Post-prostatectomy incontinence (PPI) is a well-recognized complication of transurethral or radical prostatectomy. Platelet-rich plasma (PRP) has been used in regenerative medicine. This study aimed to evaluate the therapeutic efficacy of repeated PRP injections into the urethral sphincter for PPI.

This single-center, uncontrolled retrospective study, conducted between September 2018 and May 2024, analyzed the therapeutic efficacy of PRP urethral sphincter injections in patients who developed PPI following radical prostatectomy. Treatment efficacy was primarily evaluated using the self-reported SUI VAS scoring system after each injection, along with the Global Response Assessment (GRA) score. The post-treatment GRA score served as the primary endpoint, with a score of ≥2 indicating treatment success and ≥1 indicating clinical improvement.

The mean age was 71.0±7.2 years, with a mean PPI duration of 35.5±36.8 months. After PRP injections, the mean GRA score was 1.21±1.14. A GRA score of 2 or 3 was reported in 29 (40.8%) patients, and a GRA score of ≥ 1 was reported in 56 (78.9%). Significant improvements were observed in the VAS score, UDI-6 score, and abdominal leak point pressure (ALPP). The increase in ALPP was significantly greater in the successful group than in the failed group (49.3±78.3 vs. 4.9±52.4 cmH2O, p = 0.028). Baseline cystometric bladder capacity (CBC) was identified as a significant predictor of a successful outcome (p = 0.047). The successful subgroup demonstrated a significantly greater reduction in UDI-6, IIQ-7, and VAS for SUI (all p <0.05), as well as a significantly greater increase in ALPP (49.3±78.3 vs. 4.9±52.4 cmH2O; p =0.028) (Table 1). Additionally, the baseline lower VAS of SUI (p = 0.002) and higher CBC was identified as a significant predictor of a successful outcome (p=0.041) (Table 2). At the final follow-up, which was more than 1 year, 4 patients (5.6%) achieved complete continence and no longer required pad protection. While 32 patients (45.1%) reported satisfaction despite occasional urinary incontinence, 15 patients (21.1%) noted a mild improvement in SUI severity but opted for further PRP injections.

This study revealed that repeated PRP urethral sphincter injections are a promising, less invasive treatment option for men with PPI after radical prostatectomy and significantly improve subjective symptoms while objectively increasing urethral resistance. The improvement of SUI grade in this study was mild in most of the patients with PPI after PRP injections. Because patients had used to wear a pad for protection, the pad use per day might not reflect the true amount of urine leakage per day. In the success subgroup, the mean pad use per day was decreased after treatment, which was associated with the improvement of UDI-6, IIQ-7, and SUI VAS. Most patients did not recover from SUI after PRP injection, but had shown mild (n=15, 21.1%) to moderate (n=14, 19.7%) improvement of SUI. A larger baseline CBC was identified as an independent predictor of treatment success. We did not expect PRP treatment can cure SUI, but hope this minimally invasive treatment can provide meaningful improvement of SUI severity and quality of life in male patients with PPI who do not intend to invasive surgery.

Study participants showed mild improvements in SUI severity, symptoms, and ALPP following four PRP injections.  Most patients did not recover from SUI, but had mild to moderate improvement after PRP injections. This minimally invasive treatment can provide meaningful improvement of SUI severity in male patients with PPI who do not intend to invasive surgery. Together with behavioral modification, 40% of men with PPI can achieve a better quality of life without male sling or artificial sphincter implantation.