Platelet-rich plasma as a potential therapy of cystocele: A systematic review and meta-analysis

Background: Platelet-rich plasma (PRP) therapy, is known for its regenerative properties. PRP may be able to help with cystocele cases. This review aims to explore how it might be applied to urogynecological cases, particularly those involving cystocele. Methods: The present systematic review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guideline 2020, Meta-Analysis of Observational Studies in Epidemiology (MOOSE) guideline. The present systematic review was registered with PROSPERO with the registered number CRD42023414366. PubMed, Science Direct, Epistemonikos, COCHRANE, Google Scholar, and ProQuest were among the databases we searched. "(PRP OR Platelet-Rich Plasma) AND (Cystocele OR Anterior Pelvic Organ Prolapse)" from January 2007 to December 2022. Based on the PICO framework (Population = Patients with Cystocele; Intervention = Reconstruction with platelet-rich plasma injection; Compare = Reconstruction only; Outcome: Recurrency of Cystocele), four investigators (AMS, PMA, EAU, RSD, and AH) independently assessed eligibility by titles and abstracts. Using the Joanna Briggs Institute Critical Appraisal tool, each author evaluated full-text articles based on the kind of articles they had received. When consensus could not be obtained, disagreements were settled by involving the supervisors (EF, EMK, and BS). Results: A total of 8,924 studies were identified. After removing duplicates and applying eligibility criteria, two articles were included, encompassing 65 patients. In two studies, PRP injections were found and administered post-anterior colporrhaphy at the pubovesical fascia. According to these two trials, women who had anterior colporrhaphy and PRP injections required fewer reoperations. Conclusion: PRP has the potential to be a good alternative treatment to prevent cystocele recurrence. However, it cannot be generalized to large populations due to the small number of findings. Further studies with large samples examining the efficacy and safety of the therapy are needed to prove it.<br>

背景：富血小板血浆（Platelet-rich plasma, PRP）疗法以其再生特性而闻名，PRP或可用于治疗膀胱膨出病例。本系统综述旨在探讨其在泌尿妇科病例中的应用潜力，尤其是涉及膀胱膨出的病例。
方法：本系统综述严格遵循《系统综述与Meta分析首选报告条目指南2020》（Preferred Reporting Items for Systematic Reviews and Meta-Analysis 2020, PRISMA 2020）及《流行病学观察性研究Meta分析指南》（Meta-Analysis of Observational Studies in Epidemiology, MOOSE）。本系统综述已在PROSPERO平台注册，注册编号为CRD42023414366。检索数据库包括PubMed、Science Direct、Epistemonikos、COCHRANE、Google Scholar及ProQuest，检索时限为2007年1月至2022年12月，检索式为："(PRP OR 富血小板血浆) AND (膀胱膨出 OR 盆腔器官前壁脱垂)"。本研究基于PICO框架制定纳入排除标准：研究对象（Population）=膀胱膨出患者；干预措施（Intervention）=富血小板血浆注射联合重建术；对照措施（Compare）=单纯重建术；结局指标（Outcome）=膀胱膨出复发。由4名研究人员（AMS、PMA、EAU、RSD及AH）独立通过标题和摘要筛选文献以评估其纳入资格。随后，每位研究者依据文献类型，使用乔安娜·布里格斯研究所临界评价工具（Joanna Briggs Institute Critical Appraisal tool）对全文文献进行质量评价。若出现分歧无法达成共识，则由督导（EF、EMK及BS）协调解决。
结果：本研究共检索到8924项研究。去除重复文献并符合纳入标准后，最终纳入2项文献，共涉及65名患者。两项研究均采用在前阴道前壁修补术后于耻骨膀胱筋膜处注射PRP的方案。上述两项试验结果显示，接受前阴道前壁修补术联合PRP注射的女性患者再次手术率更低。
结论：PRP或可作为预防膀胱膨出复发的有效替代治疗方案。但由于纳入研究数量较少，该结论暂无法推广至大规模人群。未来仍需开展大样本量研究，以评估该疗法的有效性与安全性，进一步验证其临床价值。