多次膀胱內注射高濃度血小板血漿對於間質性膀胱炎之療效分析：何種膀胱亞型獲益最大？

林琮翊¹、游婉茹²、張天霖¹、李宇坤¹、楊家誠¹、黃子修¹、劉民慶¹、張嘉峰¹、
江元宏¹、郭漢崇¹

¹佛教慈濟醫療財團法人花蓮慈濟醫院 泌尿部， ²護理部

Therapeutic Effects of Repeated Intravesical Platelet-rich Plasma injections　on Patients with Interstitial Cystitis – Which Bladder Subtype Benefit Most?
Tsung-Yi Lin¹, Wan-Ru Yu², Tien-Lin Chang¹, Yu Khun Lee¹, Chia-Cheng Yang¹, Tsu-Hsiu Huang¹, Ming-Ching Liu¹, Jia-Fong Jhang¹, Yuan-Hong Jiang¹, Hann-Chorng Kuo¹

Department of Urology¹ and Nursing², Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and Tzu Chi University, Hualien, Taiwan

Purpose: Interstitial cystitis/bladder pain syndrome (IC/BPS) is a challenging bladder disorder to manage. Platelet-rich plasma (PRP) has been found to have anti-inflammatory and regenerative effects on the bladder inflammation and urothelial barrier deficits. Preliminary results have shown a promising treatment outcomes. This study aimed to investigate which cystoscopic subtypes can benefit most from repeated PRP injections.

Materials and Methods: This study included 66 patients with IC/BPS, including 5 with Hunner’s IC and 61 with non-Hunner’s IC, who were not successfully managed with conventional treatments. The eligible patients underwent videourodynamic studies, completed voiding diaries, and received intravesical PRP injections once a month for a total of four treatments. Cystoscopic hydrodistention was performed, and the maximal bladder capacity and glomerulation grade were recorded. Treatment outcomes were examined using the global response assessment (GRA), and patients with a GRA score of 2 or 3 were considered to have achieved treatment success.

Results: In total, 33 (50%) patients reported a successful outcome, including 20 (30.3%) with an excellent outcome (GRA score of 3) and 13 (19.7%) with moderate improvement (GRA score of 2). The bladder pain visual analog score reduced by ≥ 3 in 23 (34.8%) patients, while the functional bladder capacity increased to ≥ 350 mL in 15 (25.9%) patients. Additionally, the glomerulation grade decreased by ≥ 1 in 20 (32.8%) patients. Although all patients reported adverse events such as urinary tract infection and urination difficulty, the IC symptom scores showed significant improvement in patients with MBC ≥ 760 mL and those with MBC < 760 mL and grade 2/3 glomerulation; however, no significant improvement was observed in those with MBC < 760 mL and grade 0 or 1.

Pain reduction was significant in patients with MBC ≥ 760 mL but not in those with MBC < 760 mL, though the latter group demonstrated a significant increase in MBC following PRP treatment. Further analysis of treatment results revealed that the successful treatment outcome was 61.1% and 66.7% in patients with grade 0/1 glomerulation and MBC ≥ 760 mL and MBC < 760 mL, respectively, compared to 47.8% and 41.1% in patients with grade 2/3 glomerulation and MBC ≥ 760 mL and MBC < 760 mL, respectively. Notably, the success rate was 40% in patients with Hunner’s IC. Post-hydrodistension glomerulation decreased by 1 in 20 (32.8%) patients, with 18 (30%) patients seeing a reduction to grade 0 (n=8) or 1 (n=10).

The current study demonstrates that four consecutive monthly intravesical PRP injections are effective in treating 50% of patients with IC/BPS refractory to conventional therapy. Specifically, patients with a baseline MBC of ≥ 760 mL and a glomerulation grade of 0 or 1 exhibited relatively higher success rates. These findings indicate that patients with IC/BPS who have a lower grade of bladder inflammation may derive the most benefit from PRP treatment.

Conclusions: In 50% of patients with IC/BPS, including the non-Hunner’s and Hunner’s IC subtypes, intravesical PRP injections are effective in reducing bladder pain, increasing bladder capacity, and improving glomerulation grade after cystoscopic hydrodistention. Moreover, patients with reduced bladder inflammation who exhibited a low glomerulation grade and a larger maximal bladder capacity at baseline had a relatively higher treatment success rate.