Overactive bladder (OAB) remains a highly prevalent condition with significant impact on quality of life. Pharmacological therapies frequently show limited efficacy or poor tolerability, and intravesical botulinum toxin, although effective, is invasive and associated with potential adverse events. Recurrence and declining efficacy suggest that current paradigms may be incomplete and that structural and neuromuscular factors may play a relevant role. Regenerative therapies such as platelet-rich plasma (PRP) may offer a novel minimally invasive alternative.The aim of this sudy is to evaluate outcomes of transvaginal platelet-rich plasma (PRP) in OAB using IABq-SF.

Prospective cohort of 634 women with OAB treated with transvaginal PRP. Outcomes were assessed using OABq-SF at 3, 6, 9, 12, and 15 months. Improvement rates were analyzed longitudinally. Statistical comparison demonstrated a significant decline over time (trend p<0.001). Blood (8 mL) are drawn using 4-mL tubes with 3.8% sodiumcitrate (GyCO. Deltalab.Spain). Centrifugation is then performedfor 7 minutes at 2000 rpm. The separated plasma israwn using 1 mm syringes. For each 1 mm syringe, 0.9 mLof the plasmais then mixed with 0.1 mL of calcium chloride(GyCO.Deltalab.Spain). The 1 mm syringes are connected to 30G × ½ (13 mm) needles. To facilitate the transvaginalinjections of the PRP in the anterior vaginal wall the authorshave developed a novel fenestrated speculum (Fig 1). Platelet enriched autologous plasma is injected in the anterior vaginal wall stranding proximally to the uterus and moving towards the urethral meatus.This is an important detail for bleeding may occurs mainly at the vaginal introitus.bevel into the vaginal mucosa at an angle of 45 degrees.Approximately 0.2 mL of PRP is placed with each injection. An average of 10 injections of PRP per side are used.

Clinical improvement was high at early follow-up (86% at 3 months), but declined progressively over time (73% at 6 months, 64% at 9 months, 58% at 12 months, and 36% at 15 months). In parallel, non-response rates increased substantially. This consistent temporal deterioration suggests that therapies targeting functional components alone fail to sustain long-term efficacy (Table 1).

These findings support a paradigm shift: OAB is not purely functional but reflects a system-level dysfunction. Structural deficits likely play a critical and under-recognized role in symptom persistence and recurrence. The observed pattern is best explained by interaction across multiple physiological domains rather than isolated dysfunction.

This study challenges the prevailing functional paradigm of OAB and introduces a clinically supported integrated model with direct implications for diagnosis, treatment strategy, and long-term outcomes.

Petros PE. The Integral Theory of Female Urinary Incontinence. Acta Obstet Gynecol Scand. 1990;69(S153):7–31.
Matz EL, Pearlman AM, Terlecki RP. Safety and feasibility of platelet rich plasma injection for the treatment of urologic conditions: A review. Translational Andrology and Urology. 2018;7(4):S533–S540.
Sukgen G, et al. PRP applications in urogynecology: emerging therapies. Int Urogynecol J. 2019.