Use of platelet-rich fibrin in bladder exstrophy repair: A prospective study

Penopubic fistula formation remains one of the most frequent early complications following bladder exstrophy repair. Platelet-rich fibrin (PRF), an autologous, high-concentration platelet, white blood cells, and fibrin biomaterial that enhances tissue healing and regeneration, has shown potential for surgical applications. However, PRF has not been applied in primary bladder exstrophy repair. This study aimed to assess the effectiveness of autologous PRF membrane applications in primary bladder exstrophy repair in male patients.

This prospective randomized comparative study enrolled 20 male children with primary classical bladder exstrophy-epispadias complex who were surgically repaired at our center between 2022 and 2025. Patients were divided into two groups according to PRF usage: PRF group, with PRF use (n = 12, 60%); non-PRF group (controls), without PRF use (n = 8, 40%); allocation concealment was reached using sequentially numbered, opaque, sealed envelopes opened during the surgery. In the PRF group, 5-10 mL of the patient's autologous venous blood was obtained intraoperatively and centrifuged at 3000 revolutions per minute for 10 min to produce a PRF clot, which was then transformed into a dense fibrin membrane. The fibrin was stitched with PDS 6/0 onto the bladder neck angle dorsally before the approximation of the pubic symphysis. All the steps of the procedure were conducted according to the sterility requirements. The patients from both groups underwent osteotomy anteriorly with fixation of a metal construction externally.

The mean operative time and length of hospital stay were comparable between the two groups. In the non-PRF group, 3 (37.5%) patients and 1 (12.5%) patient had penopubic fistula and wound dehiscence, respectively. Compared to the control group, the PRF group patients were complication-free, demonstrating a favorable preliminary signal (p = 0.014).

PRF is a simple, feasible adjunct for covering the bladder neck junction, as it suggests a potential signal toward reducing penopubic fistula formation. Due to the small sample size, these results are hypothesis-generating, and adequately larger randomized comparative studies are needed to confirm these exploratory findings.