الفهرس 
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Abstract
I
nterstitial cystitis/bladder pain syndrome (IC/BPS), also known as IC/painful bladder syndrome (IC/PBS), is a chronic and debilitating condition characterized by a range of symptoms including urinary frequency, urgency, nocturia, and pelvic pain. The disease is noted for its significant impact on sexual functioning and interpersonal relationships, predominantly affecting women aged 30 to 50. Despite being recognized for over a century, no single treatment has emerged as a universally effective solution, with the condition’s diagnosis being largely clinical and based on the exclusion of other potential causes. The disease is marked by cycles of flares and remissions, influenced by emotional and hormonal stressors, with Hunner’s ulcer being a distinct pathological feature. The pathogenesis of IC/PBS remains uncertain, with theories suggesting roles for infection, autoimmune responses, mast cell infiltration, and defects in mucosal permeability, among others.
Treatment strategies for IC/PBS are diverse, aiming to restore bladder function, prevent recurrence, and enhance quality of life. Approaches range from diet therapy and behavior adjustment training to various pharmacological and surgical interventions. Intravesical treatments, where substances are applied directly to the bladder tissue, have shown promise due to their localized effect and minimal systemic side effects. These treatments include the instillation or submucosal injection of agents such as botulinum toxin A, bacillus Calmette–Guerin, resiniferatoxin, lidocaine, chondroitin sulfate, oxybutynin, and pentosan polysulfate. Additionally, the role of platelets in tissue regeneration and wound healing, particularly through the use of platelet-rich plasma (PRP) that is rich in growth factors, highlights an evolving area of therapeutic exploration for repairing the defective epithelium in IC/PBS.
This study aimed to assess the effectiveness of submucosal intravesical injection of autologous platelet-rich plasma in the treatment of IC/PBS resistant to conventional methods of treatment.
This one-arm clinical trial at Ain Shams University hospitals in Cairo, Egypt, conducted from April 1, 2021, to April 1, 2023, aimed to evaluate the efficacy of submucosal intravesical injection of autologous platelet-rich plasma (PRP) for treating IC/PBS in 30 patients aged 30-50 years who had not responded to conventional treatments. Exclusion criteria included pregnancy, prior intravesical treatments, and other specific medical conditions. The study involved preoperative assessments including medical history, laboratory investigations, and radiological studies, followed by intraoperative PRP injections under anesthesia, with patients receiving 20 submucosal injections. Postoperative follow-up included assessments at 1, 3, and 6 months using the Global Response Assessment (GRA), O’Leary-Sant scores, and pain VAS. Success was defined by a significant improvement in GRA. Complications such as macroscopic hematuria and urinary tract infections were recorded, with ethical considerations including informed consent and privacy protection. Data analysis aimed to determine the treatment’s outcome through statistical evaluation of improvements in symptoms and quality of life.
The cohort consisted of 22 female and 4 male patients, with ages ranging from 30 to 50 years, indicating a mean age of 43.31 ± 4.97 years. The primary objective was to evaluate the effectiveness of a single submucosal intravesical injection of autologous platelet-rich plasma (PRP) on the symptoms of IC/PBS.
Postoperative complications were minimal, with hematuria observed in 3 cases (11.5%) and urinary tract infection (UTI) in 4 cases (15.4%). The study used several metrics for assessment, including the Interstitial Cystitis Symptom Index (ICSI), Interstitial Cystitis Problem Index (ICPI), O’Leary-Sant Symptom Score (OSS), and Visual Analogue Scale (VAS) for pain, urinary frequency, nocturia, and functional bladder capacity (FBC). Significant reductions were noted in ICSI, ICPI, OSS, and VAS scores from baseline to 1, 3, and 6 months post-injection, all with p-values <0.001, indicating substantial improvement in symptoms. Furthermore, there was a significant reduction in urinary frequency and nocturia and a considerable increase in FBC over the same periods.
The Global Response Assessment (GRA) indicated that by the end of 6 months, 61.54% of patients experienced a moderate to marked improvement in their condition, representing a successful outcome. These results suggest that a single submucosal intravesical injection of autologous PRP can effectively alleviate symptoms in IC/PBS patients resistant to traditional therapies, with post-procedure improvements in urinary symptoms and pain, and minimal complications.
In conclusion, this comprehensive study evaluated the efficacy of a single autologous platelet-rich plasma (PRP) injection for treating IC/PBS in 26 patients unresponsive to traditional therapies. Significant improvements were observed in symptoms, with a successful outcome in 61.54% of cases. The study highlighted PRP’s potential for enhancing urothelial regeneration and alleviating IC/PBS symptoms.