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Cristina et al. Urological application of platelet rich fibrin

Table 1: Preoperative SF-36 questionnaire score overactive bladder, dysuria, recurrent urinary infections
Preoperative SF-36 Preoperative SF-36 previously treated by conventional drugs without any
Patient score physical health score mental health responses. The mean age was 60 years (range 57-
(baseline 50) (baseline 50) 63 years). The exclusion criteria were: patients with
1 35 25 Performance Status Karnofsky index ≤ 50%; patients
2 22 25
who needed major surgery; patients affected by
SF-36: Short Form-36 cancer disease; patients presenting platelets counts
≤ 100,000 or affected by coagulopathy; pregnancy.
20-40 years old. Prevalence is increasing. In 1999, Both patients were negative for coagulation pathway
the Nurses’ Health Study has published a paper on alteration or urinary infection.
over one million women affected by IC in the United
[1]
States . Pathogenesis is still unclear and could Patients underwent flexible diagnostic cystoscopy
be multifactorial including: urothelium dysfunction, and biopsy 1 to 4 weeks before the application of
[2]
mast cell activation and neurogenic inflammation . PRF to exclude bladder cancer. One patient had a
Mast cells accumulate into the sub-urothelium, histopatological diagnosis of IC due to a previous
proliferate forming pericapillaries cluster and release transurethral resection of the bladder for suspicious
numerous inflammatory molecules (histamine; carcinoma in situ of the bladder. Each patient filled in
cytokines; prostaglandins; platelet-activating factor the urinary symptoms questionnaire for IC [11-15] and
and proteolytic enzymes (tryptase and kinase). The the SF (Short Form)-36 questionnaire [16-18] before the
[3]
process may result in ulcerative cystitis . The “up- endoscopic procedure and application of PRF. The
regulation” of bladder sensitive afferents is the cause urinary symptoms questionnaire was composed of
of symptoms such as urgency, frequency and/or pain. 73 questions covering the following domains: urinary
symptoms, pain symptoms, sexual function, menstrual
There is no standard treatment. The 2011 AUA variability, and general health status. The SF-36
Treatment Guidelines include a treatment protocol questionnaire was used to test the quality of life, using
ranging from conservative treatments to more invasive a baseline of 50 represented the general health of
[4]
interventions . The aim of that study was to test the unaffected Italian population. The results of SF-
the efficacy of platelets rich fibrin (PRF) in patients 36 questionnaire are shown in Table 1. Summary
affected by IC in controlling the clinical symptoms score of IC symptom index was higher than 6 for both
and restoring the correct functioning of urothelium patients. This score indicates that patients affected by
coating. PRF [5-9] is a blood component for local use. It IC present significant voiding and pain symptoms.
can be obtained from fresh frozen plasma or bought in
synthetic form. It has hemostatic properties replicating After the written informed consent was obtained, we
the final phase of the coagulation cascade leading took 120 mL of autologous blood sample about 1 h
to the fibrin coat. PRF is composed of fibrin glue and before the procedure from a peripheral vein (30 min is
threefold the number of platelets than normal human the time for preparing about 6 mL of PRF). PRF was
blood [10] . PRF is stable and biocompatible. It is safe obtained from autologous patient’s blood through the
and functional. It promotes angiogenesis, tissue Vivostat system (Vivolution, Birkeroed, Denmark) [19]
growth and repair through multiple growth factors according to the standards for autologous donation
such as transforming growth factor-beta, vascular (Ministerial Decrees of March 2005). Vivostat system
endothelial growth factor and platelet-derived growth is composed of 3 parts: an automated processor
factor. PRF applications do not induce inflammatory unit, an automated applicator unit and a sterile unit
processes, adverse reactions and tissue fibrosis. for dispensing which includes a set of preparation
PRF is nowadays widely applied in different clinical and an endoscopic applicator. PRF was controlled
scenarios, such as orthopedics, ophthalmology for hepatitis B virus, hepatitis C virus, and human
and healing therapies, as a growth factor pool for immunodeficiency virus. We obtained about 6 mL
improving tissue regeneration. of PRF from each patient through the Vivostat
system. Thereafter, we performed an operative rigid
CASE REPORT cystoscopy with Carbon Dioxide Insufflation. One
patient was treated under sedation, the other one
The ethics committee of Campus Bio-Medico received subarachnoid anesthesia due to serious
University of Rome approved the study (REC number: asthma condition. We instilled 6 mL of PRF in a spray
27/14 PAR) on March 2014. From March 2014 to fashion all over the bladder walls [Figures 1 and 2]
September 2014, we enrolled two women affected through the endoscopic applicator. Then we placed
by IC who presented clinical symptoms such as pain, the vesical catheter and monitored the urine output.

Mini-invasive Surgery ¦ Volume 1 ¦ December 28, 2017 187