Feasibility of Platelet-Rich Plasma in Uterosacral Ligament Suspension Surgery

Platelet-rich plasma (PRP) is an autologous biological with the potential to enhance tissue healing. Its use during native tissue pelvic organ prolapse (POP) repair has not been evaluated.

The objective of this study was to assess the acceptability and feasibility of PRP injection into the uterosacral ligament during uterosacral ligament suspension (USLS) for POP repair.

This prospective feasibility study was conducted from April to October 2024 at a large academic institution. Patients scheduled for USLS prolapse surgery for stage ≥2 POP were screened for eligibility to receive PRP injection at the time of surgery. The primary outcomes were the acceptance rate of PRP and the reasons for nonparticipation. Secondary outcomes included injection feasibility, 30-day complications, and comparison with a historical cohort of patients who underwent the same procedure from 2022 to 2023.

Of 84 eligible patients, 63 met criteria. Thirty (47.6%) consented, 26 (41.3%) declined, and 7 (11.1%) did not respond. All participants successfully received PRP injections without technical issues. One intraoperative bladder cystotomy occurred. Postoperative complications included urinary tract infection (n=6, 20.7%), urinary retention (n=1, 3.4%), vaginal cuff cellulitis (n=1, 3.4%), and 1 readmission for sepsis (n=1, 3.4%). No complications were attributed to PRP. Compared with 206 historical controls, there were no statistically significant differences in intraoperative or 30-day postoperative complications.

PRP injection during USLS was acceptable to nearly half of the eligible patients, technically feasible, and not associated with adverse events. These findings support further investigation into PRP as a regenerative adjunct to improve surgical outcomes.