Efficacy and Safety of Platelet-Rich Plasma Injections for the Treatment of Female Sexual Dysfunction and Stress Urinary Incontinence: A Systematic Review

Introduction: There is no clear evidence in the literature that platelet-rich plasma (PRP) injections improve female sexual dysfunction (FSD) and female stress urinary incontinence (SUI). Objectives: A systematic review was performed to study the efficacy and safety of PRP injections in women with the above pathologies, as well as to explore the optimal dosing, frequency and area of injections, and duration of treatment. Methods: A systematic search on PubMed, Embase and the Cochrane Library database was performed, as well as sources of grey literature from the date of database or source creation to January 2023. After title/abstract and full-text screening, clinical studies on humans evaluating the efficacy of PRP in gynecological disorders using standardized tools were included. Risk of bias was undertaken with RoB-2 for randomized-controlled trials (RCT) and the Newcastle-Ottawa Scale (NOS) for observational studies. Results: Four prospective and one retrospective study explored FSD, while six prospective and one RCT evaluated female SUI. A total of 327 women with a mean age of 51 ± 12 years were included. For FSD, PRP significantly improved the Female Sexual Function Index (FSFI), the Vaginal Health Index (VHI) and the Female Sexual Distress score (FSDS). For SUI, PRP led to a significant improvement in the International Consultation on Incontinence Questionnaire—Short Form (ICIQ-SF) and the Urogenital Distress Inventory (UDI-6). The identified RCT reported a significantly higher mean score of ICIQ-SF (p < 0.05) and UDI-6 (p < 0.01) in the midurethral sling group compared to the PRP injections group. Regarding the risk of bias, the RCT was characterized by high risk, whereas the observational studies were of moderate risk. The protocol for PRP injections for FSD is the injection of 2 mL of PRP into the distal anterior vaginal wall once a month for 3 months. For female SUI, 5–6 mL of PRP should be injected into the periurethral area once a month for 3 months. Conclusions: Despite the promising initial results of PRP injections, the level of current evidence is low due to methodological issues in the available studies. It becomes clear that there is an emerging need for high-quality research examining PRP injections for the treatment of FSD and female SUI

Evaluation and evolution of uveitic macular edema with the use of optical coherence tomography and multifocalerg

Background: To evaluate the correlation between the anatomical and the functional outcome before and after treatment of uveitic macular edema (UME). Methods: Thirty three eyes of 33 patients with UME were included in the present study best corrected visual acuity (BCVA), optical coherence tomography (OCT) and multifocal electroretinogram (mFERG) measurements were performed before and after the treatment of macular edema correlation analyses between BCVA, OCT and MFERG parameters were performed. Results: BCVA and MFERG measurements showed statistically significant improvement after the treatment of macular edema (p<0.01) and OCT measured central foveal thickness (FT) decreased significantly from 434 ±135 μm before treatment to 267±92μm after treatment (p<0.001). Correlation analyses showed that CFT before treatment was correlated with MFERG N1 response amplitude of area 1 (Spearman’s r=-0.62, P<0.001). BCVA after treatment had negative correlation with the MFERG N1 response amplitude of area 1 (Spearman’s r=-0.56, P=0.001). Also, no correlation between the final BCVA and pretreatment OCT and MFERG measurements was detected. Conclusions: I UME, the value of MFERG before treatment is related with the degree of CFT and BCVA on the contrary, after treatment. The decrease of macular thickness is not always followed by an improvement of MFERG and BCVA. This supports the view that in UME, the decrease of macular thickness after treatment may not be used as a predictor of improvement of macular function.Στόχος: Να εκτιμηθεί η σχέση ανάμεσα στην ανατομική κατάσταση και στη λειτουργική δραστηριότητα πριν και μετά τη θεραπεία του ραγοειδικού οιδήματος ωχράς κηλίδας (ΡΟΩ). Μέθοδοι: Στην παρούσα μελέτη χρησιμοποιήθηκαν τριάντα τρεις οφθαλμοί 33 ασθενών με ΡΟΩ. Έγιναν μετρήσεις της καλύτερα διορθωμένης οπτικής οξύτητας (ΚΔΟΟ), της οπτικής τομογραφίας συνοχής (OCT) και του πολυεστιακού ηλεκτροαμφιβληστροειδογραφήματος (MFERG) πριν και μετά τη θεραπεία του ωχρικού οιδήματος. Έγιναν αναλύσεις συσχετισμού ανάμεσα στη ΚΔΟΟ, OCT και MFERG. Αποτελέσματα: Οι μετρήσεις της ΚΔΟΟ και του MFERG έδειξαν στατιστικά σημαντική βελτίωση μετά τη θεραπεία του ωχρικού οιδήματος (P<0.01) και το κεντρικό πάχος ωχράς κηλίδας (ΚΠΩΚ) όπως μετρήθηκε με το OCT μειώθηκε σημαντικά από 434 ±135 μm πριν τη θεραπεία στα 267±92μm μετά τη θεραπεία (p<0.001). Η στατιστική ανάλυση έδειξε ότι το ΚΠΩΚ πρώτης θεραπείας σχετίζεται με το MFERG N1 για την περιοχή (Spearman’s r=-0.62, P<0.001). Η ΚΔΟΟ μετά τη θεραπεία είχε αρνητική συσχέτιση με το MFERG για τη περιοχή 1 (Spearman’s r=-0.56, P=0.001). Επίσης, δεν διαπιστώθηκε κανένας συσχετισμός ανάμεσα στην τελική ΚΔΟΟ και στις προ θεραπείας μετρήσεις OCT και MFERG. Συμπεράσματα: Στο ΡΟΩ, οι τιμές του MFERG προ της θεραπείας σχετίζονται ως ένα βαθμό με τις τιμές του ΚΠΩΚ και της ΚΔΟΟ. Αντίθετα, μετά τη θεραπεία η μείωση του πάχους της ωχράς δεν ακολουθείται πάντα από βελτίωση του MFERG και της ΚΔΟΟ. Το γεγονός αυτό ενισχύει την άποψη ότι στο ΡΟΩ, η μείωση του πάχους της ωχράς κηλίδας δε μπορεί να χρησιμοποιηθεί σαν προγνωστικός παράγοντας βελτίωσης της ωχρικής λειτουργίας

Efficacy and Safety of Platelet-Rich Plasma Injections for the Treatment of Female Sexual Dysfunction and Stress Urinary Incontinence: A Systematic Review

Introduction: There is no clear evidence in the literature that platelet-rich plasma (PRP) injections improve female sexual dysfunction (FSD) and female stress urinary incontinence (SUI). Objectives: A systematic review was performed to study the efficacy and safety of PRP injections in women with the above pathologies, as well as to explore the optimal dosing, frequency and area of injections, and duration of treatment. Methods: A systematic search on PubMed, Embase and the Cochrane Library database was performed, as well as sources of grey literature from the date of database or source creation to January 2023. After title/abstract and full-text screening, clinical studies on humans evaluating the efficacy of PRP in gynecological disorders using standardized tools were included. Risk of bias was undertaken with RoB-2 for randomized-controlled trials (RCT) and the Newcastle-Ottawa Scale (NOS) for observational studies. Results: Four prospective and one retrospective study explored FSD, while six prospective and one RCT evaluated female SUI. A total of 327 women with a mean age of 51 ± 12 years were included. For FSD, PRP significantly improved the Female Sexual Function Index (FSFI), the Vaginal Health Index (VHI) and the Female Sexual Distress score (FSDS). For SUI, PRP led to a significant improvement in the International Consultation on Incontinence Questionnaire—Short Form (ICIQ-SF) and the Urogenital Distress Inventory (UDI-6). The identified RCT reported a significantly higher mean score of ICIQ-SF (p p Conclusions: Despite the promising initial results of PRP injections, the level of current evidence is low due to methodological issues in the available studies. It becomes clear that there is an emerging need for high-quality research examining PRP injections for the treatment of FSD and female SUI