Platelet rich plasma as a minimally invasive approach to uterine prolapse

A pilot study: effectiveness of local injection of autologous platelet-rich plasma in treating women with stress urinary incontinence

The study aims to evaluate the effectiveness of local injection of autologous platelet rich plasma (A-PRP) as a treatment for women suffering from stress urinary incontinence (SUI). In a prospective intervention study, twenty consecutive women suffering from SUI were treated with A-PRP injection at anterior vaginal wall where mid-urethra locates. Self-reported questionnaires were used to measure pre-treatment, 1 month and 6 months post-treatment symptom severity. Secondary outcomes of sexual function and treatment effect sorted by age were analyzed with valid statistical methods. A-PRP is effective in relieving SUI symptoms at both 1 month and 6 months post-treatment without significant adverse reactions reported. It seems to have a trend that treatment success rate with cured and improved symptoms was slightly higher in the younger group, although it did not reach statistical significance (P = 0.07). No significant changes in sexual function before and after the treatment were reported by the patients. This pilot study is the first to report A-PRP treatment effect for SUI in women. The result suggested that A-PRP is a considerable treatment option for mild to moderate SUI cases. It also opens up further research opportunities for A-PRP’s clinical applications.

Biologic Grafts for Use in Pelvic Organ Prolapse Surgery: a Contemporary Review

PURPOSE OF REVIEW

Pelvic organ prolapse (POP) is a common condition and there is a plethora of surgical techniques available to address this problem. We present a review of biologic grafts, including the latest literature to help guide a surgeon's choice on the type of biologic materials to augment repairs.

RECENT FINDINGS

Since the 2019 Food and Drug Administration (FDA) ban on mesh, including xenograft, there is a sparsity of biologic graft products available for POP repairs. This has led to a significant decrease in surgical application. Surgeons must be familiar with the biochemical properties, processing, and clinical application of biologic grafts prior to use. They should also be familiar with alternative operative techniques that utilize autografts, although there is limited outcome data on these techniques. With heightened awareness of mesh and its complications, biologic grafts have made a resurgence. Surgeons must be well versed on their available options. Current literature is limited, and studies have not demonstrated superiority of biologic graft over native tissue repairs for prolapse. Nevertheless, there is a role for these types of biologic graft material in specific patient populations. Future studies are warranted.

Platelet-Rich Plasma Therapy Enhances the Beneficial Effect of Bone Marrow Stem Cell Transplant on Endometrial Regeneration

This study aimed to investigate the potential effect of platelet-rich plasma (PRP) therapy on treatment using bone marrow stem cell (BMSC) transplant for uterine horn damage, and to reveal the potential underlying molecular mechanism. Uterine horn damage was established in a rat model, which can be repaired by transplant using BMSCs receiving control or PRP treatment. Immunohistochemistry was conducted to evaluate thickness and expression of α-SMA and vWF in the regenerated endometrium tissues. mRNA and proteins of insulin-like growth factor-1 (IGF-1) and interleukin-10 (IL-10) were measured both in the regenerated endometrium tissues and in cultured BMSCs to evaluate the effect of PRP treatment on their expression. Enzyme-linked immunosorbent assay was employed to measure the secretory levels of IL-10 in cultured BMSCs. Multi-differentiation assays were performed to address the effect of PRP treatment on tri-lineage potential of cultured BMSCs. Chromatin immunoprecipitation and luciferase reporter assays were applied to analyze NF-κB subunit p50 binding on IL-10 promoter and the resulted regulatory effect. PRP treatment significantly improved the efficacy of BMSC transplant in repairing uterine horn damage of rats, and elevated IGF-1 and IL-10 expression in regenerated endometrium tissues and cultured BMSCs, as well as enhanced tri-lineage differentiation potential of BMSCs. On the other hand, p50 inhibition and silencing suppressed the PRP-induced expression and secretion of IL-10 without affecting IGF-1 in the BMSCs. Furthermore, p50 was able to directly bind to IL-10 promoter to promote its expression. Data in the current study propose a working model, where PRP therapy improves endometrial regeneration of uterine horn damage in rats after BMSC transplant therapy, likely mediated through the NF-κB signaling pathway subunit p50 to directly induce the expression and production of IL-10.

Current clinical applications of platelet-rich plasma in various gynecological disorders: An appraisal of theory and practice

The purpose of this paper is to review the current clinical uses of platelet-rich plasma (PRP) in the field of gynecology. All relevant articles published from January 2000 to December 2017 were reviewed and analyzed. The articles on PRP in the field of gynecology were mainly case series, pilot studies, or case reports. PRP is currently considered a new therapeutic modality for some disorders that are refractory to conventional drugs.

Vaginal hysterectomy with repair for treatment of patients with severe uterine prolapse complicated with chronic atrophic gastritis: Impact on surgical indicators and complications

AIM

To evaluate the effect of vaginal hysterectomy with repair on surgical indicators and complications in patients with severe uterine prolapse and chronic atrophic gastritis. '

METHODS

One hundred and twenty patients with severe uterine prolapse accompanied by chronic atrophic gastritis treated at Wucheng First People's Hospital from June 2014 to June 2016 were selected and divided into a vaginal hysterectomy group (control group, 60 cases) and a vaginal hysterectomy with surgical repair group (observation group, 60 cases). The control group underwent vaginal hysterectomy alone, and the observation group underwent vaginal hysterectomy with repair. Surgical indicators and complications were compared between the two groups.

RESULTS

Intraoperative blood loss, time to ambulation, and analgesic use showed no statistical difference between the two groups (P > 0.05), while operative time, time to anal exhaust, and hospitalization duration differed significantly (P < 0.05). The cure rate was significantly higher in the observation group than in the control group (90% vs 70%, P < 0.05). Clinical efficacy also differed significantly between the two groups (P < 0.05). The incidence of complications was comparable between the control group (18.33%) and the observation group (10%; P > 0.05).

CONCLUSION

Vaginal hysterectomy with repair in the treatment of patients with severe uterine prolapse with chronic atrophic gastritis can not only cure uterine prolapse, but also make the physiological structure of the vaginal wall more perfect, promote wound healing, and improve the therapeutic effect.