Two-phase Intravesical Injection of Apheresis-derived Platelet-rich Plasma for Non-ulcerative Primary Bladder Pain Syndrome: A Prospective Single-center Study.

OBJECTIVE

To prospectively evaluate the efficacy and predictive factors of a 2-phase intravesical injection protocol using apheresis-derived platelet-rich plasma (PRP) in patients with refractory non-ulcerative primary bladder pain syndrome (PBPS).

MATERIALS AND

METHODS

Between June 2023 and August 2025, 102 patients with PBPS were stratified into Groups A, B, and C based on cystoscopic grading of hydrodistention (Grade I-III). All patients underwent video-urodynamic studies and PRP collection, followed by a 2-phase intravesical injection protocol comprising an intensive weekly phase for three weeks and a consolidation monthly phase for three months. Follow-up assessments were conducted at baseline, 1 month, and 6 months after the treatment. Outcome measures included Global Response Assessment, questionnaire scores and voiding diary.

RESULTS

Compared with baseline, all groups demonstrated significant improvements in questionnaire scores and voiding diary at 1 month post-treatment, with Groups B and C showing significantly greater improvement than Group A in most of these. At 6 months post-treatment, only Groups B and C maintained significant improvements in all aforementioned parameters. Consistently, the treatment success rate was significantly lower in Group A than in Groups B and C at follow-up. Nine patients (9.4%) experienced self-limiting gross hematuria, and no other adverse events were reported. Maximal bladder capacity and cystoscopic grade were associated with 1-month post-treatment efficacy. However, only cystoscopic grade was independently predictive factor.

CONCLUSION

Two-phase intravesical injection of autologous apheresis-derived PRP is a safe and effective treatment for refractory non-ulcerative PBPS. Cystoscopic grading of hydrodistention serves as an independent predictor of treatment response.