自體血小板濃厚血漿（Autologous platelet‐rich plasma, A-PRP），可以刺激細胞增殖、分化和血管生成，從而幫助組織修復、再生和癒合，在許多疾病的治療上有不錯的效果。在動物實驗中，尿道A-PRP的注射可以改善SUI；而過去臨床研究亦顯示， A-PRP之尿道注射，可以改善內括約肌閉鎖不全患者之SUI。然而，目前針對A-PRP治療SUI之效果仍需更多臨床研究之佐證。

本篇探討A-PRP對於SUI治療之臨床應用，收錄60名SUI之亞洲女性，將患者分為兩組。第一組為接受A-PRP搭配骨盆底肌肉訓練(pelvic floor muscle training, PFMT); 第二組則為單純接受PFMT。在接受治療後3個月，第一組(A-PRP+PFMT)在1-hour pad test中，漏尿量從16.89g 降低至7.28g (減少8.84g); 然而第二組(PFMT) 漏尿量從17.23g降低至16.46g(減少0.77g)，顯示A-PRP+PFMT較單純PFMT更能改善患者尿失禁之情形。在ICIQ-FLUTS、及PGI‐I scores上， 第一組(A-PRP+PFMT)之改善幅度亦較大。第一組(A-PRP+PFMT)中有90%患者認為漏尿情況有改善50%以上，而在第二組(PFMT)中只有14%有相同的進步。在副作用方面，A-PRP除了注射處疼痛之外，並無其他副作用。

雖然目前仍需更多更大規模的研究佐證A-PRP在SUI上的療效，但這篇研究顯示， A-PRP在治療SUI上是一種有前景的選項，尤其是與PFMT結合時，效果可能比單純PFMT更好。

Importance
Autologous platelet-rich plasma (A-PRP) injection is a novel intervention for stress urinary incontinence (SUI) in women. However, no Phase II clinical trial has compared the outcomes of A-PRP injection combined with pelvic floor muscle training (PFMT) with those of PFMT alone in these women.

Objective
The primary aim was to compare the efficacy of A-PRP + PFMT versus PFMT alone in women with SUI. The secondary aim was to determine any adverse effects of A-PRP injection.

Design
Randomized clinical trial, single-blind assessment.

Setting
Urogynecology clinic at a tertiary medical center.

Participants
Women with previously untreated SUI. Women in whom there was any suspicion of urgency, those with an Overactive Bladder Symptoms Score of ≥1, and those with obesity, pelvic organ prolapse, thrombocytopenia, or coagulopathy were excluded.

Interventions
Two injections of A-PRP were administered with a 1-month interval between injections in the A-PRP injection + PFMT group. Both groups received PFMT.

Main Outcomes and Measures
The primary outcome was determined using the 1-h pad weight test (PWT). Secondary outcomes were measured using the Incontinence Quality of Life Questionnaire, item 11 on the International Consultation on Incontinence Questionnaire-Female Lower Urinary Tract Symptoms questionnaire, Patient Global Impression of Improvement, and the percentage subjective improvement score.

Results
Data for 60 study participants were available for analysis (A-PRP + PFMT group, n = 31; PFMT group, n = 29). The 1-h PWT decreased significantly in the A-PRP + PFMT group but only slightly in the PFMT group at the 5-month follow-up. There was a statistically significant between-group difference in the 1-h pad weight of about 8 g in favor of the A-PRP + PFMT group. A statistically significant difference in symptoms of SUI measured by the questionnaires was found between the A-PRP + PFMT group and the PFMT group at the 2- and 5-month follow-up assessments. There were no reports of adverse events following injection of A-PRP.

Conclusions and Relevance
A-PRP + PFMT could be a treatment option for women with SUI. Large Phase III randomized controlled trials are required to confirm our findings.