Platelet-Rich Plasma (PRP) therapy is now a common regenerative medicine treatment used in various medical fields. The treatment involves extracting the patient's blood, purifying it to remove red and white blood cells, and isolating a high concentration of platelets and multiple growth factors. This platelet-rich plasma is then injected back into the body to achieve therapeutic effects. Pelvic floor disorders include urinary incontinence, pelvic organ prolapse, voiding dysfunction, postmenopausal urological syndrome, and chronic pelvic pain. There is increasing research on using PRP injections to address the aging processes associated with these conditions by supplementing growth factors, aiming to improve patient symptoms.
For patients undergoing pelvic reconstruction surgery, new-onset urgency or urge urinary incontinence (de novo urgency or urge urinary incontinence) wound occur after extensive anterior vaginal wall dissection. This study aimed to investigate whether bladder injection with PRP during surgery could effectively improve bladder oversensitivity.

We retrospectively analyzed patients who underwent POP surgery by the same doctor in our institution between January 2015 and December 2022. We included patients who was diagnosed with bladder oversensitivity defined by strong desire ≤ 250ml in pre-operative urodynamic study. All of the patients were divided into two groups. Patients in group A underwent pelvic reconstructive surgery only, and patients in group B received bladder injection with PRP during operation. All of the patients received urodynamic study and questionnaires to assess bladder function and life quality in pre-operative and post-operative 2 months. Analysis was done using Wilcoxon signed rank test to assess intra-group difference and the Wilcoxon rank-sum test to assess between-group difference. A p-value of 0.05 or lower is generally considered statistically significant.

There were 94 women (no PRP, n = 64; and no PRP, n = 30) were included. All of them had UDS exam and questionnaires included OABSS, UDI-6, and IIQ-7 before and after treatment. Before operation, urgency, urgency incontinence, OABSS total score and question no.2 of UDI-6 were higher in group A(p<0.01)(Table 1). After operation, except daytime frequency, the other OABSS sub-score and total score, question no.1 and 2 in UDI-6 short-form and all questions in IIQ-7 were improved after intervention in both groups(Table 2); however, there were no between-group differences in the changes from baseline after intervention (Table 2). In UDS assessment, except first desire, there were significant within-group comparison of other parameters of bladder sensation (NDV, SDV, Urgency) in both groups; further more, there were significant between-group differences of bladder capacity (strong desire and urgency) in the changes from baseline after intra-operative bladder injection with PRP(p-value < 0.01).(Table 3)

Patients in group A had significant improvement after pelvic reconstructive surgery in questionnaires assessment, also showed increased bladder capacity after surgery, which inferred that pelvic reconstructive surgery can improved lower urinary tract symptoms. Prolapse surgery could improve or cure the symptoms of OAB. 

Bladder injection with PRP may have some benefits in increased bladder capacity in patients who underwent para-vesical space opening plus anterior vaginal mesh implantation.

Transvaginal pelvic reconstruction surgery can improved bladder storage function. Intra-operative bladder injection with platelet-rich-plasma during transvaginal pelvic reconstruction seemed to have more benefits in patients with bladder oversensitivity.

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