Page 196 - Read Online

Cristina et al. Urological application of platelet rich fibrin

bladder biopsy is a search for urothelial carcinoma/ of PRF. Questionnaires score showed a significant
carcinoma in situ of the bladder, which may be improvement of patients’ symptomatology during the
confused with IC [26] . follow-up. Our patients presented improvement in
quality of life and symptoms especially regarding the
We enrolled patients according to their typical and mental health. Both the mental and the physical health
highly disabling symptoms. Once we excluded the increased significantly and remained stable after 28
presence of bladder cancer, the aim of this study days and 3 months. PGI-I and SF-36 questionnaires
was to test the safety and the efficacy of endovesical can provide an overall appraisal of a patients’ condition
instillation of PRF to stimulate tissue regeneration and they are practical for clinical use by their simplicity
and control the clinical symptoms. Because in administration and interpretability. The interstitial
standardized treatment for IC does not exist, patients cystitis symptom index has been designed to capture
usually try many kinds of procedures such as many the most important voiding and pain symptoms and to
drugs (pentosan polysulphate, antidepressants); assess how problematic patients find them. Almost no
endovesical instillation of hyaluronic acid or Bacillus IC patients score less than 6 while almost no controls
Calmette-Guerin; sacral neuromodulation or surgery score as high as 6. In our study, the symptom index
(laser ablation of ulceration, cystectomy, bladder was higher than 6 for both patients and this value is
augmentation). Instillation therapy has a direct comparable to the score of O’Leary et al. . No further
[11]
action on the urothelium and sub-urotheliium to clinical improvements were seen after the first weeks
restore the normal bladder lining. Endovesical fibrin after PRF instillation. This may justify revaluation
glue has been succesfully used also for refractory during the follow-up for new endovesical treatments
hemorrhagic cystitis occurred after unrelated marrow, even though they presented partial or no response.
cord blood, and haploidentical hematopoietic PRF is an autologous blood component and it is safe
stem cell transplantation [27] . Campus Bio-Medico
University (Urology and Hematology Departments) and biocompatible. Patients treated with PRF did not
has already conducted, as coordinating center of present any immediately or long term side effects.
Rome Transplanta Network in 2009, a study on 35 The small series represents the major limitation of the
patients affected by severe hemorrhagic cystitis after study. Further cases are needed to achieve stronger
allogeneic hematopoietic stem cell transplantation. results.
All 35 patients showed clinical response and pain
resolution. In this new study, we treated patients In conclusion, PRF is an autologous component
affected by IC and we demonstrated that the typical that promotes angiogenesis, tissue growth and
urothelium coating involution can be successfully repair through multiple growth factors. It is safe and
helped by PRF that promotes angiogenesis, tissue biocompatible; it is widely applied in different clinical
growth and repair through multiple growth factors as scenarios to promote the tissue regeneration. Our
showed for transplanted patients. preliminary data show that patients affected by IC who
underwent endovesical application of PRF over the
A significant number of patients with ulcerative IC damaged urothelium, present significant improvement
show ulceration, severe inflammation, and granulation in clinical symptoms and quality of life. Further studies
tissue [28] . The inflammatory infiltrates are usually are needed to obtain more data.
superficial, and restricted to the lamina propria [29] . The
lamina propria is edematous, with stromal hemorrhage DECLARATIONS
and congested venules. In these patients, the rupture
of the bladder mucosa subsequently resulted in Authors’ contributions
reparative granulation tissue [30] . Hemorrhage is present Study conception and design: F. Cristina
in 90% of nonulcerative IC. While generally localized, PRF production: M.C. Tirindelli
the hemorrhage may extend into the urothelium [25] and Data collection: A. Nicotera
causes the mucosal rupture. Usually inflammation is Analysis and interpretation of data: T. Petitti
mild, but edema and vascular congestion are frequently Drafting of manuscript: M. Buscarini
seen. In both cases (ulcerative and non-ulcerative IC) Critical revision: G. Avvisati
the urothelium is particularly fragile. Baseline symptom
assessment and regular symptom level reassessment Financial support and sponsorship
are essential to document efficacy of single and None.
combined treatments [31] . We used different types
of questionnaires to compare the entity of patients’ Conflicts of interest
discomfort before and after the endoscopic application There are no conflicts of interest.

Mini-invasive Surgery ¦ Volume 1 ¦ December 28, 2017 189