Prolapse Symptom Outcomes After Uterosacral Ligament Suspension With and Without Platelet-Rich Plasma Injection

INTRODUCTION: Platelet-rich plasma (PRP) is an autologous biologic therapy enriched with growth factors that may enhance tissue healing. While PRP’s role in pelvic organ prolapse (POP) is not well established, studies in other pelvic floor disorders suggest regenerative potential. Native tissue apical POP repairs, such as uterosacral ligament suspension (USLS), avoid mesh complications but have higher recurrence rates due to limited tissue regeneration. PRP may augment outcomes by promoting ligament healing. OBJECTIVE: To compare prolapse symptoms before and after surgery among patients undergoing USLS with PRP injection versus without PRP. METHODS: This prospective feasibility study was conducted from April 2024 to September 2025. Eligible participants were ≥18 years with stage ≥2 POP. Exclusion criteria included prior prolapse repair, prior PRP or blood product reactions, thrombocytopenia, hemoglobin <10 g/dL, platelet count <150 k/µL, immunocompromised status, or immunosuppressive/antiplatelet therapy. In the PRP cohort, 10 mL of whole blood was collected intraoperatively, centrifuged, and 4 mL of autologous PRP was injected at USLS suture sites. The control “survey-only” cohort met identical criteria but did not receive PRP. Both cohorts completed validated surveys: Pelvic Floor Disability Index (PFDI-20) and Pelvic Floor Impact Questionnaire Short Form 7 (PFIQ-7) preoperatively, at 6 weeks, and at 3 months, and the Patient Global Impression of Improvement (PGI-I) postoperatively. Thirty patients were enrolled in each cohort. RESULTS: Fifty-six patients (28 PRP; 28 control) were analyzed. Both cohorts demonstrated significant improvement in prolapse-related symptoms after surgery, reflected by reductions in mean PFDI-20 scores at 6 weeks and 3 months. In the PRP cohort, baseline mean PFDI-20 scores (148.0±45.3) decreased by 52.5 points at 6 weeks and 66.1 points at 3 months (p<0.00001). In the control survey-only cohort, baseline mean PFDI-20 scores (146.9±36.6) decreased by 47.7 points at 6 weeks and 59.8 points at 3 months (p<0.00001). Both groups showed numerical reductions in PFIQ-7 at 6 weeks and significant improvement at 3 months. In the PRP cohort, baseline PFIQ-7 scores (51.19±64.5) decreased at both 6 weeks (26.9±55.7, p=0.06) and 3 months (13.75±47.4, p=0.002). In the control survey-only cohort, baseline PFIQ-7 scores (41.9 ± 38.6) decreased at both 6 weeks (32.7±39.3, p=0.11) and 3 months (27.7±55.5, p=0.03). Although between-group differences of PFDI-20 scores and PFIQ-7 did not reach statistical significance, the magnitude of improvement was greater in the PRP cohort at both follow-up timepoints (Figures 1 and 2). At 3 months, PGI-I scores indicated that majority of participants in both groups reported being “much better” or “very much better,” with slightly higher proportions in the PRP cohort (92.9%, n=26) compared with controls (89.3%, n=25). CONCLUSIONS: Patients undergoing USLS with or without PRP experienced substantial improvements in pelvic floor symptoms, with reductions in symptom distress evident by 6 weeks and persisting at 3 months. While both groups benefited, the PRP cohort demonstrated numerically greater improvement, supporting feasibility and suggesting potential benefit that warrants further investigation in larger trials.Figure 1Figure 2