LS treatment & Applications of PRP in various gynecologic disorders/ Published online 2018 Jun 29

Applications of PRP in various gynecological disorders

Tissue repair begins with clot formation and is followed by platelet degranulation with the release of platelet growth factors. These are necessary and well-regulated processes to achieve wound healing. PRP preparations are used in gynecology for various diseases based on its known mechanisms, which involve the wound healing process and the initiation of inflammatory reactions [2].

PRP in skin lesions and wound healing

Due to the ability of PRP to promote angiogenesis and wound healing, it is widely used in dermatology for purposes including the treatment of ulcers, scars, and alopecia. With this in mind, PRP was tested by Tehranian et al. [16] in wound healing in high-risk women undergoing cesarean sections. They applied PRP in 70 patients and compared them to 71 control cases without PRP application. The inclusion criteria were a body mass index (BMI) >25 kg/m2, prior cesarean section, diabetes, twin pregnancy, use of corticosteroid medication, and anemia. They found a greater reduction in the redness, edema, ecchymosis, discharge, approximation score than in the control group (85.5% reduction in the PRP group vs. 72% in the control group) (p<0.001). They concluded that PRP was an effective therapeutic approach for wound healing, and faster wound healing can be expected when PRP is used due to the presence of more platelets and growth factors.

Another study was conducted of 55 patients undergoing major gynecological surgery, in whom PRP was directly applied to the surgical site. The authors found that autologous platelet grafts applied in gynecological surgery were effective for pain reduction and were not associated with any adverse effects [17].

PRP in cervical ectopy

Hua et al. [18] conducted a randomized clinical study to compare the effectiveness of autologous PRP application to that of laser treatment for benign cervical ectopy. They applied PRP twice on the area of cervical erosion with a 1-week interval in 60 patients, while laser treatment was used in the other 60 patients. They found that the complete cure rate was 93.7% in the PRP group and 92.4% in the laser group (p>0.05). The mean time to re-epithelialization was significantly shorter in the PRP group (p<0.01). The rate of adverse treatment effects (i.e., vaginal discharge or vaginal bleeding) was much lower in the PRP group than in the laser group (p<0.01). They concluded that autologous PRP application appeared promising for the treatment of cervical ectopy in symptomatic women, as it yielded a shorter tissue healing time and milder adverse effects than laser treatment.

PRP in vulvar dystrophy

PRP has been tried in many dermatological and autoimmune conditions nonresponsive to corticosteroids, such as lichen sclerosus (LS) and eczema. LS affects the vulva and causes extensive scarring, with progressive loss of the labia minora, sealing of the clitoral hood, and burying of the clitoris. LS also causes progressive pruritus, dyspareunia, and genital bleeding. It has a considerable impact on the quality of life of affected patients by disturbing physical activity, sexual pleasure, and causing emotional and psychological problems [19].

This condition is treated by topical and systemic corticosteroids. Application of PRP in cases of LS resistant to steroid therapy was tried by Behnia-Willison et al. [20] in 28 patients with LS. They injected PRP into the vulva in a fanning pattern. Patients received three PRP treatments 4 to 6 weeks apart and again at 12 months. Nearly all patients exhibited clinical improvements in the size of their lesions, and in 28.6% of the patients, the lesions disappeared completely after PRP treatment. Minimal pain and no complications were reported. They concluded that PRP injections could therefore be considered an effective therapy for LS.

PRP in reconstructive surgery for vulvar cancer

Morelli et al. [21] conducted a retrospective study of patients who underwent surgery for vulvar cancer (radical vulvectomy). The aim of their study was to evaluate the efficacy of platelet gel application in women after radical surgery. They divided patients into two groups: group A (n=10), who had platelet gel placed on the vaginal breach during reconstructive surgery, and group B (n=15), who underwent only surgical treatment. They found significantly lower rates of wound infection (p=0.032), necrosis of vaginal wounds (p=0.096), and wound breakdown (p=0.048) in group A than in group B. They also found a reduction in the postoperative fever rate, a shorter hospital stay, and faster wound healing in group A, which received PRP gel treatment. They concluded that platelet gel application before vulvar reconstruction represented an effective strategy for preventing wound breakdown after surgery to treat locally advanced vulvar cancer

PRP in urogenital disorders

(1) PRP in genital fistulae

Genital fistulae are treated by many modalities, as listed by Bodner-Adler et al. [22] in a systemic review that assessed conservative and surgical treatments. They found that small fistulae could be treated conservatively with various therapies, including PRP, with success rates ranging from 67% to 100%.

PRP has been tried in the treatment of vesicovaginal fistulae as a novel, minimally invasive approach for the closure of genital fistulae. Shirvan et al. [23], in a series of 12 patients, injected PRP around the fistula into the tissue, and platelet-rich fibrin (PRF) glue was interpositioned in the tract. They followed the cases for 6 months and found that 11 patients were clinically cured, with normal findings on transvaginal physical examinations and cystography. They concluded that autologous PRP injection and PRF glue interposition offered a safe, effective, and novel minimally invasive approach for the treatment of vesicovaginal fistulae that obviated the need for open surgery.

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