Intravesical Platelet-Rich Plasma Injection for Refractory Interstitial Cystitis/Painful Bladder Syndrome: A Systematic Review and Meta-analysis.

INTRODUCTION AND HYPOTHESIS: Intravesical injection of platelet-rich plasma (PRP) has emerged as a novel therapeutic approach for patients with interstitial cystitis/ bladder pain syndrome (IC/BPS). This systematic review and meta-analysis aim to evaluate the efficacy of PRP in alleviating pain and other related symptoms and outcomes in women.

METHODS

This systematic review and meta-analysis followed PRISMA guidelines and the PICO framework. A comprehensive search was conducted in multiple databases. Risk of bias was assessed using the Cochrane Review Manager (RevMan), and quality of evidence was evaluated using the Modified Oxford Centre for Evidence-Based Medicine tool. All included studies were quasi-experimental, uncontrolled, and non-randomized, resulting in a low overall level of evidence. A pre-post meta-analysis was performed assessing outcomes such as Global Response Assessment (GRA), pain (VAS), symptom scores (ICSI, ICPI, OSS), urinary frequency, nocturia, and urodynamic parameters. Standardized mean differences were calculated using a random-effects model, and heterogeneity was assessed using Cochran's Q test and the I2 statistic.

RESULTS

The meta-analysis revealed a potential treatment effect, with a mean success rate (GRA ≥ 2) of 48%. Given that all the results derive from uncontrolled and non-randomized studies, they should therefore be interpreted with caution. Statistically significant improvements were observed in pain scores, urinary frequency, nocturia, and bladder function, including increases in Qmax and voided volume.

CONCLUSIONS

Intravesical PRP injection may represent a promising therapeutic option for refractory IC/BPS, showing trends toward improvement in pain, nocturia, frequency, and bladder capacity. However, as current evidence is derived exclusively from uncontrolled and non-randomized studies, its efficacy remains uncertain and the findings should be interpreted with caution. Nonetheless, higher-quality randomized controlled trials are required to confirm its efficacy and better define its role in clinical practice.