Stress Urinary Incontinence: Treatment With Platelet-Rich-Plasma Injection and Placement of Polydioxanone Threads—A Pilot Study

Abstract

Stress urinary incontinence is an important clinical problem that affects millions of women worldwide. The aim of this article was the evaluation of a minimally invasive procedure as an alternative treatment for mild urinary stress incontinence in women, using platelet-rich-plasma (PRP) injections and polydioxanone (PDO) threads. A total of 23 patients with mild urinary incontinence, mean age 46, were evaluated with detailed history, examination, urinary diary, complete laboratory tests, ultrasonography, urodynamic studies, and completion of International Consultation on Incontinence Questionaire–Urinary Incontinence Short Form (ICIQ-UI SF). Under local anesthesia, PRP was injected through the anterior vaginal wall, PDO threads placed in paraurethral, suburethral, and lateral urethrovaginal spaces, using instruments developed for safe and effective performance. Patients were analyzed at 1, 2, 4, 8 weeks and 6 months posttreatment. A total of 10 patients were biopsed preoperatively and 60 days after treatment. Symptoms and ICIQ-UI SF score were significantly improved. Postoperative urodynamic studies were normal in all cases. Biopsies after treatment showed a dense connective tissue tridimensional mesh. No complications or adverse effects were observed. All patients declared satisfaction with results, will have the procedure again, and will recommend it. The minimally invasive technique presented here results in strengthening of the paraurethral, suburethral, and lateral urethrovaginal spaces and the mucosa of the anterior vaginal wall. The combination of PRP injections and the placement of PDO threads creates a fibrotic and absorbable mesh-like structure, aimed to increase the urethral resistance, so that under effort the intravesical pressure does not overcome the urethral pressure. These results suggest that the procedure is safe and a cost-effective alternative in patients with mild urinary incontinence, reducing the need for invasive surgical procedures. Larger studies are needed to confirm the results of this study.