic floor muscle training during pregnancy and after childbirth on prevention and treatment of urinary incontinence: a systematic review. Br J Sports Med 2014; 48(4):299-310. doi: 10.1136/bjsports-2012-091758.
  2.  Wein A, Kavoussi L, Partin A, Peters C. Campbell-Walsh Urology. 11th ed. Philadelphia: Elsevier-Sounders; 2015. p. 1871-95.
  3. Dumoulin C, Hay-Smith J. Pelvic floor muscle training versus no treatment for urinary incontinence in women. A Cochrane systematic review. Eur J Phys Rehabil Med 2008; 44(1):47-63.
  4.  Berghmans LC, Hendriks HJ, Bo K, Hay-Smith EJ, de Bie RA, van Waalwijk van Doorn ES. Conservative treatment of stress urinary incontinence in women: a systematic review of randomized clinical trials. Br J Urol 1998; 82(2):181-91. doi: 10.1046/j.1464-410x.1998.00730.x.
  5. Nikolopoulos KI, Pergialiotis V, Perrea D, Doumouchtsis SK. Restoration of the pubourethral ligament with platelet rich plasma for the treatment of stress urinary incontinence. Med Hypotheses 2016; 90:29-31. doi: 10.1016/j.mehy.2016.02.019.
  6.  Schimpf MO, Rahn DD, Wheeler TL, Patel M, White AB, Orejuela FJ, et al. Sling surgery for stress urinary incontinence in women: a systematic review and metaanalysis. Am J Obstet Gynecol 2014; 211(1):71.e1-27. doi: 10.1016/j.ajog.2014.01.030.
  7. Davis NF, Kheradmand F, Creagh T. Injectable biomaterials for the treatment of stress urinary incontinence: their potential and pitfalls as urethral bulking agents. Int Urogynecol J 2013; 24(6):913-9. doi: 10.1007/s00192-012-2011-9.
  8.  Amable PR, Carias RB, Teixeira MV, da Cruz Pacheco I, Corrêa do Amaral RJ, Granjeiro JM, et al. Platelet-rich plasma preparation for regenerative medicine: optimization and quantification of cytokines and growth factors. Stem Cell Res Ther 2013; 4(3):67. doi: 10.1186/scrt218.
  9.  Mamut A, Carlson KV. Periurethral bulking agents for female stress urinary incontinence in Canada. Can Urol Assoc J 2017; 11(6Suppl2):S152-54. doi: 10.5489/cuaj.4612.
  10.  Gibble JW, Ness PM. Fibrin glue: the perfect operative sealant? Transfusion 1990; 30(8):741-7. doi: 10.1046/j.1537-2995.1990.30891020337.x.
  11.  Marx RE, Garg AK. Dental and Craniofacial Applications of Platelet-Rich Plasma. USA: Quintessence; 2005.
  12.  Sampson S, Gerhardt M, Mandelbaum B. Platelet rich plasma injection grafts for musculoskeletal injuries: a review. Curr Rev Musculoskelet Med 2008; 1(3-4):165-74. doi: 10.1007/s12178-008-9032-5.
  13.  Chen CH, Cao Y, Wu YF, Bais AJ, Gao JS, Tang JB. Tendon healing in vivo: gene expression and production of multiple growth factors in early tendon healing period. J Hand Surg Am 2008; 33(10):1834-42. doi: 10.1016/j.jhsa.2008.07.003.
  14.  Martínez CE, Smith PC, Alvarado VA. The influence of platelet-derived products on angiogenesis and tissue repair: a concise update. Front Physiol 2015; 6:290. doi: 10.3389/fphys.2015.00290.
  15.  Alsousou J, Ali A, Willett K, Harrison P. The role of platelet-rich plasma in tissue regeneration. Platelets 2013; 24(3):173-82. doi: 10.3109/09537104.2012.684730.
  16.  Oklu R, Walker TG, Wicky S, Hesketh R. Angiogenesis and current antiangiogenic strategies for the treatment of cancer. J Vasc Interv Radiol 2010; 21(12):1791-805. doi: 10.1016/j.jvir.2010.08.009.
  17. El-Sharkawy H, Kantarci A, Deady J, Hasturk H, Liu H, Alshahat M, et al. Platelet-rich plasma: growth factors and pro-and anti-inflammatory properties. J Periodontol 2007; 78(4):661-9. doi: 10.1902/jop.2007.060302.
  18. Guevara-Alvarez A, Schmitt A, Russell RP, Imhoff AB, Buchmann S. Growth factor delivery vehicles for tendon injuries: Mesenchymal stem cells and Platelet Rich Plasma. Muscles Ligaments Tendons J 2014; 4(3):378-85.
  19.  Han J, Lee K, Choo M. Management of recurrent or persistent stress urinary incontinence after mid-urethral sling. Low Urin Tract Symptoms 2012; 4(Suppl 1):95-100. doi: 10.1111/j.1757-5672.2011.00129.x.
  20.  Nitti VW. Complications of midurethral slings and their management. Can Urol Assoc J 2012; 6(5 Suppl 2):S120-2. doi: 10.5489/cuaj.12197.
  21.  Therapeutic Goods Administration. TGA actions after review into urogynaecological surgical mesh implants. [cited 2019 Aug 31] Available from: https://www.tga.gov.au/alert/tga-actions-after-review-urogynaecological-surgical-mesh-implants.
  22. Hart ML, Izeta A, Herrera-Imbroda B, Amend B, Brinchmann JE. Cell Therapy for Stress Urinary Incontinence. Tissue Eng Part B Rev 2015; 21(4):365-76. doi: 10.1089/ten.TEB.2014.0627.
  23. Hakim L, De Ridder D, Van der Aa F. Slings for urinary incontinence and the application of cell-based therapy. Adv Drug Deliv Rev 2015; 82-3: 22-30. doi: 10.1016/j.addr.2014.11.006.
  24. Kleinert S, Horton R. Retraction—autologous myoblasts and fibroblasts for treatment of stress urinary incontinence: a randomised controlled trial. Lancet 2008; 372(9641):789-90. doi: 10.1016/S0140-6736(08)61320-3.
  25. Peters KM, Dmochowski RR, Carr LK, Robert M, Kaufman MR, Sirls LT, et al. Autologous muscle derived cells for treatment of stress urinary incontinence in women. J Urol 2014; 192(2):469-76. doi: 10.1016/j.juro.2014.02.047.
  26. Pokrywczynska M, Adamowicz J, Czapiewska M, Balcerczyk D, Jundzill A, Nowacki M, et al. Targeted therapy for stress urinary incontinence: Asystematic review based on clinical trials. Expert Opin Biol Ther 2016; 16(2):233-42. doi: 10.1517/14712598.2016.1118459.
  27.  Behnia-Willison F, Nguyen TT, Norbury AJ, Mohamadi B, Salvatore S, Lam A. Promising impact of platelet rich plasma and carbon dioxide laser for stress urinary incontinence. Eur J Obstet Gynecol Reprod Biol X 2019; 5:100099. doi: doi: 10.1016/j.eurox.2019.100099.
  28.  Amirzargar MA, Jafari M, Mohamadi B, Moradi A. Comparison of platelet rich plasma in combination with autologous fat injection versus injection of autologous fat in bladder neck for treatment of stress urinary incontinence of women. J Res Urol. 2016; 1(1):12-7. doi: 10.21859/ruj-01014.
  29. Shirvan MK, Alamdari DH, Mahboub MD, Ghanadi A, Rahimi HR, Seifalian AM. A novel cell therapy for stress urinary incontinence, short-term outcome. Neurourol Urodyn 2013; 32(4):377-82. doi: 10.1002/nau.22301.