INTRODUCTION: Pelvic organ prolapse is a common and burdensome condition, with growing demand for safe and effective surgical approaches. While transvaginal native tissue repairs offer lower morbidity than mesh-augmented procedures, concerns persist regarding higher failure rates, particularly in the anterior compartment. Platelet-rich plasma (PRP), an autologous concentrate rich in bioactive growth factors, promotes tissue healing and regeneration and has been widely used in multiple surgical specialties. However, its application in gynecologic surgery remains underexplored. OBJECTIVE: To assess efficacy and safety of repair augmentation with autologous PRP injection into the fibromuscular connective tissue during anterior colporrhaphy over 12 months post native tissue prolapse surgery. METHODS: A double-blind, randomized, placebo-controlled pilot trial was conducted at a single tertiary-care center from July 2023 to August 2025, enrolling 60 women with symptomatic prolapse beyond the hymen undergoing transvaginal native tissue apical repair, including anterior colporrhaphy. Concomitant procedures for prolapse or urinary incontinence were permitted. Participants received intraoperative injections of either autologous PRP or placebo (normal saline) into the anterior compartment’s fibromuscular connective tissue in a grid-like pattern (0.5 mL-per-site, ≥1cm apart) following vaginal epithelium dissection. Intraoperatively, PRP was prepared from 15 mL of whole blood, centrifuged at 1500 rpm for 5 minutes using a commercial kit. The primary outcome was POP-Q point Ba over 12 months. Secondary outcomes included other POP-Q points, prolapse symptoms, retreatment, composite success (no prolapse beyond the hymen, no bulge symptoms, no retreatment), Pelvic Organ Prolapse Distress Inventory-6 (POPDI-6), Patient Global Impression of Improvement (PGI-I), and adverse events, assessed at 6 weeks, 3, 6, and 12 months. POP-Q point Ba was analyzed via multiple linear regression with a priori covariates (parity, vaginal estrogen, baseline variables with p<0.20). Ba and C were assessed over time via mixed-effects model for repeated measures. RESULTS: Of 60 participants, 28 PRP and 30 placebo (97%) were available for 12-month analysis. Baseline and intraoperative characteristics did not differ between groups (Table 1). Mean PRP volume injected was 4.5 mL (95% CI: 4.0, 5.0). At 12 months, adjusted POP-Q Ba was PRP: –1.8 (95% CI: –2.4, –1.3) vs placebo: –1.8 (95% CI: –2.4, –1.3), after controlling for parity, estrogen use, and insurance types with no difference over time (Figure 1, Table 2). Composite success rates were PRP 92.6% (PRP) vs placebo 82.1% (P=0.42). Prolapse symptoms occurred in 3.9% vs 3.7%, and retreatment 0% vs 3.6%. Both groups demonstrated clinically significant improvement in POPDI-6 scores from baseline, exceeding the minimally important difference (11 points). Median PGI-I was 1 (“very much better”) in both groups. Adverse events were similar between groups (Table 2). CONCLUSIONS: This pilot placebo-controlled trial demonstrated that autologous PRP injection into the anterior compartment during native tissue repair was feasible. No differences in surgical outcomes were observed, and estimates of the POP-Q points provide preliminary data to inform a larger clinical trial. Both groups sustained high success rates over 12 months. Postoperative adverse events were infrequent and not specifically attributed to PRP. Larger studies are needed to explore these findings further, considering PRP application methods, location of injection, and longer-term follow-up.Figure 1Table 1Table 2
Meyer et al. (Fri,) studied this question.