Platelet Rich Plasma(PRP) as a therapy in Induratio Penis
Evaluation of safety and efficacy of PRP, containing growth factors and cytokines, in naive patients affected by Induratio Penis (IP)
Materials and Methods
25 males, age 44-80, with IP diagnosed by examination, ultrasound, pictures and symptom score (pain, curvature) were scheduled to receive intra- and periplaque injection of autologue blood enriched with platelets. Symptoms ranged one to 16 months: 20 had penis recurvatum ranging 15-30 degree, 5 only plaque with pain. After anticoagulation plasma is activated with calcium chloride wich induces release of growth factors and cytokines. Men were treated every twenty days, as outpatients procedure on local anesthesia, with evaluation of symptom, plaque size and tenderness, relief of curvature. Injection were performed with a 22 gauge needle with purpose to break the plaque. Counselling was given about stretching of erected penis. The trial includes six injection and re-evaluation after one month at the end of the set of injections.
15 patients has complete satisfaction: reduced plaque size, tenderness and pain with erection (60%). 5 patients had improvements after only 3 treatments (20%) with regard of pain, plaque tenderness and recurvatum.
5 men reported only improvement in pain and plaque size and tenderness (20%)
5 patients reported no improvement (20%), three of them accepted plaque surgery.
Only one patient experienced transient swelling of inguinal nodes; every patients reported minimal pain during injection and oedema in the site of puncture (a few hours). No fever or general symptoms.
We treated about three patients a day owing to the time blood unit needs to treat plasma: activation with calcium chloride and injection needs only 3 – 5 minutes.
Clinical use of PRP ranges from muscle pain and bone repair, scar treatment and hair growth. Owing to rich content of growth factors and cytokines plastic surgeons widely use in scars and connective tissue diseases. Cochrane review from 2009 to 2014 founded only a few large trials about hair treatment and scars with variable results on pain and scars tenderness. IP can be actually considered a connective disease of albuginea penis with variable evolution in each patient. We adopted this rationale and treated naive patient with good results, even if in a little sample; the better result are observed in younger men and early treatment. Plaque size has no importance if soft, while recurvatum over 20-25 degrees is a negative factor, Older men with hard plaques went worse.
Urologic indications to PRP treatment are currently restricted to foreskin lichen sclerosus or chronic balanopostitis resulting in scar: this illness always shows good response cause growth factors and cytokines can change old connective tissue in a younger one. PRP procedure in IP can be used with the same purpose, is safe and promising; in our series, with follow-up ranging 2 – 9 months, no complications occurred, patients are satisfied and the procedure well-accepted. IP is a dynamic disease liable to evolution over time and PRP injections can be safely repeated in case of new plaques. Lipofilling plus PRP is actually under investigation in non- responders as intra- and post-surgery treatment.
1) Dohan Ehrenfest DM, Rasmusson L, Albrektsson T (2009). "Classification of platelet concentrates: from pure platelet-rich plasma (P-PRP) to leucocyte- and platelet-rich fibrin (L-PRF)". Trends in Biotechnology 27 (3): 158–67.
2) Por YC, Shi L, Samuel M, Song C, Yeow VK (2009). "Use of tissue sealants in face-lifts: a metaanalysis". Aesthetic Plastic Surgery 33 (3): 336–9.