A Novel Management for Postprostatectomy Urinary Incontinence

Stress urinary incontinence (SUI) can occur in men after radical prostatectomy (RP), referred to as postprostatectomy incontinence (PPI). PPI can cause significant distress and affect the quality of life. With the increased number of surgeries for prostate cancer, there has been a concomitant increase in PPI prevalence.

The initial management of PPI includes lifestyle interventions, pelvic floor muscle training, bladder retraining, pharmacotherapy and combination therapy.

Platelet-rich plasma (PRP) is an autologous blood-derived product obtained directly from patients’ peripheral blood. It comprises a high concentration of platelets and a pool of cytokines, chemokines and growth factors and is known to contribute to regeneration.

A group of researchers Lee, et al studied a group of 28 patients that had postprostatectomy urinary incontinence and treated them with urethral sphincter PRP injections, and found that the severity of the SUI reduced significantly. They performed injections transurethrally using rigid cystoscopic injection instruments and repeated the injection every month with a total of 4 injections. They observed a decrease in visual analogue scale (VAS) from 6.5-7 to 3.5.  Significant therapeutic effects were observed immediately after the first injection treatment and persisted throughout the study period.

This is the first study that demonstrated the efficacy and safety of repeated PRP urethral sphincter injections for treatment on PPI with significant clinical evidence. More importantly, this injection procedure is safe and does not have major adverse effects even after repeated procedures. PRP urethral sphincter injection has the potential to be a novel approach for the management of PPI.

It is hypothesized that the deficient urethral sphincter function improves after regenerated innervation and increased striated muscle cell volume via repeated PRP urethral sphincter injections into the external urethral sphincter.

This procedure is minimally invasive and effective and can potentially be translated to women suffering from the same type of condition.  

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Source: Lee, PJ., Jiang, YH. & Kuo, HC. A novel management for postprostatectomy urinary incontinence: platelet-rich plasma urethral sphincter injection. Sci Rep 11, 5371 (2021).

Source link: https://www.nature.com/articles/s41598-021-84923-1#citeas