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Platelet-Rich Plasma (PRP)

Platelet-rich plasma (PRP) is an autologous blood-derived biologic with applications across a remarkably broad range of urologic and urogynecologic conditions. The strongest and most rapidly growing evidence is for intravesical injection in refractory interstitial cystitis / bladder pain syndrome (IC/BPS) — two 2026 meta-analyses now support significant improvement in pain, urinary symptoms, and bladder function.[1][2] PRP has also been studied as an adjunct to internal urethrotomy, for female SUI and male post-prostatectomy incontinence, erectile dysfunction, Peyronie's disease, genital lichen sclerosus, and hypospadias-repair complication prevention. The dominant cross-cutting limitation across urology is the lack of standardization in preparation protocols, concentrations, activation methods, and dosing.[3][4]

This article is the class-level hub across urologic PRP applications. For narrower deep-dives, see Antimitotics & antifibrotics (PRP as a stricture adjunct among other antifibrotics), Peyronie's disease agents (PRP as one of several intralesional options), and Intravesical IC/BPS agents (the broader instillation armamentarium).

Mechanism and preparation​

PRP is produced by centrifugation of autologous whole blood, yielding a platelet concentrate at 2–7× baseline.[5][6] After activation (thrombin, calcium chloride, or collagen), platelet α-granules release a growth-factor cascade:[5][7]

FactorRole
PDGFFibroblast recruitment and proliferation
TGF-βECM synthesis and remodeling (can also drive fibrosis — see caveat below)
VEGFAngiogenesis and revascularization
IGF-1, EGF, bFGF, HGFCell proliferation, differentiation, tissue regeneration

The sequential effect is (1) revascularization, (2) fibroblast-mediated connective-tissue restoration, and (3) mesenchymal-stem-cell differentiation into tissue-specific cell types.[5] The autologous nature eliminates disease-transmission and immunogenic concerns.[5]

Classification and standardization problem​

Classification systems include Dohan Ehrenfest (P-PRP, L-PRP, P-PRF, L-PRF based on leukocyte and fibrin content) and the PAW, DEPA, and MARSPILL systems.[8][4] Across urologic PRP literature, there is no standard for:[4]

  • Single vs double spin; target platelet concentration
  • Leukocyte content (leukocyte-rich vs leukocyte-poor)
  • Activation method
  • Injection volume, number of sessions, and session interval
  • Outcome measures and follow-up

This is the single biggest obstacle to cross-study comparison and clinical adoption.

IC/BPS — the strongest urologic application​

Two 2026 meta-analyses define the current evidence.

Meta-analyses​

  • Ali 2026 (8 studies) — intravesical PRP improved VAS pain (pooled SMD −0.78; 95% CI −1.15 to −0.41; p < 0.001), urinary frequency, O'Leary-Sant ICSI / ICPI scores, cystometric capacity, and GRA responder rates.[1]
  • Simões 2026 — confirmed the signal but noted all included studies were quasi-experimental / uncontrolled / non-randomized; overall evidence level low. Mean GRA ≥ 2 success rate 48%.[2]

Key prospective data​

StudynProtocolFinding
Jiang 202040 refractory IC/BPS4 monthly intravesical injections (10 mL, 2.5× concentration)GRA ≥ 2 70.6% at 1 mo and 76.7% at 3 mo after 4th injection; urinary biomarkers showed ↓ NGF, MMP-13, VEGF with ↑ PDGF-AB[9]
Xu 2026102 non-ulcerative primary BPSNovel 2-phase protocol — weekly × 3 wk, then monthly × 3 mo; apheresis-derived PRPHigher cystoscopic hydrodistention grades (II–III) showed greater and more durable improvement than Grade I; cystoscopic grade was the only independent predictor of response[10]
Jiang 2022 (dose-finding)ComparativeSingle high-dose (100 mL blood) vs 4 low-dose (50 mL blood)4 low-dose injections superior to single high-dose at 6 mo; saline-vs-plasma vehicle and injection site number (20 vs 40) had no effect[11]

Practical takeaway​

The multi-session (4 monthly) protocol is best-supported; cystoscopic hydrodistention grade predicts response; biomarker data confirm biological effect. See Intravesical IC/BPS agents for the broader instillation framework including triamcinolone for Hunner lesions.

Urethral stricture — adjunct to internal urethrotomy​

The single RCT evidence base is covered in Antimitotics & antifibrotics. Key points repeated here for reference:

  • Rezaei 2019 RCT (n = 87, bulbar strictures) — IU + submucosal PRP vs IU + saline: 12-mo recurrence 9.09% vs 26.82% (p = 0.032); 24-mo 21.95% vs 43.90% (p = 0.34, not significant); PRP also reduced stricture length in recurrence cases[12]
  • Aydın 2020 rat urethral-trauma model — PRP reduced mucosal inflammation, spongiofibrosis, and edema[13]
  • Tavukcu 2018 — PRP normalized the collagen I:III ratio toward uninjured controls in a rat urethral-injury model[14]
  • Gul 2016 hypothesis — TGF-β1-neutralization-antibody-modified PRP could further enhance antifibrotic effect by eliminating the pro-fibrotic growth-factor component while preserving regenerative activity[15]

The TGF-β paradox is worth noting: PRP delivers TGF-β (pro-fibrotic) alongside regenerative factors, and the net antifibrotic effect observed in urethral studies suggests either dose-dependent biphasic response or that the other factors dominate in this tissue. Modified PRP engineering may refine this.

Stress urinary incontinence​

Female SUI​

Utama 2026 systematic review + meta-analysis (8 studies, 3 RCTs + 5 quasi-experimental; n = 257) — PRP significantly improved symptom severity (UDI-6, ICIQ-SF) with:[16]

  • Abdominal leak-point pressure ↑ (MD +51.07 cmH₂O; 95% CI 36.21–65.93; p < 0.001)
  • Significant reduction in 1-hour pad weight
  • Significant improvement in patient-reported symptoms
StudynKey finding
Saraluck 2023 RCT60A-PRP + PFMT vs PFMT alone — A-PRP arm had 8 g greater reduction in 1-h pad weight; symptom improvement sustained at 2 and 5 mo; no AEs[17]
Chiang & Kuo 202226 ISD4 monthly urethral-sphincter injections — GRA ≥ 2 50%; complete dryness 46.2% initial / 26.9% at 12 mo; ALPP 117.5 → 133.6 cmH₂O (p = 0.045)[18]
Long 202120Anterior vaginal wall / mid-urethral A-PRP injection — significant symptom improvement at 1 and 6 mo; trend toward better outcomes in younger patients (p = 0.07)[19]

Male post-prostatectomy incontinence​

Lee 2021 prospective (n = 28 PPI, 4 monthly urethral-sphincter injections):[20]

  • Complete continence (pad-free): 21.4%
  • GRA ≥ 2 success rate: 71.4%
  • GRA ≥ 1 clinical improvement: 92.9%
  • VAS SUI 6.5 → 3.5 (p < 0.001)

Erectile dysfunction — conflicting RCTs​

The ED evidence is genuinely conflicting — the only double-blind placebo-controlled RCT is negative, while a single-blind RCT is positive.

Masterson 2023 (negative RCT)[21]​

Double-blind placebo-controlled (n = 61 mild-to-moderate ED, 2 intracavernosal PRP vs placebo):

  • No difference in MCID achievement (58.3% PRP vs 53.6% placebo; p = 0.730)
  • No difference in IIEF-EF scores at any timepoint
  • No change in penile Doppler parameters
  • PRP was safe but showed no efficacy over placebo

Shaher 2023 (positive RCT)[22]​

Single-blind randomized (n = 100, 3 PRP vs saline): significant improvement in IIEF-EF, SEP Q2/Q3, and duplex parameters at 1, 3, and 6 mo (p < 0.05).

Du 2024 meta-analysis[23]​

12 controlled trials (n = 991) + 11 single-arm (n = 377) — PRP better than controls: IIEF SMD +0.59 (95% CI 0.34–0.84); MCID RR 1.94 (95% CI 1.33–2.83). Authors stressed the need for further high-quality trials.

Practical interpretation: the negative Masterson RCT, with rigorous blinding, likely better reflects true efficacy. The positive results from open-label / single-blind trials may reflect placebo effect. See PDE5 inhibitors for the established pharmacologic first-line.

Peyronie's disease — early signal​

Ledesma 2024 Phase 2 RCT crossover design (n = 41; preliminary analysis of 28) — PRP safe with no AEs. PRP-placebo group: curvature 40° → 25° at 6 mo (p = 0.047). Placebo-PRP group: curvature to 32.5° (p = 0.490); PDQ reduction significant (p = 0.020) — consistent with a delayed PRP effect still playing out in long-term follow-up.[24]

Asmundo 2024 systematic review — PRP studies for PD generally showed small-to-moderate benefits with mild transient side effects; protocol variation, small samples, and short follow-up limit interpretation.[4]

See Peyronie's disease agents for the Dachille 2025 and Zugail 2024 PRP data alongside CCH, IFN, and verapamil.

Vulvar lichen sclerosus​

Emerging application as a regenerative adjunct for corticosteroid-refractory LS.

  • El Attar 2026 comprehensive review — 1 RCT, 11 single-arm, 1 case series, 1 case report. Most studies reported symptomatic relief, improved sexual function, vaginal health, tissue quality, and QoL. PRP works well alongside other regenerative options (e.g., adipose-derived stem cells)[25]
  • Boero 2024 pilot (n = 50 refractory VLS, 3 PRP injections) — 100% satisfied or very satisfied at 6 mo; significant NRS reductions for itching, burning, dyspareunia, dysuria (all p < 0.05)[26]
  • Medina Garrido 2023 (n = 28 postmenopausal refractory VLS, 3 PRP infiltrations) — statistically significant CSS improvement maintained throughout 1-year monitoring[27]
  • Tedesco 2020 combination AD-SVF + PRP superior to AD-SVF alone in early-stage LS; combinatory therapy discouraged in late-stage LS[28]
  • Sun 2025 mechanistic study — platelet-rich fibrin (PRF) attenuated VLS inflammation and fibrosis via TGF-β/SMAD3 pathway inhibition — decreased fibronectin and collagen I; increased CD31 and VEGF[29]

See High-potency topical corticosteroids for first-line LS management and Topical calcineurin inhibitors for the other non-steroid option.

Hypospadias repair — complication prevention​

Eryilmaz 2020 RCT (n = 40 pediatric mid-penile hypospadias, Snodgrass TIPU ± PRP graft): PRP group had lower rates of postoperative urethrocutaneous fistula, urethral stenosis, and infection — both early and long-term. PRP has plausible role in preventing the most common complications of hypospadias repair.[30]

One cautionary preclinical signal — renal ischemia-reperfusion​

Martín-Solé 2016 rat model — subcapsular PRP injection resulted in worse kidney blood flow (p = 0.045) and more histopathologic damage (p < 0.05) in ischemia-reperfusion injury.[31]

PRP should not be assumed universally beneficial across urologic tissues. The renal-parenchymal signal argues against empiric intraparenchymal use in partial nephrectomy or renal-trauma settings without further evidence.

Safety — excellent across urologic applications​

DomainSignal
Common AEsMild, self-limiting — dysuria, transient hematuria, micturition pain, UTI[1][20][21]
Serious AEsNone reported in any urologic study
Immunogenicity / disease transmissionNone — autologous[5]
Preparation standardizationPoor across studies — the main source of heterogeneity[4]
Renal IR cautionary signalPreclinical (Martín-Solé 2016) — argues against empiric intraparenchymal use[31]

Summary by indication​

IndicationRouteBest evidenceKey outcomeVerdict
IC/BPS (refractory)Intravesical injection2 meta-analyses; Jiang 2020, 2022; Xu 2026VAS SMD −0.78; GRA ≥ 2 in 48–77%Strongest urologic signal — reasonable for refractory disease[1][2][9][10]
Urethral strictureSubmucosal at IU1 RCT (Rezaei)9% vs 27% recurrence at 12 moSingle RCT; evidence less strong than MMC — see Antimitotics[12]
Female SUIPeriurethral / sphincterUtama 2026 meta; Saraluck 2023 RCTALPP +51 cmH₂O; pad weight −8 gPromising — small studies, short follow-up[16][17]
Male PPIUrethral-sphincter injectionLee 2021 prospective71.4% GRA ≥ 2; 21.4% pad-freeSingle study; no control[20]
Erectile dysfunctionIntracavernosalConflicting RCTs1 negative, 1 positiveMasterson 2023 negative DB RCT is most rigorous — no efficacy over placebo[21]
Peyronie's diseaseIntralesionalLedesma 2024 Phase 2 RCT (preliminary)Curvature 40° → 25° at 6 moPromising delayed effect; see Peyronie's disease agents[24]
Vulvar lichen sclerosusIntralesionalEl Attar 2026 review; Boero 2024 pilot100% satisfaction in refractory VLSAdjunct to topical steroids when refractory[25][26]
Hypospadias repairGraft applicationEryilmaz 2020 RCTLower fistula / stenosis / infectionSmall single study[30]
Renal ischemia-reperfusionSubcapsular / parenchymalPreclinical (Martín-Solé 2016)Worse blood flow, more damageAvoid[31]

Evidence Summary​

IndicationEvidence levelKey source
IC/BPSLevel 2 (meta + multiple prospective)Ali 2026[1]; Simões 2026[2]; Jiang 2020[9]
Urethral strictureLevel 1 (single RCT)Rezaei 2019[12]
Female SUILevel 1 (meta + RCT)Utama 2026[16]; Saraluck 2023[17]
Male PPILevel 3Lee 2021[20]
EDLevel 1 (conflicting RCTs)Masterson 2023 negative[21]; Shaher 2023 positive[22]
Peyronie'sLevel 2 (Phase 2 RCT)Ledesma 2024[24]
Vulvar LSLevel 3 (review + pilots)El Attar 2026[25]; Boero 2024[26]
HypospadiasLevel 2Eryilmaz 2020[30]
Renal IR cautionPreclinicalMartín-Solé 2016[31]

Clinical Positioning​

  • IC/BPS is the strongest urologic PRP application. Two 2026 meta-analyses show consistent VAS and symptom improvement. The best-supported protocol is 4 monthly intravesical injections per Jiang 2022, with response predicted by cystoscopic hydrodistention grade (Xu 2026).[1][2][10][11]
  • PRP is a legitimate adjunct for refractory IC/BPS after failing AUA first- and second-line therapies, and fits beside intravesical lidocaine, DMSO, and heparin-based cocktails in the instillation armamentarium.[1]
  • For ED, the rigorous double-blind Masterson 2023 RCT is negative. Do not default to PRP for ED — the IIEF and Doppler signals are no different from placebo. The conflicting Shaher 2023 positive RCT was single-blind and likely reflects placebo effect.[21][22]
  • For urethral stricture, MMC remains the better-supported adjunct (Pang 2021 OR 0.23 vs PRP's single-RCT signal). Reserve PRP for patients in whom MMC is contraindicated or unavailable, or in trial settings.[12]
  • For female SUI, PRP + PFMT shows modest RCT-supported benefit (Saraluck 2023) — a reasonable adjunct where slings are declined or contraindicated, but not a first-line replacement.[17]
  • For male PPI, single-study data (Lee 2021) show 71.4% GRA ≥ 2 and 21.4% pad-free — reasonable consideration after pelvic-floor PT failure, before committing to AUS.[20]
  • For Peyronie's, PRP is one of several intralesional options, not FDA-approved; see Peyronie's disease agents for comparison with CCH (FDA-approved), IFN α-2b, and verapamil.[24]
  • For vulvar LS, reserve PRP for topical-steroid-refractory disease. First-line remains clobetasol 0.05% ointment; PRP is an emerging regenerative adjunct, particularly when combined with adipose-derived stem cells in early-stage disease (Tedesco 2020).[25][28]
  • For hypospadias repair complication prevention, the Eryilmaz 2020 RCT shows promise — reasonable in selected pediatric cases, though the single-study evidence base limits broad adoption.[30]
  • The standardization problem is the biggest barrier to adoption. When prescribing PRP, document preparation protocol (spin number, platelet concentration, leukocyte content, activation), volume, injection sites, number of sessions, and interval so that response data can be compared against the literature.[4]
  • Avoid empiric intraparenchymal renal PRP given the Martín-Solé 2016 renal-IR cautionary signal.[31]
  • Safety is excellent across indications — mild self-limiting AEs, no immunogenicity, no disease transmission. The conversation is about efficacy, not harm.[4][5]

See Also​

References​

1. Ali F, Haseeb A, Khan HB, Maaz M, Mohammed W. "Efficacy of platelet-rich plasma in interstitial cystitis/bladder pain syndrome: a systematic review and meta-analysis." Int Urogynecol J. 2026. doi:10.1007/s00192-026-06579-7

2. Simões GCS, de Oliveira C, Gon LM, Riccetto CLZ. "Intravesical platelet-rich plasma injection for refractory interstitial cystitis/painful bladder syndrome: a systematic review and meta-analysis." Int Urogynecol J. 2026. doi:10.1007/s00192-026-06515-9

3. Sheean AJ, Anz AW, Bradley JP. "Platelet-rich plasma: fundamentals and clinical applications." Arthroscopy. 2021;37(9):2732–2734. doi:10.1016/j.arthro.2021.07.003

4. Asmundo MG, Durukan E, von Rohden E, et al. "Platelet-rich plasma therapy in erectile dysfunction and Peyronie's disease: a systematic review of the literature." World J Urol. 2024;42(1):359. doi:10.1007/s00345-024-05065-3

5. Etulain J. "Platelets in wound healing and regenerative medicine." Platelets. 2018;29(6):556–568. doi:10.1080/09537104.2018.1430357

6. Dos Santos RG, Santos GS, Alkass N, et al. "The regenerative mechanisms of platelet-rich plasma: a review." Cytokine. 2021;144:155560. doi:10.1016/j.cyto.2021.155560

7. Moraes VY, Lenza M, Tamaoki MJ, Faloppa F, Belloti JC. "Platelet-rich therapies for musculoskeletal soft tissue injuries." Cochrane Database Syst Rev. 2014;(4):CD010071. doi:10.1002/14651858.CD010071.pub3

8. Marín Fermín T, Calcei JG, Della Vedova F, et al. "Review of Dohan Ehrenfest et al. (2009) on 'Classification of platelet concentrates: from pure platelet-rich plasma (P-PRP) to leucocyte- and platelet-rich fibrin (L-PRF).'" J ISAKOS. 2024;9(2):215–220. doi:10.1016/j.jisako.2023.07.010

9. Jiang YH, Kuo YC, Jhang JF, et al. "Repeated intravesical injections of platelet-rich plasma improve symptoms and alter urinary functional proteins in patients with refractory interstitial cystitis." Sci Rep. 2020;10(1):15218. doi:10.1038/s41598-020-72292-0

10. Xu S, Zhu Q, Wang C, et al. "Two-phase intravesical injection of apheresis-derived platelet-rich plasma for non-ulcerative primary bladder pain syndrome: a prospective single-center study." Urology. 2026;210:24–29. doi:10.1016/j.urology.2026.02.007

11. Jiang YH, Jhang JF, Lin TY, et al. "Therapeutic efficacy of intravesical platelet-rich plasma injections for interstitial cystitis/bladder pain syndrome — a comparative study of different injection number, additives and concentrations." Front Pharmacol. 2022;13:853776. doi:10.3389/fphar.2022.853776

12. Rezaei M, Badiei R, Badiei R. "The effect of platelet-rich plasma injection on post-internal-urethrotomy stricture recurrence." World J Urol. 2019;37(9):1959–1964. doi:10.1007/s00345-018-2597-8

13. Aydın A, Sönmez MG, Oltulu P, et al. "Histopathologic evaluation of the effects of intraurethral platelet-rich plasma in urethral trauma experimentally induced in rat model." Urology. 2020;141:187.e9–187.e14. doi:10.1016/j.urology.2020.03.025

14. Tavukcu HH, Aytaç Ö, Atuğ F, et al. "Protective effect of platelet-rich plasma on urethral injury model of male rats." Neurourol Urodyn. 2018;37(4):1286–1293. doi:10.1002/nau.23460

15. Gul M. "Modified platelet-rich plasma with transforming growth factor β1 neutralization antibody injection may reduce recurrence rate of urethral stricture." Med Hypotheses. 2016;97:1–3. doi:10.1016/j.mehy.2016.10.007

16. Utama BI, Birru ABA, Cuandra KN, et al. "Therapeutic efficacy and safety of injectable platelet-rich plasma in women with stress urinary incontinence: a systematic review and meta-analysis." Front Med. 2026;13:1728478. doi:10.3389/fmed.2026.1728478

17. Saraluck A, Chinthakanan O, Kijmanawat A, et al. "Autologous platelet-rich plasma (A-PRP) combined with pelvic-floor muscle training for the treatment of female stress urinary incontinence: a randomized controlled clinical trial." Neurourol Urodyn. 2023. doi:10.1002/nau.25365

18. Chiang CH, Kuo HC. "The efficacy and mid-term durability of urethral sphincter injections of platelet-rich plasma in treatment of female stress urinary incontinence." Front Pharmacol. 2022;13:847520. doi:10.3389/fphar.2022.847520

19. Long CY, Lin KL, Shen CR, et al. "A pilot study: effectiveness of local injection of autologous platelet-rich plasma in treating women with stress urinary incontinence." Sci Rep. 2021;11(1):1584. doi:10.1038/s41598-020-80598-2

20. Lee PJ, Jiang YH, Kuo HC. "A novel management for post-prostatectomy urinary incontinence: platelet-rich plasma urethral sphincter injection." Sci Rep. 2021;11(1):5371. doi:10.1038/s41598-021-84923-1

21. Masterson TA, Molina M, Ledesma B, et al. "Platelet-rich plasma for the treatment of erectile dysfunction: a prospective, randomized, double-blind, placebo-controlled clinical trial." J Urol. 2023;210(1):154–161. doi:10.1097/JU.0000000000003481

22. Shaher H, Fathi A, Elbashir S, Abdelbaki SA, Soliman T. "Is platelet-rich plasma safe and effective in treatment of erectile dysfunction? Randomized controlled study." Urology. 2023;175:114–119. doi:10.1016/j.urology.2023.01.028

23. Du S, Sun S, Guo F, Liu H. "Efficacy of platelet-rich plasma in the treatment of erectile dysfunction: a meta-analysis of controlled and single-arm trials." PLoS One. 2024;19(11):e0313074. doi:10.1371/journal.pone.0313074

24. Ledesma BR, Velasquez DA, Egemba C, et al. "A Phase 2 randomized, placebo-controlled crossover trial to evaluate safety and efficacy of platelet-rich plasma injections for Peyronie's disease: clinical trial update." Int J Impot Res. 2024;36(8):813–817. doi:10.1038/s41443-024-00844-3

25. El Attar A, DeLucia C, Landau M, Kroumpouzos G. "Platelet-rich plasma in the management of genital lichen sclerosus: a review of mechanisms, evidence, and future directions." Clin Dermatol. 2026;44(2):356–362. doi:10.1016/j.clindermatol.2026.02.001

26. Boero V, Cetera GE, Caia C, et al. "Is there a role for platelet-rich plasma injection in vulvar lichen sclerosus? A self-controlled pilot study." Arch Gynecol Obstet. 2024;309(6):2719–2726. doi:10.1007/s00404-024-07424-2

27. Medina Garrido C, Cano García A, de la Cruz Cea L, Oreja Cuesta AB. "Mid-term symptomatic relief after platelet-rich plasma infiltration in vulvar lichen sclerosus." Arch Dermatol Res. 2023;315(6):1527–1532. doi:10.1007/s00403-023-02529-1

28. Tedesco M, Bellei B, Garelli V, et al. "Adipose tissue stromal vascular fraction and adipose tissue stromal vascular fraction plus platelet-rich plasma grafting: new regenerative perspectives in genital lichen sclerosus." Dermatol Ther. 2020;33(6):e14277. doi:10.1111/dth.14277

29. Sun SH, Fan HH, Wang XW, Bing BD, Hu YJ. "Platelet-rich fibrin attenuates inflammation and fibrosis in vulvar lichen sclerosus via the TGF-β/SMAD3 pathway." Arch Dermatol Res. 2025;317(1):360. doi:10.1007/s00403-025-03811-0

30. Eryilmaz R, Şimşek M, Aslan R, et al. "The effect of platelet-rich plasma graft on post-operative complications in mid-penile hypospadias." Andrologia. 2020;52(7):e13652. doi:10.1111/and.13652

31. Martín-Solé O, Rodó J, García-Aparicio L, et al. "Effects of platelet-rich plasma (PRP) on a model of renal ischemia-reperfusion in rats." PLoS One. 2016;11(8):e0160703. doi:10.1371/journal.pone.0160703