Platelet rich Plasma (PRP) in three cases of complex recurrent urethral stenosis
Urethral stenosis after surgery are common and challenging for urologist; recurrence rate are high and variable owing to reports and surgeons. We tried PRP injection in case of recurrent stenosi to evaluate clinical impact on .
Materials and Methods
Three male patients, age 50 -67, who underwent previous surgery (salvage radical prostatectomy, simple open prostatic surgery and TURP) with high recurrence rate urethral stenosis. First patient was treated with cold incision of urethral-vesical anastomosis. Remain patients experienced scar in bulbar urethra: all were operated by cold knife incision to the perianastomotic fat or periurethral tissue. First patient recurred about every months, the latter two every two-three monts. Patients received up to 15 -20 cc of autologus PRP in the scar and the close tissue by Orandi needle; then we performed incision. Catheter was maintained up to three days, the patients discharged the days after procedure, performed in spinal anaesthesia.
We observed no complication in injection site, nor systemic effects. Bleeding was not more abundant than usual scar incision procedure and no patients needed bladder irrigation. Also catheter was well-tolerated with no hematuria or fever. The recurrence rate improved up to six months after two injection and incisions in the first patient. Scar tissue also was softer and shorter; patient well tolerated both procedures. Also the patients with bulbar stenosis went well and one is actually free of scar. We evaluated all of them by uroflow, thatconfirmed the subjective improvement referred by patient, and urethroscopy..
Follow-up ranges 6 to 12 months.
Urethral stenosis has high recurrence rate owing its physiopathology: fibrosis of periurethral tissues outside the lumen. Open urethral surgery acts by removing the scar or inserting different autologue tissues to enlarge the lumen; procedures often includes plate incisions. PRP is used in many clinical setting: to date we have no reports in urethral stenosis. We used PRP in stenosis, as plastic surgeons use it in skin scar; rationale is logic and our early results are promising. The patient with scar after open oncologic surgery, usually challenging for urologist, is going well but good results are observed in the three cases reported.
Adjuvant theraphy after stenosis incision includes cortisosteroid injection and laser therapy with variable results: the goal to reduce the recurrence rate of scars in periurethral tissue by laser is not confirmed. Only one study tested steroid injection after electric incision of strictures following radical prostatectomy. The experience we reported is limited to three cases with high recurrence rates and hard scars: these case are usually difficult and our results, even with short follow-up, are promising. No side-effect or risks, low costs and repeatability encourage to carry on this way and try to apply in lichen stenosis and stenosis recurrence in the short term or immediately after removal of the urethral catheter.
1) Int Urol Nephrol. 1995;27(1):101-6.
Recurrence of urethral stricture after single internal urethrotomy.
Ishigooka M1, Tomaru M, Hashimoto T, Sasagawa I, Nakada T, Mitobe K.
2) Everts PA, Knape JT, Weibrich G, et al. Platelet-rich plasma and
platelet gel: a review. J Extra Corpor Technol 2006;38:174-187.
3) Marx RE. Platelet-rich plasma: Evidence to support its use. J Oral