Number №2, 2019 - page 158-163

Clinical effectiveness of complex treatment vesicovaginal fistula using of the platelet reach autoplasma compared to standard approach to fistuloplasty DOI: 10.29188/2222-8543-2019-11-2-158-162

Medvedev V.L., Opol'skiy A.M., Kogan M.I.
Information about authors:
  • Medvedev V.L. – Dr. Sc., professor, head of the Department of urology of Kuban state medical University, Chief urologist of Krasnodar region, Krasnodar, medvedev_vl@mail.ru
  • Opolsky M.A. – urologist «Research Institute, Regional clinical hospital № 1 named after Professor S. V. Ochapovskogo» Ministry of healthcare of Krasnodar region, Krasnodar, opolartem@gmail.com
  • Kogan M. I. – Dr. Sc., professor, head of the Department of urology and human reproductive health with a course of pediatric urology-andrology of Rostov state medical University, President Of the Association of urologists, Rostov-on-Don, ORCID 0000-0002-1710-0169

Background: Vesico-vaginal fistulae (VVF) are one of the most relevant and socially significant problems in modern medicine, being associated with severe impairment of patients’ quality of life and profound disability.

Aim of the study: to determine the efficacy of local interstitial autologous platelet-rich plasma use in combined treatment of VVF.

Materials and methods: the study included 52 patients who were surgically treated for VVF. Mean age of patients was 47,3 years. Subjects were divided into 2 groups: group 1 - 30 patients (standard protocol (SP) fistuloplasty), group 2 - 22 patients (local interstitial therapy with autologous platelet-rich plasma (APRP) prior to scheduled surgical treatment).

Results. Groups’ baseline parameters are similar(p>0,05). InAPRP group mean catheter removal time was 7,14 days (± 4,1 days), while in SP group itwas 11,1 days(±2,4 days). Operative time in PRP groupwas 95 minutes(±52 minutes), in SP group – 121,7 minutes(±31,5 minutes) (p<0,05). there were no differences in terms of pain, hematuria duration and dysuria symptoms. there were 3 spontaneous fistula closures in APRP group (recurrence-free period of 12 months). In 11 APRP group patients we observed a decrease in fistula diameter over 50%.

Discussion. To diminish inflammatory process and to stimulate angiogenesis we proposed interstitial use of APRP. Quicker removal of urethral catheter in APRP group, when compared with SP, was related to improved surgical wound healing, inflammation, neoangiogenesis and saturation with biologically active molecules. Operative time was influenced by reduced scarring, improved blood supply, decreased VVF diameter on APRP therapy by no less than 50% in 11 cases.

Conclusion. Improved tissue regeneration, activation of inflammatory pathways leading to improved wound healing give evidence of feasibility for local interstitial use of autologous platelet-rich plasma in combined treatment of vesico-vaginal fistulae.

Authors declare lack of the possible conflicts of interests

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regenerative medicine, platelet rich plasma, platelets, vesicovaginal fistula

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