# Critical Appraisal of Evidence on Platelet-Rich Plasma and Stem Cell Therapy for Stress Urinary Incontinence: A Narrative Review

## TL;DR

This paper reviews the current evidence on using platelet-rich plasma and stem cell therapy for treating stress urinary incontinence, highlighting the need for standardized protocols and better outcome measures.

## Contribution

The paper provides a critical analysis of regenerative therapies for SUI and outlines recommendations for future clinical trials.

## Key findings

- Nine clinical trials were identified, but inconsistencies in treatment protocols limit the reliability of findings.
- There is a lack of standardized methods for PRP preparation and assessment of sphincter regeneration.
- Future trials should include objective outcome measures like urodynamic parameters and MRI evidence of regeneration.

## Abstract

Stress urinary incontinence (SUI) is a common condition, affecting 20% of individuals. It is defined by the involuntary loss of urine during activities that increase intra-abdominal pressure, such as coughing or physical exertion. SUI may result from urethral hypermobility or intrinsic sphincter deficiency. Conventional treatments, including pelvic floor exercises, sling surgeries, and bulking agents, have varying success rates and complications. Emerging regenerative therapies such as platelet-rich plasma (PRP) and stem cell therapy (SCT) hold promise for improving urethral support and rhabdosphincter function.

This review critically examines recent evidence on the efficacy and safety of PRP and SCT for treating SUI. A thorough search of databases was conducted, focusing on clinical studies published on adult SUI patients treated with PRP and SCT interventions. Nine clinical trials met the inclusion criteria. All studies were conducted between 2011 and 2024. The keywords used were "Stress Urinary Incontinence", "Regenerative Medicine”, Cell- and Tissue-Based Therapy”, “Stem Cell Transplantation”, and “Stem Cell".

These studies investigated the use of PRP and mesenchymal stem cells, but inconsistencies in treatment protocols raise concerns about the reliability and generalizability of their findings. Additionally, there was a lack of detailed assessment tools to evaluate sphincter regeneration post-treatment and no standardized methods for PRP preparation.

This review describes the current status of stem cell research on SUI and suggests future directions to facilitate clinical applications. Future trials should follow a standardized protocol that includes detailed methods for stem cell or PRP preparation, dosage determination, application techniques, and necessary pre-procedural assessments. Objective outcome measures must incorporate improvements in urodynamic parameters, MRI evidence of sphincter regeneration, and comprehensive long-term follow-up evaluations. This approach ensures consistency and reliability in assessing treatment efficacy.