Investig Clin Urol.  2018 Jan;59(1):61-65. 10.4111/icu.2018.59.1.61.

Safety and feasibility of platelet rich fibrin matrix injections for treatment of common urologic conditions

• Matz EL
• Pearlman A
• Terlecki R

• KMID: 2399267
• DOI: http://doi.org/10.4111/icu.2018.59.1.61

Abstract

PURPOSE
Autologous platelet rich plasma (PRP) is used increasingly in a variety of settings. PRP injections have been used for decades to improve angiogenesis and wound healing. They have also been offered commercially in urology with little to no data on safety or efficacy. PRP could theoretically improve multiple urologic conditions, such as erectile dysfunction (ED), Peyronie's disease (PD), and stress urinary incontinence (SUI). A concern with PRP, however, is early washout, a situation potentially avoided by conversion to platelet rich fibrin matrix (PRFM). Before clinical trials can be performed, safety analysis is desirable. We reviewed an initial series of patients receiving PRFM for urologic pathology to assess safety and feasibility.
MATERIALS AND METHODS
Data were reviewed for patients treated with PRFM at our center from November 2012 to July 2017. Patients were observed immediately post-injection and at follow-up for complications and tolerability. Where applicable, International Index of Erectile Function (IIEF-5) scores were reviewed before and after injections for ED and/or PD. Pad use data was collected pre/post injection for SUI.
RESULTS
Seventeen patients were identified, with a mean receipt of 2.1 injections per patient. Post-procedural minor adverse events were seen in 3 men, consisting of mild pain at injection site and mild penile bruising. No patients experienced complications at follow-up. No decline was observed in men completing pre/post IIEF-5 evaluations.
CONCLUSIONS
PRFM appears to be a safe and feasible treatment modality in patients with urologic disease. Further placebo-controlled trials are warranted.

Keyword

Erectile dysfunction; Penile induration; Platelet-rich fibrin; Platelet-rich plasma; Urinary incontinence, stress

MeSH Terms

Blood Platelets*
Erectile Dysfunction
Fibrin*
Follow-Up Studies
Humans
Male
Pathology
Penile Induration
Platelet-Rich Plasma
Urinary Incontinence
Urinary Incontinence, Stress
Urologic Diseases
Urology
Wound Healing
Fibrin

Reference

1. Andia I, Maffulli N. Platelet-rich plasma for managing pain and inflammation in osteoarthritis. Nat Rev Rheumatol. 2013; 9:721–730.

2. Jiritano F, Serraino GF, Rossi M, Dominijanni A, Brescia A, Renzulli A. Ventricular assist device driveline infection: treatment with platelet-rich plasma. Ann Thorac Surg. 2013; 96:e37–e38.

3. Marck RE, Middelkoop E, Breederveld RS. Considerations on the use of platelet-rich plasma, specifically for burn treatment. J Burn Care Res. 2014; 35:219–227.

4. Schiavone G, Raskovic D, Greco J, Abeni D. Platelet-rich plasma for androgenetic alopecia: a pilot study. Dermatol Surg. 2014; 40:1010–1019.

5. Zhou B, Ren J, Ding C, Wu Y, Chen J, Wang G, et al. Protection of colonic anastomosis with platelet-rich plasma gel in the open abdomen. Injury. 2014; 45:864–868.

6. Galliera E, Corsi MM, Banfi G. Platelet rich plasma therapy: inflammatory molecules involved in tissue healing. J Biol Regul Homeost Agents. 2012; 26:2 Suppl 1. 35S–42S.

7. Randelli P, Randelli F, Ragone V, Menon A, D'Ambrosi R, Cucchi D, et al. Regenerative medicine in rotator cuff injuries. Biomed Res Int. 2014; 2014:129515.

8. Nurden AT, Nurden P, Sanchez M, Andia I, Anitua E. Platelets and wound healing. Front Biosci. 2008; 13:3532–3548.

9. Werner S, Grose R. Regulation of wound healing by growth factors and cytokines. Physiol Rev. 2003; 83:835–870.

10. Xie X, Zhang C, Tuan RS. Biology of platelet-rich plasma and its clinical application in cartilage repair. Arthritis Res Ther. 2014; 16:204.

11. Sampson S, Gerhardt M, Mandelbaum B. Platelet rich plasma injection grafts for musculoskeletal injuries: a review. Curr Rev Musculoskelet Med. 2008; 1:165–174.

12. Gigante A, Del Torto M, Manzotti S, Cianforlini M, Busilacchi A, Davidson PA, et al. Platelet rich fibrin matrix effects on skeletal muscle lesions: an experimental study. J Biol Regul Homeost Agents. 2012; 26:475–484.

13. Kushida S, Kakudo N, Morimoto N, Hara T, Ogawa T, Mitsui T, et al. Platelet and growth factor concentrations in activated platelet-rich plasma: a comparison of seven commercial separation systems. J Artif Organs. 2014; 17:186–192.

14. Wu CC, Wu YN, Ho HO, Chen KC, Sheu MT, Chiang HS. The neuroprotective effect of platelet-rich plasma on erectile function in bilateral cavernous nerve injury rat model. J Sex Med. 2012; 9:2838–2848.

15. Wu YN, Wu CC, Sheu MT, Chen KC, Ho HO, Chiang HS. Optimization of platelet-rich plasma and its effects on the recovery of erectile function after bilateral cavernous nerve injury in a rat model. J Tissue Eng Regen Med. 2016; 10:E294–E304.

16. Weiss RA. Autologous cell therapy: will it replace dermal fillers? Facial Plast Surg Clin North Am. 2013; 21:299–304.

17. Derby CA, Araujo AB, Johannes CB, Feldman HA, McKinlay JB. Measurement of erectile dysfunction in population-based studies: the use of a single question self-assessment in the Massachusetts Male Aging Study. Int J Impot Res. 2000; 12:197–204.

18. Feldman HA, Goldstein I, Hatzichristou DG, Krane RJ, McKinlay JB. Construction of a surrogate variable for impotence in the Massachusetts Male Aging Study. J Clin Epidemiol. 1994; 47:457–467.

19. Vlachopoulos C, Aznaouridis K, Ioakeimidis N, Rokkas K, Vasiliadou C, Alexopoulos N, et al. Unfavourable endothelial and inflammatory state in erectile dysfunction patients with or without coronary artery disease. Eur Heart J. 2006; 27:2640–2648.

20. Li J, Shi Q, Pu C, Tang Y, Bai Y, Yuan H, et al. Phosphodiesterase type 5 inhibitors for the treatment of post-nerve sparing radical prostatectomy erectile dysfunction in men. Sci Rep. 2014; 4:5801.

21. Greenfield JM, Levine LA. Peyronie's disease: etiology, epidemiology and medical treatment. Urol Clin North Am. 2005; 32:469–478, vii.

22. Levine LA, Burnett AL. Standard operating procedures for Peyronie's disease. J Sex Med. 2013; 10:230–244.

23. Gelbard M, Goldstein I, Hellstrom WJ, McMahon CG, Smith T, Tursi J, et al. Clinical efficacy, safety and tolerability of collagenase clostridium histolyticum for the treatment of peyronie disease in 2 large double-blind, randomized, placebo controlled phase 3 studies. J Urol. 2013; 190:199–207.

24. Davis NF, Kheradmand F, Creagh T. Injectable biomaterials for the treatment of stress urinary incontinence: their potential and pitfalls as urethral bulking agents. Int Urogynecol J. 2013; 24:913–919.

25. Tang YQ, Han BM, Yao XQ, Hong Y, Wang Y, Zhao FJ, et al. Chimeric molecules facilitate the degradation of androgen receptors and repress the growth of LNCaP cells. Asian J Androl. 2009; 11:119–126.

26. Shirvan MK, Alamdari DH, Ghoreifi A. A novel method for iatrogenic vesicovaginal fistula treatment: autologous platelet rich plasma injection and platelet rich fibrin glue interposition. J Urol. 2013; 189:2125–2129.

27. Maher CF, O'Reilly BA, Dwyer PL, Carey MP, Cornish A, Schluter P. Pubovaginal sling versus transurethral Macroplastique for stress urinary incontinence and intrinsic sphincter deficiency: a prospective randomised controlled trial. BJOG. 2005; 112:797–801.