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Cristina et al. Urological application of platelet rich fibrin

Figure 1: Instillation of platelets rich fibrin during operative cystoscopy Figure 2: Appearance of bladder walls at the end of the procedure

Physical Health Mental Health
70 80
60 70
60
50
50
40
40
30
30
20 20
10 10
0 0
Preop 28 days 90 days Preop 28 days 90 days
Figure 3: Physical health improvement after platelets rich fibrin Figure 4: Mental health improvement after platelets rich fibrin
instillation (Short Form-36 questionnaire score) instillation (Short Form-36 questionnaire score)

Both patients maintained the vesical catheter DISCUSSION
postoperatively and presented good urinary output.
We discharged patients after removal of the catheter During the 2003 Kyoto workshop, the IC was defined
and spontaneous urination. to be a syndrome characterized by 3 main symptoms:
frequency; urgency; pain [21] . The discomfort [22]
The follow-up was performed at 28 days, and 3 significantly alters the quality of life of patients. The
months through clinical visits and patients were asked etiology and pathogenesis of this condition are still
to fill in the SF-36 questionnaire again. During the unknown and it remains diagnosed by exclusion.
last follow-up at 3 months, patients filled in also the According to the European Society for the study of
Patient Global Impression of Improvement (PGI-I) IC/BPS (ESSIC) recommendations [23] , the first line of
questionnaire [20] . PGI-I is a 1-item questionnaire diagnosis is patient selection based on symptoms and
designed to assess the patient’s impression of exclusion of other diseases with similar presentation.
changes in urinary symptoms on a 7-point scored During the cystoscopy, little pink ulcerations (ulceration
scale. Global clinical response was evaluated through of Hunner [24] ) described in 1914 and “glomerulation”
clinical examinations and postoperative questionnaires described by Keene in 1920 as sub-mucosal capillary
that patients filled in during the follow-up. Patients bleeding can be found. The histologic findings are
reported significant improvement of symptoms (pain also neither specific for diagnosis nor correlated with
and dysuria) and quality of life especially regarding the symptoms. The histologic sample of bladder biopsy
mental health at the SF-36 questionnaire [Figures 3 can show the coating involution, the urothelium
and 4]. Both patients answered the PGI-I questionnaire thinning, the inflammatory sub-urothelium infiltration
to feel “much better” after PRF instillation. Neither and the mast cells presence [25] . While a patient’s
patient treated with PRF experienced any short- or history and examination are important, bladder biopsy
long-term side effects. is not essential. The most common indication for

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