Platelet-rich plasma in selected urological conditions: a narrative review of biological rationale, current evidence, and limitations.

BACKGROUND AND OBJECTIVE: Platelet-rich plasma (PRP) has been increasingly investigated as an autologous regenerative product in urology. Its proposed biological effects, including angiogenesis, inflammation modulation, neuroprotection, and tissue remodeling, have prompted exploratory use in erectile dysfunction (ED), Peyronie's disease (PD), interstitial cystitis/bladder pain syndrome (IC/BPS), urethral reconstruction, and urinary incontinence. Because published studies are methodologically heterogeneous and many are small or uncontrolled, a cautious narrative synthesis is needed. This narrative review aimed to summarize the biological rationale, current clinical evidence, safety considerations, and limitations of PRP in selected urological conditions.

METHODS: We performed a narrative review of PubMed and Web of Science, with the search updated to March 2026. We included representative English-language preclinical and clinical studies relevant to PRP in urology. This review was designed as a narrative overview rather than a systematic review; therefore, no Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flow diagram, formal risk-of-bias assessment, or evidence grading was undertaken.

KEY CONTENT AND FINDINGS: Available preclinical studies support plausible urology-relevant mechanisms, particularly endothelial support, cavernous nerve protection, urothelial repair, and antifibrotic signaling. Clinically, early studies suggest potential short-term benefit in selected patients with ED, IC/BPS, urethral reconstruction, hypospadias repair, and sphincteric incontinence. However, results are inconsistent. In ED, sham-controlled trials and updated meta-analytic data indicate that observed improvements may be modest, short-lived, or not superior to placebo in some settings. In PD, IC/BPS, reconstructive surgery, and urinary incontinence, the evidence remains preliminary and is limited by single-center designs, protocol heterogeneity, and incomplete reporting of PRP composition.

CONCLUSIONS: PRP remains an investigational therapy in urology. Its biological rationale is compelling, but current clinical evidence is insufficient to support broad routine use. Future progress depends on standardized PRP characterization and reporting, disease-specific sham-controlled trials, consistent outcome measures, and longer follow-up.