PRP INJECTIONS IN THE TREATMENT FORSTRESS URINARY INCONTINENCE
I. APOLIKHINA1, E.GORBUNOVA 1, A. SAIDOVA 1, G. SUKHIKH 2;
1Aesthetic Gynecology and Rehabilitation, Res. Ctr.for Obstetrics, Gynecology and Per, Moscow, Russian Federation,2Directorate, Res. Ctr. for Obstetrics, Gynecology andPerinatology, Moscow, Russian Federation.
Introduction: We know 2 mainmechanisms leading to stress urinary incontinence (SUI): they areurethral hypermobility and sphincter deficiency. The urethralhypermobility is indication for surgical approach, such assling-urethral-pexy. The sphincter deficiency is indication forbulking agents. We decide to use PRP-HA (platelet-rich plasma andhyaluronic Acid) injections in case of sphincterdeficiency.
Objective: This study aimed to assess theefficacy and feasibility of autologous PRP-HA injections in thetreatment of stress urinary incontinence in women in theRussia.
Methods: To date, 15 women (age 59.2 ± 6.8 years)have been treated. We treated 15 women with SUI. Symptoms wereassessed before and after every PRP-HA injections . Subjective(visual analog scale) and objective (Vaginal Health Index Score,VHIS, high-frequency ultrasound Doplerography, Urodynamic test)measures were used during the study period to assess symptoms. Duringthe urodynamic tests we accessed the cough test results, weidentified SUI type and its degree. All women had light and moderatedegree of SUI and positive cough test. Quality of life was measuredby using the WHO QOL. Quality of sexual life was measured by usingthe PISQ-12 and the Female Sexual Function Index (FSFI). All patientscompleted the International Consultation on IncontinenceQuestionnaire-Short Form (ICIQ-SF). A treatment cycle included 2treatments with urethral PRP-HA injections at 4-6-weekintervals.
Results: Initial improvement was noted in mostpatients, right off the first treatment. We also used high-frequencyultrasound Doplerography to measure of local microcirculation in fourreference points, which we inject for PRP. We registered an increasein blood circulation in the peri urethral area through 2-3 days afterPRP. Physical and mental scores of quality of life and quality ofsexual life were significantly improved in comparison with baseline,as well as the VHIS. 2 months following treatment with PRP injectionsthe symptoms of SUI disappear as was see from Urodynamic test andcaught test became negative.
Conclusions: Preliminary datashow significant improvement in all symptoms of SUI. In our previousexperience we successfully used bulking agents Dextranomer andhyaluronic acid (HA) injections for SUI. Injections of PRP and HA notonly leads to collagen synthesis, but also makes blood circulationand regeneration better, and provide for mechanical compression ofthe periurethral area.
References: 1. Pubo-urethralligament injury causes long-term stress urinary incintinence infemale rats: an animal model of the integral theory. J.C. Jefer, G.Liu, F. Daneshgari, 2009. 2. Urethral injection of bulking agents forintrinsic sphincter deficiency. Bent A. E. 2007